title: GP supply, deprivation and emergency admission to hospital for COPD and diabetes complications in counties across Ireland: an exploratory analysis.
abstract: BACKGROUND
  Geographical variation in rates of emergency inpatient admission for chronic disease may be due to variation in health need. However, it may also reflect differences in the provision of services which reduce the risk of inpatient admission for chronic disease, such as primary care.
  
  
  OBJECTIVE
  The aim of this paper was to examine the effect of primary care provision [general practitioner (GP) supply] and deprivation on county-specific rates of emergency admission to hospital for diabetes complications and chronic obstructive pulmonary disease (COPD) in Ireland.
  
  
  METHODS
  Data on emergency inpatient discharges were obtained from the hospital inpatient enquiry (HIPE) system. Secondary data on GP supply were obtained from a recently published study, while secondary data on deprivation were obtained from the Small Area Health Research Unit. The effect of county-level GP supply and deprivation on age-standardised rates of discharge for diabetes complications and COPD were examined, adjusting for population density and the proportion of the population who were eligible for free primary care.
  
  
  RESULTS
  Greater deprivation and lower GP supply are associated with increased rates of discharge from hospital for COPD and diabetes complications. However, these associations are stronger in counties where a lower proportion of the population are eligible for free primary care.
  
  
  CONCLUSIONS
  Geographical variation in rates of admission to hospital for chronic disease is associated with both population need and health system factors. These findings suggest that primary care resourcing must be a key consideration in any efforts to tackle acute hospital capacity problems.
authors.affiliation: Department of Medical Gerontology, TILDA Project, Trinity College Dublin, Dublin, Ireland. eisexton@tcd.ie.
authors.forename: E
authors.initials: E
authors.lastname: Sexton
authors.affiliation: Royal College of Surgeons in Ireland (RCSI) Hospitals, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Bedford
mesh_terms: D000328:Adult; D002908:Chronic Disease; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D058005:General Practitioners / Q000600:supply & distribution*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007494:Ireland; D008297:Male; D010351:Patient Discharge; D011320:Primary Health Care / Q000458:organization & administration; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*
keywords: Ambulatory-care sensitive conditions; Chronic disease; Geographical variation; Hospital discharges; Ireland; Primary care