title: Referral outcomes of attendances at general practitioner led urgent care centres in London, England: retrospective analysis of hospital administrative data.
abstract: OBJECTIVE
  To identify patient and attendance characteristics that are associated with onwards referral to co-located emergency departments (EDs) or other hospital specialty departments from general practitioner (GP) led urgent care centres (UCCs) in northwest London, England.
  
  
  METHODS
  We conducted a retrospective analysis of administrative data recorded in the UCCs at Charing Cross and Hammersmith Hospitals, in northwest London, from October 2009 to December 2012. Attendances made by adults resident in England were included. Logistic regression was used to model the associations between the explanatory variables-age; sex; ethnicity; socioeconomic status; area of residence; distance to UCC; GP registration; time, day, quarter, year; and UCC of attendance-and the outcome of onwards referral to the co-located EDs or other hospital specialty departments.
  
  
  RESULTS
  Of 243 042 included attendances, 74.1% were managed solely within the UCCs without same day referral to the EDs (16.8%) or other hospital specialty departments (5.7%), or deferred referral to a fracture, hand management or soft tissue injury management clinic (3.3%). The adjusted odds of onwards referral was estimated to increase by 19% (OR 1.19, 95% CI 1.18 to 1.19) for a 10 year increase in a patient's age. Men, patients registered with a GP and residents of less socioeconomically deprived areas were also more likely to be referred onwards from the UCCs.
  
  
  CONCLUSIONS
  The majority of patients, across each category of all explanatory variables, were managed solely within the UCCs, although a large absolute number of patients were referred onwards each year. Several characteristics of patients and their attendances were associated with the outcome variable.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Thomas E
authors.identifier: http://orcid.org/0000-0003-1524-4393
authors.initials: TE
authors.lastname: Cowling
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Farzan
authors.initials: F
authors.lastname: Ramzan
authors.affiliation: London Central and West Unscheduled Care Collaborative, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Ladbrooke
authors.affiliation: Emergency Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Millington
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Shamini
authors.initials: S
authors.lastname: Gnani
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: emergency care systems, emergency departments; emergency care systems, primary care; hospitalisations