title: Primary Care Access, Emergency Department Visits, and Unplanned Short Hospitalizations in the UK.
abstract: OBJECTIVE
  Demand for unplanned hospital services is rising, and children are frequent users, especially where access to primary care is poor. In England, universal health care coverage entitles parents to see a general practitioner (GP) for first-contact care. However, access to GP appointments is variable, and few patients can see their own regular GP out of hours (OOH). The goal of this study explored the association between access to GPs , emergency department (ED) visits and short hospitalizations (<2 days) in children in England.
  
  
  METHODS
  ED visit and short hospitalization rates were investigated in 9.5 million children aged <15 years registered with English family practices between April 2011 and March 2012 by using administrative hospital data. Six access categories ranked all practices according to patients' reported ability to schedule GP appointments; from national GP Patient Survey data. GP consulting hours were 8:00 am to 6:30 pm on weekdays.
  
  
  RESULTS
  There were 3 074 616 ED visits (56% OOH) and 470 752 short hospitalizations over the 12 months studied. Children registered with practices in the highest access group compared with the lowest were 9% less likely to visit an ED (adjusted rate ratio: 0.91 [95% confidence interval: 0.89-93]), particularly OOH compared with consulting hours (10% vs 7%). Children in the highest access groups were equally likely to be admitted for a short stay.
  
  
  CONCLUSIONS
  Increasing GP accessibility might alleviate the burden of ED visits from children, particularly during peak times OOH. Short hospitalizations may be more sensitive to other aspects of health systems.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and e.cecil@imperial.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cecil
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Cowling
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Wolfe
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and.
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D006113:United Kingdom