The role of general practice in reducing unplanned hospital admissions

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study

BACKGROUND

There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations.

METHODS

Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA).

RESULTS

The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority.

CONCLUSIONS

Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

Trend of hospitalizations for ambulatory care sensitive conditions and related aspects in Sergipe, 2010 to 2019

Objective: To analyze the trend of hospitalization rates for ambulatory care-sensitive conditions (HACSC) in Sergipe and its seven health regions between 2010 and 2019, correlating with financial investments in health and primary care, strategy coverage of family health, and the number of hospital beds. Methods: This is an ecological time-series study trend with secondary data from the Ministry of Health. The trend verification was done by segmented linear analysis and the correlation between the variables by Spearman's correlation. Results: HACSC in the state of Sergipe showed a trend towards stability. In the Nossa Senhora do Socorro region, an increasing rate trend was identified from 2010 to 2017 and a non-significant decreasing trend from 2017 to 2019, with a negative correlation with per capita investment in PHC. The Itabaiana region showed a trend of reduction in rates from 2010 to 2012, followed by a trend of growth in rates from 2012 to 2020, with no significant correlation with any of the variables. Conclusions: Monitoring HACSC rates and understanding their multifactorial influence are essential since this indicator is helpful in local situational diagnosis and contributes to planning actions.