Article Text
Abstract
Objective To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI).
Design, setting, participants Retrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database.
Outcomes and analysis Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC).
Results Risk of A&E presentation was 13% lower (HR 0.87, 95% CI 0.77 to 0.98) and risk of admission to hospital for ACSC was 23% lower (HR 0.77, 95% CI 0.60 to 0.99) for patients with a care plan documented in the previous year compared with those without a care plan. Risk of A&E presentation was 19% lower for those who had a care plan documented earlier but not updated in the previous year (HR: 0.81, 95% CI 0.67 to 0.97) compared with those without a care plan. Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews.
Conclusions Care plans documented in primary care for people with SMI are associated with reduced risk of A&E attendance and reduced risk of unplanned admission to hospital for physical health problems, but not with risk of admission for mental health problems. Annual reviews of physical health are not associated with risk of unplanned hospital utilisation.
- schizophrenia & psychotic disorders
- primary care
- quality in health care
- data linkage
- hospital utilisation
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Footnotes
Contributors JR, PK, NG, CK, TD, AM, NR, HG, MG, TK, NS, SG, CRJD, LA, RW and RJ contributed to the design of the research questions, analytical approach and interpretation of the findings. JR produced a first draft of the paper and PK, NG, CK, TD, AM, NR, HG, MG, TK, NS, SG, CRJD, LA, RW and RJ contributed to and approved the final manuscript.
Funding This project was funded by the National Institute for Health Research HS&DR programme (project number 13/54/40).
Disclaimer The views expressed are those of the author(s) and not necessarily those of the HS&DR programme, NHS, the NIHR or the Department of Health.
Competing interests None declared.
Patient consent Not required.
Ethics approval The study protocol was approved by the Independent Scientific Advisory Committee of the Clinical Practice Research Datalink (protocol number 15_213R2A2).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Due to the sensitive and confidential nature of the data used for this analysis, and the permissions required to access it, the dataset is not publicly available.