This site is intended for health professionals only


Easier GP access ‘could cut asthma emergency admissions’



Practices where patients report relatively good access to GP services have fewer patients admitted to hospital for asthma attacks, a study has found.

Researchers said this suggested that improving access to primary care could help prevent thousands of avoidable admissions for asthma every year.

The study – published in the British Journal of General Practice – looked at the seven measures of patient-reported access recorded in the GP Patient Survey at more than 7,000 practices in 2010/11.

Some three million patients with asthma were registered with these practices, of whom more than 55,000 were admitted for an exacerbation that year – a median of 16 emergency admissions per 1,000 patients.

None of the seven individual access scores in the GP patient survey – which includes questions on how easy it is to get through to the practice on the phone, to book an appointment in two days with a GP or to see a practice nurse – was linked to asthma hospitalisations, after taking into account practice characteristics.

But there was a statistically significant association between practices’ overall composite score for access and emergency asthma admissions – such that each 10% increase in access score was linked to a 32% reduction in admissions.

The authors calculated this meant that an overall 10% improvement in the composite access score could have avoided nearly 18,000 emergency admissions for asthma that year – around two fewer admissions in each practice.

They concluded: ‘Practices with higher patient-reported access had lower rates of emergency admissions for asthma. Policymakers should consider improving access to primary care as one potential way to help prevent emergency admissions for asthma.’

Lead researcher Dr Robert Fleetcroft, honorary senior fellow at the University of East Anglia and a part-time GP, told Pulse it was ‘plausible’ that simply improving access to general practice could help prevent people with an asthma attack going to hospital, although he added that other factors such as better practice organisation could explain the association.

Dr Fleetcroft explained: ‘We know with asthma that many admissions are avoidable and most patients will take several days to develop a full-blown asthma attack. So it may be that if you can get to see your nurse or doctor, if you are able to get treatment readily when an attack starts then that can prevent deterioration.’

But he added: ‘It might be that practices able to achieve better access scores have another factor – their organisation, for example – that might also mean patients are less likely to be admitted. Asthma plans may be important.’

Professor Martin Roland, emeritus professor of health service research at the University of Cambridge, said: ‘This is not the only study to suggest that A&E department attendance may be increased when patients find it difficult to get to see a GP. Once the patient is in A&E, especially for something like asthma, it may be hard for the hospital doctor not to admit them.’

Professor Roland said it was ‘important for practices to make arrangements for patients with urgent problems like an exacerbation of asthma to be able to be seen promptly’.

He added: ‘Of course, this does not need to be their own GP surgery out of working hours, but many patients are often confused about out-of-hours arrangements and end up going unnecessarily to the hospital.’

Dr Rupert Jones, a GP expert in respiratory medicine, cautioned that ‘interpretation of these data is very difficult and the associations found are not causal and may be confounded by many factors… which have nothing to do with patient access’.

It comes as a Pulse survey revealed that the average waiting time for a routine GP appointment has almost hit two weeks, with GPs expecting this to grow to 17 days by next year unless more resources are provided for core general practice.

Br J Gen Pr 2016; available online 21 June