The combined influence of distance and neighbourhood deprivation on Emergency Department attendance in a large English population: a retrospective database study.

The frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation.

Weekend admission to hospital has a higher risk of death in the elective setting than in the emergency setting: a retrospective database study of national health service hospitals in England.

BACKGROUND: Although acute hospitals offer a twenty-four hour seven day a week service levels of staffing are lower over the weekends and some health care processes may be less readily available over the weekend. Whilst it is thought that emergency admission to hospital on the weekend is associated with an increased risk of death, the extent to which this applies to elective admissions is less well known. We investigated the risk of death in elective and elective patients admitted over the weekend versus the weekdays. METHODS: Retrospective statistical analysis of routinely collected acute hospital admissions in England, involving all patient discharges from all acute hospitals in England over a year (April 2008-March 2009), using a logistic regression model which adjusted for a range of patient case-mix variables, seasonality and admission over a weekend separately for elective and emergency (but excluding zero day stay emergency admissions discharged alive) admissions. RESULTS: Of the 1,535,267 elective admissions, 91.7% (1,407,705) were admitted on the weekday and 8.3% (127,562) were admitted on the weekend. The mortality following weekday admission was 0.52% (7,276/1,407,705) compared with 0.77% (986/127,562) following weekend admission. Of the 3,105,249 emergency admissions, 76.3% (2,369,316) were admitted on the weekday and 23.7% (735,933) were admitted on the weekend. The mortality following emergency weekday admission was 6.53% (154,761/2,369,316) compared to 7.06% (51,922/735,933) following weekend admission. After case-mix adjustment, weekend admissions were associated with an increased risk of death, especially in the elective setting (elective Odds Ratio: 1.32, 95% Confidence Interval 1.23 to 1.41); vs emergency Odds Ratio: 1.09, 95% Confidence Interval 1.05 to 1.13). CONCLUSIONS: Weekend admission appears to be an independent risk factor for dying in hospital and this risk is more pronounced in the elective setting. Given the planned nature of elective admissions, as opposed to the unplanned nature of emergency admissions, it would seem less likely that this increased risk in the elective setting is attributable to unobserved patient risk factors. Further work to understand the relationship between weekend processes of care and mortality, especially in the elective setting, is required.

Estimating the future healthcare costs of an aging population in the UK: expansion of morbidity and the need for preventative care.

BACKGROUND: The healthcare costs of an aging population have major consequences for healthcare organizations and have major implication for strategic planning of services. An impending freeze in budgets in the UK makes these consequences especially significant. METHODS: We present a methodology of estimating the future healthcare costs to an organization due to an aging population that takes account of the excess costs in the years before death and the effect of morbidity compression or expansion. The performance of three different models is evaluated. RESULTS: The three models all give markedly different estimated costs. Models failing to take into account both the cost burden towards the end of life and compression or expansion of morbidity can vastly under- or overestimate the most accurate estimates of healthcare expenditure due to an aging population with annual increases in costs varying from 0.48 to 1.12%. CONCLUSION: The importance of being able to accurately predict demand and costs of health care within the NHS cannot be underestimated. Making over simplistic assumptions and not using well-established principles in these models leads to greatly different outcomes that have the potential to have massive organizational consequences in terms of short-to-medium term strategic planning.

GPs' opinions on the NHS and HPA response to the first wave of the influenza A/H1N1v pandemic.

The first wave of influenza A/H1N1v resulted in a significant demand on primary care services. This cross-sectional study describes GPs' opinions of how information was communicated to them during this period and the overall response of the NHS and Health Protection Agency. Accessibility of current guidance and ease of obtaining antiviral medication were perceived as strengths, but clarity of the information provided was consistently perceived as poor. The majority of GPs supported the introduction of the National Pandemic Flu Service, although many raised concerns about its safety.