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Chronic disease detection and access: does access improve detection, or does detection make access more difficult?
Mohammed Saqib Anwar1, Richard Baker, Nicola Walker
1NIHR CLAHRC for LNR, Department of Health Sciences, University of Leicester, UK.
Insights
Patient-reported access to general practice, particularly appointment booking, may influence recorded chronic disease rates. Practices with higher deprivation and older populations show increased recorded chronic disease, potentially impacting appointment availability.
Area of Science:
- General Practice
- Health Services Research
- Chronic Disease Management
Background:
- Recorded chronic disease detection in general practices is often lower than population survey estimates.
- Understanding factors influencing recorded disease rates is crucial for accurate prevalence assessment.
Purpose of the Study:
- To investigate if patient-reported access to general practice predicts recorded chronic disease detection rates.
- To explore the relationship between appointment availability and chronic disease recording.
Main Methods:
- Cross-sectional study of 146 general practices in England.
- Utilized Quality and Outcomes Framework (QOF) disease registers for coronary heart disease, COPD, hypertension, and diabetes.
- Included practice population characteristics and patient experience of appointment access in regression models.
Main Results:
- Patient and practice characteristics like deprivation, age, and QOF achievement correlated with recorded chronic diseases.
- Increased patient-reported ease of booking appointments was associated with lower recorded chronic disease rates.
- Ability to consult a doctor within two days showed no association with recorded disease levels.
Conclusions:
- Higher recorded chronic disease rates are linked to practice deprivation and older patient populations.
- Increased chronic disease recording may strain practice capacity for advance appointment booking.
- Some practices may require enhanced capacity for chronic disease detection and management.
Background:
The recorded detection of chronic disease by practices is generally lower than the prevalence predicted by population surveys.
Aim:
To determine whether patient-reported access to general practice predicts the recorded detection rates of chronic diseases in that setting.
Design And Setting:
A cross-sectional study involving 146 general practices in Leicestershire and Rutland, England.
Method:
The numbers of patients recorded as having chronic disease (coronary heart disease, chronic obstructive pulmonary disease, hypertension, diabetes) were obtained from Quality and Outcomes Framework (QOF) practice disease registers for 2008-2009. Characteristics of practice populations (deprivation, age, sex, ethnicity, proportion reporting poor health, practice turnover, list size) and practice performance (achievement of QOF disease indicators, patient experience of being able to consult a doctor within 2 working days and book an appointment >2 days in advance) were included in regression models.
Results:
Patient characteristics (deprivation, age, poor health) and practice characteristics (list size, turnover, QOF achievement) were associated with recorded detection of more than one of the chronic diseases. Practices in which patients were more likely to report being able to book appointments had reduced recording rates of chronic disease. Being able to consult a doctor within 2 days was not associated with levels of recorded chronic disease.
Conclusion:
Practices with high levels of deprivation and older patients have increased rates of recorded chronic disease. As the number of patients recorded with chronic disease increased, the capacity of practices to meet patients' requests for appointments in advance declined. The capacity of some practices to detect and manage chronic disease may need improving.
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