Understanding the relationship between frequent users of emergency departments and primary care quality: A...

Emergency department (A&E) crowding is a growing issue in many countries, negatively affecting patient outcomes. While demand and supply constraints are known drivers, the link between primary care quality and frequent A&E use remains unclear.

To explore the relationship between primary care quality and frequent A&E users in England.

We conducted a retrospective observational study using national-level secondary data covering all major A&E attendances in England in 2016/17. We applied negative binomial regression to model the association between GP practice-level counts of frequent A&E users and nine primary care quality measures: the number of admissions with ambulatory care-sensitive conditions (ACSCs) per 1,000 registered patients, clinical performance under the Quality and Outcomes Framework (QOF), and seven GP Patient Survey-based experience indicators. Additional analyses examined total A&E users and total A&E attendances.

Frequent A&E users were positively associated with admission rates for ACSCs and negatively associated with patient experience (the proportion of patients recommending their GP and the ability to get same-day appointments). In additional analyses, admission rates for ACSCs were similarly associated with increased total A&E users and total A&E attendance volumes. The ability to see or speak with a preferred GP was associated with a reduction in the total volume of A&E users.

The findings highlight the varying aspects of primary care quality that influence frequent A&E users. Policies aiming to reduce A&E demand could focus on improving primary care quality by reducing admission rates for ACSCs and improving patient experience at GP practices.