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. 2000 Jun;50(455):449–454.

Inequalities in access to coronary angiography and revascularisation: the association of deprivation and location of primary care services.

J Hippisley-Cox 1, M Pringle 1
PMCID: PMC1313721  PMID: 10962781

Abstract

BACKGROUND: Coronary artery surgery reduces re-infarction rates and mortality in patients with ischaemic heart disease. This study examines inequality in relation to primary care services. AIM: To determine the effect of primary care services on access to coronary angiography and revascularisation. METHOD: A cross-sectional survey of all 180 Nottinghamshire practices in the Trent region that were in existence between 1993 and 1997. The numbers of coronary bypass grafts, angioplasties, and angiographies were determined from the regional National Health Service database and linked to a database of general practice characteristics. Poisson regression analysis was used to determine the relationship between the angiography and revascularisation rates and the following practice characteristics: deprivation score, distance from nearest secondary or tertiary referral centre, medical cardiology admission rate for ischaemic heart disease, fundholding status, and partnership size. Multiple linear regression analysis was used to determine the relationship between practice characteristics and the waiting times for revascularisation and angiography. RESULTS: Practices with high deprivation scores had significantly lower rates of utilisation of angiography and revascularisation procedures. Their patients also waited longer for angiography. Practices that were 20 km or further from a revascularisation centre had significantly lower angiography and revascularisation rates. On average, their patients had to wait more than twice as long for an angiography compared with patients from nearer practices. Fundholding practices had higher angiography rates but similar revascularisation rates compared with non-fundholding practices. CONCLUSION: The results suggest that there may be some under-investigation and/or treatment of patients with ischaemic heart disease from 'deprived' practices and for those from practices far from a secondary or tertiary referral centre.

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Selected References

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  1. Ben-Shlomo Y., Chaturvedi N. Assessing equity in access to health care provision in the UK: does where you live affect your chances of getting a coronary artery bypass graft? J Epidemiol Community Health. 1995 Apr;49(2):200–204. doi: 10.1136/jech.49.2.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Black N., Langham S., Petticrew M. Coronary revascularisation: why do rates vary geographically in the UK? J Epidemiol Community Health. 1995 Aug;49(4):408–412. doi: 10.1136/jech.49.4.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bonneux L., Looman C. W., Barendregt J. J., Van der Maas P. J. Regression analysis of recent changes in cardiovascular morbidity and mortality in The Netherlands. BMJ. 1997 Mar 15;314(7083):789–792. doi: 10.1136/bmj.314.7083.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crombie I. K., Kenicer M. B., Smith W. C., Tunstall-Pedoe H. D. Unemployment, socioenvironmental factors, and coronary heart disease in Scotland. Br Heart J. 1989 Feb;61(2):172–177. doi: 10.1136/hrt.61.2.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Crombie I. K., Smith W. C., Tavendale R., Tunstall-Pedoe H. Geographical clustering of risk factors and lifestyle for coronary heart disease in the Scottish Heart Health Study. Br Heart J. 1990 Sep;64(3):199–203. doi: 10.1136/hrt.64.3.199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davis B. S., McWhirter M. F., Gordon D. S. Where needs and demands diverge: health promotion in primary care. Public Health. 1996 Mar;110(2):95–101. doi: 10.1016/s0033-3506(96)80053-9. [DOI] [PubMed] [Google Scholar]
  7. Dowling B. Effect of fundholding on waiting times: database study. BMJ. 1997 Aug 2;315(7103):290–292. doi: 10.1136/bmj.315.7103.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Glassman A. H. Cardiovascular effects of antidepressant drugs: updated. J Clin Psychiatry. 1998;59 (Suppl 15):13–18. [PubMed] [Google Scholar]
  9. Gray D., Hampton J. R., Bernstein S. J., Kosecoff J., Brook R. H. Audit of coronary angiography and bypass surgery. Lancet. 1990 Jun 2;335(8701):1317–1320. doi: 10.1016/0140-6736(90)91196-h. [DOI] [PubMed] [Google Scholar]
  10. Griffiths C., Sturdy P., Naish J., Omar R., Dolan S., Feder G. Hospital admissions for asthma in east London: associations with characteristics of local general practices, prescribing, and population. BMJ. 1997 Feb 15;314(7079):482–486. doi: 10.1136/bmj.314.7079.482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hippisley-Cox J., Hardy C., Pringle M., Fielding K., Carlisle R., Chilvers C. The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire. BMJ. 1997 May 17;314(7092):1458–1461. doi: 10.1136/bmj.314.7092.1458. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jarman B. Identification of underprivileged areas. Br Med J (Clin Res Ed) 1983 May 28;286(6379):1705–1709. doi: 10.1136/bmj.286.6379.1705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jarman B. Underprivileged areas: validation and distribution of scores. Br Med J (Clin Res Ed) 1984 Dec 8;289(6458):1587–1592. doi: 10.1136/bmj.289.6458.1587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kammerling R. M., Kinnear A. The extent of the two tier service for fundholders. BMJ. 1996 Jun 1;312(7043):1399–1401. doi: 10.1136/bmj.312.7043.1399a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kee F., Gaffney B., Currie S., O'Reilly D. Access to coronary catheterisation: fair shares for all? BMJ. 1993 Nov 20;307(6915):1305–1307. doi: 10.1136/bmj.307.6915.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Moore A. T., Roland M. O. How much variation in referral rates among general practitioners is due to chance? BMJ. 1989 Feb 25;298(6672):500–502. doi: 10.1136/bmj.298.6672.500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Payne N., Saul C. Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality. BMJ. 1997 Jan 25;314(7076):257–261. doi: 10.1136/bmj.314.7076.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rees J. L. Accuracy of hospital activity analysis data in estimating the incidence of proximal femoral fracture. Br Med J (Clin Res Ed) 1982 Jun 19;284(6332):1856–1857. doi: 10.1136/bmj.284.6332.1856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Roland M. O., Bartholomew J., Morrell D. C., McDermott A., Paul E. Understanding hospital referral rates: a user's guide. BMJ. 1990 Jul 14;301(6743):98–102. doi: 10.1136/bmj.301.6743.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. White J. A., McAlpine P. J., Antonarakis S., Cann H., Eppig J. T., Frazer K., Frezal J., Lancet D., Nahmias J., Pearson P. Guidelines for human gene nomenclature (1997). HUGO Nomenclature Committee. Genomics. 1997 Oct 15;45(2):468–471. doi: 10.1006/geno.1997.4979. [DOI] [PubMed] [Google Scholar]

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