Table 2.
Associations between regularity of GP appointments and emergency inpatient admissions and A&E attendances for the cohort: multilevel random intercept negative binomial regression models for all years 2000–2015 (inpatient admissions) and 2008–2015 (A&E attendances)a
| Emergency inpatient admission | A&E visit | |||||||
|---|---|---|---|---|---|---|---|---|
|
|
|
|||||||
| Incidence rate ratio | 95% CI | P-value | Incidence rate ratio | 95% CI | P-value | |||
| Coefficient of variation for gaps between consultations | ||||||||
| <0.75 | 1 (ref) | 1 (ref) | ||||||
| ≥0.75, <0.95 | 1.05 | 1.01 | 1.09 | 0.01 | 1.01 | 0.97 | 1.05 | 0.63 |
| ≥0.95, <1.20 | 1.07 | 1.03 | 1.12 | <0.01 | 1.04 | 0.99 | 1.08 | 0.10 |
| ≥1.20 | 1.15 | 1.10 | 1.20 | <0.01 | 1.05 | 1.01 | 1.10 | 0.03 |
| Undefined (<2 consultation gaps in year) | 1.24 | 1.19 | 1.29 | <0.01 | 0.91 | 0.88 | 0.95 | <0.01 |
|
| ||||||||
| No. of consultations in year | 1.04 | 1.04 | 1.04 | <0.01 | 1.03 | 1.03 | 1.03 | <0.01 |
| Year | 0.96 | 0.95 | 0.96 | <0.01 | 1.03 | 1.03 | 1.04 | <0.01 |
|
| ||||||||
| Sex | ||||||||
| Male | 1 (ref) | 1 (ref) | ||||||
| Female | 1.04 | 1.00 | 1.08 | 0.08 | 0.95 | 0.91 | 0.99 | 0.02 |
|
| ||||||||
| Ethnic group | ||||||||
| Black African | 1.11 | 0.95 | 1.30 | 0.17 | 1.06 | 0.92 | 1.22 | 0.43 |
| Black Caribbean | 1.31 | 1.04 | 1.64 | 0.02 | 1.49 | 1.19 | 1.88 | <0.01 |
| Black other | 1.39 | 1.09 | 1.79 | 0.01 | 1.50 | 1.19 | 1.89 | <0.01 |
| Bangladeshi | 1.16 | 0.84 | 1.61 | 0.37 | 0.92 | 0.68 | 1.24 | 0.58 |
| Chinese | 0.83 | 0.56 | 1.23 | 0.35 | 1.06 | 0.72 | 1.55 | 0.78 |
| Indian | 0.86 | 0.73 | 1.01 | 0.07 | 0.93 | 0.79 | 1.08 | 0.34 |
| Pakistani | 1.07 | 0.94 | 1.22 | 0.30 | 0.99 | 0.87 | 1.13 | 0.89 |
| Other Asian | 1.36 | 1.14 | 1.61 | <0.01 | 1.24 | 1.06 | 1.46 | 0.01 |
| White | 1 (ref) | 1 (ref) | ||||||
| Mixed | 1.24 | 1.08 | 1.42 | <0.01 | 1.16 | 1.02 | 1.32 | 0.02 |
| Other | 1.08 | 0.92 | 1.27 | 0.33 | 1.19 | 1.03 | 1.38 | 0.02 |
|
| ||||||||
| Age group, years | ||||||||
| <1 | 3.48 | 3.29 | 3.68 | <0.01 | 1.94 | 1.79 | 2.11 | <0.01 |
| 1–5 | 1 (ref) | 1 (ref) | ||||||
| 6–10 | 0.46 | 0.45 | 0.48 | <0.01 | 0.65 | 0.62 | 0.68 | <0.01 |
| 11–15 | 0.44 | 0.42 | 0.46 | <0.01 | 0.69 | 0.65 | 0.73 | <0.01 |
| 16–20 | 0.44 | 0.41 | 0.46 | <0.01 | 0.72 | 0.68 | 0.76 | <0.01 |
| 21–25 | 0.43 | 0.41 | 0.46 | <0.01 | 0.80 | 0.75 | 0.84 | <0.01 |
|
| ||||||||
| Main diagnostic group | ||||||||
| Circulatory | 1.79 | 1.56 | 2.06 | <0.01 | 1.22 | 1.06 | 1.39 | 0.01 |
| Congenital | 1 (ref) | 1 (ref) | ||||||
| Gastrointestinal | 2.80 | 2.36 | 3.32 | <0.01 | 1.32 | 1.12 | 1.56 | <0.01 |
| Genitourinary | 3.05 | 2.78 | 3.36 | <0.01 | 1.65 | 1.51 | 1.82 | <0.01 |
| Haematology | 1.84 | 1.67 | 2.03 | <0.01 | 1.19 | 1.08 | 1.31 | <0.01 |
| Metabolic | 1.97 | 1.78 | 2.19 | <0.01 | 1.34 | 1.20 | 1.49 | <0.01 |
| Neurology | 1.70 | 1.60 | 1.81 | <0.01 | 1.33 | 1.25 | 1.41 | <0.01 |
| Oncology | 1.93 | 1.82 | 2.06 | <0.01 | 1.01 | 0.95 | 1.08 | 0.68 |
| Perinatal | 0.89 | 0.76 | 1.05 | 0.17 | 0.97 | 0.83 | 1.12 | 0.65 |
| Respiratory | 2.29 | 2.12 | 2.47 | <0.01 | 1.29 | 1.19 | 1.39 | <0.01 |
| Other | 1.53 | 1.23 | 1.90 | <0.01 | 1.23 | 1.01 | 1.50 | 0.04 |
|
| ||||||||
| Deprivation category | ||||||||
| 1 (least deprived) | 0.72 | 0.67 | 0.77 | <0.01 | 0.63 | 0.59 | 0.67 | <0.01 |
| 2 | 0.75 | 0.70 | 0.80 | <0.01 | 0.66 | 0.62 | 0.71 | <0.01 |
| 3 | 0.82 | 0.77 | 0.88 | <0.01 | 0.78 | 0.73 | 0.83 | <0.01 |
| 4 | 0.95 | 0.89 | 1.01 | 0.10 | 0.86 | 0.80 | 0.91 | <0.01 |
| 5 (most deprived) | 1 (ref) | 1 (ref) | ||||||
|
| ||||||||
| Model parameters | ||||||||
| Degrees of freedom | 39 | 39 | ||||||
| Log likelihood | −91 244.5 | −63 549.9 | ||||||
| BIC | 182 939.0 | 127 531.9 | ||||||
a
’No. of consultations in year’ and ‘Year’ are continuous variables — incident rate ratios indicate the expected proportional change in outcome rate for one additional consultation and 1 year later in time. A&E = accident and emergency. BIC = Bayesian information criterion.