Opportunities for primary care to reduce hospital admissions: A cross-sectional study of geographical variation

John Busby*, Sarah Purdy, William Hollingworth

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)


Background Reducing unplanned hospital admissions is a key priority within the UK. Substantial interpractice variation in admission rates for ambulatory care sensitive conditions (ACSC) suggests that decreases might be possible. Aim To identify the clinical areas and patient subgroups where the greatest opportunities exist for GPs to improve ACSC care. Design and setting Cross-sectional study using routine hospital data from patients registered at 8123 English GP practices during 2011 and 2012. Method The authors used random effects Poisson models to estimate interpractice variation after adjusting for several drivers of healthcare need and availability of local hospital services. Interpractice variation was contrasted across patient subgroups based on age. Results There were 1.8 million hospital admissions. Overall, high-utilisation practices had ACSC admission rates that were 55% (95% CI = 53 to 56) greater than low-utilisation practices. Differences of 67% (95% CI = 65 to 69) were found for chronic ACSCs, which was much larger than the 51% (95% CI = 49 to 52) difference exhibited by acute presentations. At least two-fold differences were found for 15 (54%) ACSCs, although large interpractice variations were not ubiquitous. Admission rates were consistently more variable among younger-than-average patients. The most variable conditions tended to disproportionately affect deprived patients. Conclusion Substantial interpractice variation suggests that current efforts to standardise primary care have had a limited effect on unplanned hospital admissions. GPs and healthcare commissioners should ensure they are offering best practice care for the most variable clinical areas and patient subgroups identified in the study, particularly in adults aged <70 years with chronic conditions.

Original languageEnglish
Pages (from-to)e20-e28
JournalBritish Journal of General Practice
Issue number654
Publication statusPublished - 01 Jan 2017
Externally publishedYes


  • Ambulatory care
  • General practice
  • Geographical distribution
  • Patient admission
  • Primary health care

ASJC Scopus subject areas

  • Family Practice

Fingerprint Dive into the research topics of 'Opportunities for primary care to reduce hospital admissions: A cross-sectional study of geographical variation'. Together they form a unique fingerprint.

  • Cite this