Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care–Sensitive Conditions

The Article in Brief

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions

Elizabeth Cecil , and colleagues

Background In 2004, the United Kingdom National Health Service (NHS) introduced major reforms to primary care policy which aimed to improve working conditions for primary care physicians and health outcomes for patients. It focused on improving chronic disease management in adults, with few health targets for children?s care. Revisions allowing primary care physicians to opt out of providing acute primary care services during evenings and weekends reduced access associated with increased emergency department visits. This study assessed the impact of these reforms on potentially avoidable short stay unplanned hospital admissions for children with primary care sensitive conditions.

What This Study Found The introduction of health care reforms coincided with an increase in short-stay admission rates for children with primary-care sensitive chronic conditions and with more children being admitted through emergency departments. Specifically, between April 2000 and March 2013, there were 7.8 million unplanned hospital admissions for children younger than 15 years. More than one-half were short stay admissions for potentially avoidable infections and chronic conditions. The primary care policy reforms implemented in April 2004 were associated with an 8 percent increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3 percent annual increasing trend. These increases, the authors note, were accompanied by falls in admissions of children referred by a primary care physician. Notably, the policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5 percent annual before April 2004.

Implications

• The authors suggest that the more steady increase in admission rates for primary care-sensitive infections may be attributed to lowered thresholds for hospital admission.
• While the authors cannot infer causation from the findings, the magnitude of an 11 percent increase in short-stay admissions for chronic disease lends weight to speculation that such admissions may increase when primary care provision is withdrawn. That short-stay admission rates among children with chronic conditions changed immediately in 2004 and are now surpassing other causes of admission in older children, they assert, is particularly concerning. They contend that this development may indicate an adverse impact of financial incentive schemes focusing on chronic conditions in adults.