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Title: An epidemiological study of varying emergency medical admission rates in Glasgow
Author: Blatchford, Oliver
ISNI:       0000 0001 3467 8336
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1999
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Background: Emergency medical admissions in the United Kmgdom have been rising for many years. This rise has resulted in increasing pressures on hospitals' resources, with consequent difficulties in coping with peaks of admissions. This rise has not been intended or planned. The epidemiology of emergency medical admissions is poorly understood. Aims: To investigate the epidemiology of emergency medical admissions in Glasgow in terms of time, person and place. To explore variations in Glasgow's general practices' and hospitals' emergency medical admission rates. Literature review: Articles relating to variations in emergency medical admission rates were identified by searching bibliographic databases, cross referencing from known articles, consulting other researchers and hand searching of journal indexes. Relevant articles were included in a systematic review of the epidemiology of varying rates of hospitals' emergency admissions. Articles that postulated causes of the rise of emergency admissions or factors associated with varying admission rates were also reviewed. A summary of mechanisms whereby hospitals might cope with pressures of emergency admissions concluded the literature review. Published evidence of variations of rates of hospital emergency admission was limited. Most articles were found to contain postulated associations with variations in hospitals' emergency admissions. While many published mechanisms for hospitals to adapt to pressures from emergency admissions were identified, only a minority of these had been formally evaluated. 3 Setting: Greater Glasgow Health Board residents (813,029 adults at June 1997). Data obtained from the Health Board's Community Health Index (CHI). Subjects: 537,798 Greater Glasgow Health Board residents admitted to Glasgow hospitals7 medical beds between 1980 and 1997 (43,236 patients in 1997). Data obtained from Scottish Morbidity Record database one (SMRl). Methods: Anonymised CHI and SMRl datasets linked by patients' general practitioners' codes, using a computer database package. Standardised emergency medical admission rates were calculated by the database. Computerised maps of standardised emergency medical admission ratios were plotted for Glasgow7s postcode sectors to show geographical variations. Correlation and logistic regression were used to explore variations in standardised emergency medical admission ratios. Outcome measures: Crude emergency medical admission rates. Standardised emergency medical admission ratios adjusted for patients7 age, sex and Carstairs7 deprivation categories. Results: The numbers of emergency medical admissions doubled between 1980 and 1997. Emergency medical admission rates increased steeply with increasing age of patients, more than doubling for every two decades. Men above 40 years had approximately 20% higher age specific emergency medical admission rates than women. Emergency medical admission rates were more than twice as high amongst patients from Glasgow's most deprived areas, compared with the most affluent. Cardiovascular disease (ICD10 chapter IX) discharge diagnoses were commonest (27.2% in 1997)' followed by the non-specific diagnoses in ICDlO chapter XVII (21.0%). The non-specific diagnoses mainly comprised chest pain (9.6%) which was the commonest reason for admission. Between 1980 and 1997, non-specific diagnoses (ICD10 chapter XVII) increased at twice the rate of all other ICDlO chapters of diagnoses. There were two areas of Glasgow that had raised standardised emergency medical admission ratios (adjusted for patients' ages, sex and deprivation). These corresponded to the catchment areas of two acute hospitals, which had substantially higher adjusted emergency medical admission ratios than had the other three. There was a 2.51 fold variation between the top and bottom deciles of Glasgow's general Practices' crude emergency medical admission rates. After adjustment for their patients' age, sex and deprivation characteristics, this reduced to a 1.87 fold variation. Additional adjustment for general practices' admitting hospitals (along with their patients' age, sex and deprivation) accounted for a total of 84% of the inter-practice variation in crude emergency medical admission rates. Fundholding general practices had modestly raised emergency medical admission rates (odds ratio 1.06.) There were no associations between practices' rates of emergency medical admissions and any other measured practices' characteristics (including numbers of partners, practices' sizes or dispersions, immunisation and cytology rates). Conclusions: This large study discovered epidemiological associations between emergency medical admission rates and patients' sex and socioeconomic deprivation that had not previously been shown. It showed that emergency admission rate variations between general practices were only partly accounted for by patient characteristics. Apart from fundholding status, difference between practices were not related to variations in their rates of emergency medical admissions. However, a substantial part of the variation between general practices could be attributed to differences between their admitting hospitals.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA0421 Public health. Hygiene. Preventive Medicine