CoChat
Sign Up
Cited by 60Emergency and Acute Care StudiesPrimary Care and Health OutcomesHealthcare Systems and Challenges

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey

Open access
Carlisle, R., Groom, L. M, Avery, A. J, Boot, D., Earwicker, S.·1998·BMJ
DOI 10.1136/bmj.316.7130.520PMC PMC2665670
Open this paper in CoChat — free accountOpen PDF

Abstract

Abstract Objectives: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. Design: Six month longitudinal study. Setting: Six general practices and the sole accident and emergency department in Nottingham. Subjects: 4745 out of hours contacts generated by 45 182 patients from 23 electoral wards registered with six practices. Main outcome measures: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards. Results: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from −23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P=0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis. Conclusions: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other. Key messages We studied the out of hours activity of six general practices and the local accident and emergency department in Nottingham for six months There were wide variations between electoral wards in both general practice and accident and emergency events Deprivation scores explained more than half of the variation, with out of hours activity being highest in deprived inner city areas Highly deprived areas close to the accident and emergency department generated high levels of work for both general practice and accident and emergency services, with no evidence of one service substituting for the other

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bmj.316.7130.520

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is significant evidence of lower use of preventive services among more deprived groups, as well as evidence of higher use of accident and emergency facilities, emergency admissions and out-of-hours use.

    “There is significant evidence of lower use of preventive services among more deprived groups, [33,34] as well as evidence of higher use of accident and emergency facilities, emergency admissions and out-of-hours use [35,35,37,38].”

    From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [38]

    The Out of hours activity section reports that higher deprivation scores were associated with higher out-of-hours rates for both general practice and accident and emergency services. The cited paper does not establish higher emergency admissions; the preventive-services claim is attached to different citations. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 13

  1. Wilkin D. Patterns of referral: explaining variation. In: Roland M, Coulter A, eds. Hospital referrals. Oxford: Oxford University Press, 1992:76-91.
  2. MacRae K. Socio-economic deprivation and health and the ecological fallacy. BMJ 1994;309:1478-9.
  3. Pitt J. Hours of work and fatigue in doctors. J R Coll Gen Pract 1988;38:2-3.
  4. Hallam L. Primary medical care outside normal working hours; review of published work. BMJ 1994;308:249-53.
  5. Salisbury C. Visiting through the night. BMJ 1993;306:762-4.
  6. Soler M, Dowers A, Jones RB. Out of hours work in primary care: audit of an urban co-operative deputising service. Health Bull 1991;49(1):40-7.
  7. Hallam L, Cragg D. Organisation of primary care services outsider normal working hours. BMJ 1994;309:1621-3.
  8. McKee M, Priest P, Ginzler M, Black N. Which general surgical operations must be done at night? Ann R Coll Surg Engl 1991;73(5):295-301, discus- sion 301-2.
  9. Yeatman M, Cameron-Smith A, Moore JM. Nocturnal orthopaedic oper- ating: can we let sleeping orthopaedic surgeons lie? Ann R Coll Surg Engl 1994;76(2):90-4.
  10. Salisbury C. Observational study of a general practice out-of-hours coop- erative: measures of activity. BMJ 1997;314:182-6.
  11. Jessopp L, Beck I, Hollins L, Shipman C, Reynolds M, Dale J. Changing the pattern of out-of-hours: a survey of general practice cooperatives. BMJ 1997;314:199-200.
  12. South Wiltshire Out of Hours Project (SWOOP) Group. Nurse telephone triage in out-of-hours primary care: a pilot study. BMJ 1997;314:198-9.
  13. Hallam L. Commentary: changing the culture of out-of-hours care. BMJ 1996;312:1402.

Cited by

Sorted by citations

Related

Authors
Carlisle, R., Groom, L. M., Avery, A. J., Boot, D., & Earwicker, S.
Affiliations
University of Nottingham (GB)
Corresponding author
Carlisle, R.
ORCID
Avery, A. J
Venue
BMJ
Publisher
BMJ
Published
1998-02-14
Volume
316
Issue
7130
Pages
520-523
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.316.7130.520
PMC
PMC2665670
OpenAlex
W2038187897
Cited by
60
References
23
Citations by year
2022: 1 · 2021: 2 · 2020: 1 · 2018: 1 · 2015: 3 · 2013: 3
FWCI
6.33
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
Keywords
out-of-hours care, general practice, accident and emergency services, socioeconomic deprivation, distance to hospital, emergency department workload, Nottingham
MeSH terms
Emergency Service, Hospital, England, Family Practice, Holidays, Humans, Longitudinal Studies, Night Care, Poverty Areas, Time Factors, Utilization Review, Workload, Small-Area Analysis, Urban Health Services

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review