Associations of GP practice characteristics with the rate of ambulatory care sensitive conditions in people living with dementia in England: An ecological analysis of routine data
Open accessAbstract
BACKGROUND: Hospital admissions for Ambulatory Care Sensitive Conditions (ACSCs) are potentially avoidable. Dementia is one of the leading chronic conditions in terms of variability in ACSC admissions by general practice, as well as accounting for around a third of UK emergency admissions. METHODS: Using Bayesian multilevel linear regression models, we examined the ecological association of organizational characteristics of general practices (ACSC n=7076, non-ACSC n=7046 units) and Clinical Commissioning Groups (CCG n=212 units) in relation to ACSC and non-ACSC admissions for people with dementia in England. RESULTS: The rate of hospital admissions are variable between GP practices, with deprivation and being admitted from home as risk factors for admission for ACSC and non-ACSC admissions. The budget allocated by the CCG to mental health shows diverging effects for ACSC versus non-ACSC admissions, so it is likely there is some geographic variation. CONCLUSIONS: A variety of factors that could explain avoidable admissions for PWD at the practice level were examined; most were equally predictive for avoidable and non-avoidable admissions. However, a high amount of variation found at the practice level, in conjunction with the diverging effects of the CCG mental health budget, implies that guidance may be applied inconsistently, or local services may have differences in referral criteria. This indicates there is potential scope for improvement.
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Inconsistent referral criteria and service availability across geographical regions contributed to inequitable access to transitional care support.
“Furthermore, studies highlighted that inconsistent referral criteria and service availability across geographical regions contributed to inequitable access to transitional care support (de Vries et al., 2019; Eyles et al., 2021; Jennings et al., 2020; Kupeli et al., 2019; Parker et al., 2021; Pond et al., 2019).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Eyles et al., 2021
The Conclusions (page unavailable) suggest that guidance may be applied inconsistently and that local referral guidance and services may vary; they also note unexplained geographical differences in avoidable admissions for people with dementia. The paper does not establish that those differences caused inequitable access to transitional care support. It studies hospital admissions, and its explanation for the variation is tentative. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPeople from lower-income backgrounds and rural regions faced greater barriers to continuous primary care and specialist services.
“People from lower-income backgrounds and rural regions faced greater barriers to continuous primary care and specialist services (Brooks et al., 2022a; Eyles et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Eyles et al., 2021
The Discussion (page not available) links higher area deprivation to more hospital admissions among people living with dementia, but does not establish that lower-income people faced greater barriers to continuous primary care or specialist services. The Background names poor continuity and rurality as factors affecting admissions; the Discussion reports that rurality was not linked to increased admissions in this study. The claimed rural service barriers are not supported. (LLM, conf=0.81)
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Cites
Gelman, A., Carlin, J. B., Stern, H. S., Dunson, D. B., Vehtari, A., & Rubin, D. B. (2013) · doi:10.1201/b16018 · Cited by 27,276 · see citing works
Hewson, P. (2014) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.1111/j.1467-985x.2014.12096_1.x · Cited by 1,368 · see citing works
Purdy, S., Griffin, T. P., Salisbury, C., & Sharp, D. (2009) · Public Health · doi:10.1016/j.puhe.2008.11.001 · Cited by 604 · see citing works
Self-citationDementia in the acute hospital: prospective cohort study of prevalence and mortality
Sampson, E. L., Blanchard, M. R., Jones, L., Tookman, A. J., & King, M. (2009) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.108.055335 · Cited by 598 · see citing works
Association of Incident Dementia With Hospitalizations
Phelan, E. A., Borson, S., Grothaus, L., Balch, S., & Larson, E. B. (2012) · JAMA · doi:10.1001/jama.2011.1964 · Cited by 547 · see citing works
runmlwin : A Program to Run the MLwiN Multilevel Modeling Software from within Stata
Leckie, G., & Charlton, C. (2012) · Journal of Statistical Software · doi:10.18637/jss.v052.i11 · Cited by 347 · see citing works
MCMC Estimation in MLwiN (Version 2.13) Centre for Multilevel Modelling, University of Bristol
Browne, W. J. (2009) · Bristol Research (University of Bristol) · Cited by 295 · see citing works
Organizational aspects of primary care related to avoidable hospitalization: a systematic review
van Loenen, T., van den Berg, M. J., Westert, G. P., & Faber, M. J. (2014) · Family Practice · doi:10.1093/fampra/cmu053 · Cited by 263 · see citing works
Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis
Shepherd, H., Livingston, G., Chan, J., & Sommerlad, A. (2019) · BMC Medicine · doi:10.1186/s12916-019-1369-7 · Cited by 232 · cited 2× · see citing works
“It is estimated that 25% of hospital beds are occupied by PWD[13], and they are admitted more frequently than those without [14].”
BackgroundSundmacher, L., Fischbach, D., Schuettig, W., Naumann, C., Augustin, U., & Faisst, C. (2015) · Health Policy · doi:10.1016/j.healthpol.2015.08.007 · Cited by 194 · see citing works
Hospital Transfers of Nursing Home Residents with Advanced Dementia
Givens, J. L., Selby, K. J., Goldfeld, K. S., & Mitchell, S. L. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03919.x · Cited by 177 · see citing works
Sommerlad, A., Perera, G., Singh‐Manoux, A., Lewis, G., Stewart, R. J., & Livingston, G. (2018) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2018.02.012 · Cited by 149 · see citing works
Causes of Hospital Admission for People With Dementia: A Systematic Review and Meta-Analysis
Toot, S., Devine, M., Akporobaro, A., & Orrell, M. W. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.01.011 · Cited by 143 · see citing works
Emmett, C., Poole, M., Bond, J., & Hughes, J. C. (2012) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2012.11.009 · Cited by 107 · see citing works
Tropea, J., LoGiudice, D., Liew, D., Gorelik, A., & Brand, C. A. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4491 · Cited by 97 · see citing works
Thorpe, J. M., Houtven, C. H. V., Sleath, B. L., & Thorpe, C. T. (2010) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2010.00276.x · Cited by 62 · see citing works
Lin, P., Zhong, Y., Fillit, H. M., Cohen, J. T., & Neumann, P. J. (2017) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2017.08.010 · Cited by 61 · see citing works
Busby, J., Purdy, S., & Hollingworth, W. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0638-9 · Cited by 53 · see citing works
Self-citationPreventable hospitalizations among older patients with cognitive impairments and dementia
Wolf, D. G. F., Rhein, C., Geschke, K., & Fellgiebel, A. (2018) · International Psychogeriatrics · doi:10.1017/s1041610218000960 · Cited by 53 · see citing works
The effect of hospital ownership on quality of care: Evidence from England
Moscelli, G., Gravelle, H. S. E., Siciliani, L., & Gutacker, N. (2018) · Journal of Economic Behavior & Organization · doi:10.1016/j.jebo.2018.05.009 · Cited by 41 · see citing works
Busby, J., Purdy, S., & Hollingworth, W. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x687949 · Cited by 32 · see citing works
Self-citationKasteridis, P., Mason, A., Goddard, M. K., Jacobs, R., Santos, R., & McGonigal, G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0121506 · Cited by 28 · see citing works
Pimouguet, C., Rizzuto, D., Fastbom, J., Lågergren, M., Fratiglioni, L., & Xu, W. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-150853 · Cited by 20 · see citing works
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Determinants of hospital readmissions in older people with dementia: a narrative review
Browne, B., Ali, K., Ford, E., & Tabet, N. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04905-6 · Cited by 18 · see citing works
Greene, L., Brain, J., Watkins, P., Kafadar, A. H., Sabatini, S., Blundell, B., Bothe, E., Harper, K., Hersh, D., Morrisby, C., et al. (2026) · The Gerontologist · doi:10.1093/geront/gnaf275 · Cited by 9 · see citing works
- Authors
- Eyles, E., Redaniel, M. T., Purdy, S., Tilling, K., & Ben-Shlomo, Y.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Eyles, Emily
- Venue
- BMC Health Services Research
- Published
- 2021-06-29
- Volume
- 21
- Issue
- 1
- Pages
- 613-613
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC8240405
- OpenAlex
- W3173943200
- Cited by
- 7
- References
- 23
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Explore Bristol Research (submittedVersion, cc-by)
- Funders
- National Institute for Health Research Applied Research Collaboration West, United Kingdom
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- ambulatory care sensitive conditions, dementia, avoidable hospitalizations, general practice characteristics, clinical commissioning groups, socioeconomic deprivation, emergency admissions, referral criteria, regional variation in care, England
- MeSH terms
- Ambulatory Care, Bayes Theorem, Dementia, England, Hospitalization, Humans
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