PT  - JOURNAL ARTICLE
AU  - Yin Zhou
AU  - Gary Abel
AU  - Fiona Warren
AU  - Martin Roland
AU  - John Campbell
AU  - Georgios Lyratzopoulos
TI  - Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey
AID  - 10.1136/emermed-2013-203451
DP  - 2015 May 01
TA  - Emergency Medicine Journal
PG  - 373--378
VI  - 32
IP  - 5
4099  - http://emj.bmj.com/content/32/5/373.short
4100  - http://emj.bmj.com/content/32/5/373.full
SO  - Emerg Med J2015 May 01; 32
AB  - Introduction It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. Methods We analysed data from 567 049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal. Results Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal. Conclusions This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access.