The Association Between Evidence-Based Medication Use And Unplanned Hospital Admissions: A National Observational Study in Primary Care

The UK has experienced a 47% increase in unplanned hospital admissions over the last 15 years that has seriously strained the healthcare system. In 2012-2013 there were 5.3 million unplanned hospital admissions representing 67% of hospital bed days in England and costing approximately £12.5 billion. This represents a huge problem that is unsustainable and needs to change. As a result, admission reductions are a priority of the National Health Service.

Unplanned hospital admissions are unpredictable and occur at short notice because of a perceived need for immediate health care. Primary care physicians- as the gate keepers of patient care- have a crucial role to help reduce unplanned admissions. Research shows that some primary care practices are more successful than others in controlling rates of hospital admissions among their patients but the reasons for this are unclear. Studies attempting to identify the keys to success have found few conclusive results. However, one of the most fundamental components of effective primary care has not been assessed; the use of evidence-based medications. There is wide variation in primary care prescribing practices, including both under- and over-utilization of medications. These variations may explain why some physicians more successfully manage hospitalisation rates among their patients compared to others. 

Therefore, the objective of this study is to assess the association between evidence-based medication use in primary care and unplanned hospital admissions. We will use national databases with primary care and hospital data for all patients registered with a primary care practice in England from 2011-2014. Our multidisciplinary team includes experts in evidence-based medicine, general practitioners, and researchers with expertise in analysing large databases. Ethics approval is not required as we will use anonymous data.

This project will help to determine the extent to which improving prescribing practices in primary care could reduce hospital admissions in England. The project will lead to future research and policy recommendations to improve primary care and to help resolve the hospital admissions