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GENERAL PRACTICE: Azeem Majeed, Martin Bardsley, David Morgan, Caoimhe O'Sullivan, and Andrew B Bindman Cross sectional study of primary care groups in London: association of measures of socioeconomic and health status with hospital admission rates BMJ 2000; 321: 1057-1060 [Abstract] [Full text]

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The Inverse Care Law

John Hopkins   (30 October 2000)

True but less valid

Rudiger Pittrof   (1 November 2000)

The Inverse Care Law 30 October 2000
John Hopkins, General Practitioner Darlington Send response to journal: Re: The Inverse Care Law	Dear Dr Smith, Majeed and his colleagues conclude that primary care groups have variable patient and practice characteristics and that hospital admission rates are higher in areas with greater deprivation. This supports Tudor Hart's Inverse Care Law which argues that those with the greatest need of health care are likely to live in areas with the poorest provision of health and social services. The current orthodoxy of primary care groups encourages them to take a "big picture" view of their role and to include health improvement in their planning and objectives. The problem with this, entirely laudable, aim is that to achieve substantial changes in housing, employment and education will require massive amounts of time, expertise and funding. A focussed approach, with PCGs concentrating on clearly defined and clinically led outcomes is more likely to deliver measurable improvements in care within a realistic timetable. Yours sincerely, Dr John Hopkins
True but less valid 1 November 2000
Rudiger Pittrof, SpR GUM St George's Hospital, London Send response to journal: Re: True but less valid	The results of the study by Majeed and colleagues are very important, are compatible with the findings of others, fit into the current political landscape and intuitively make sense. Many of the conclusions are based on the secondary analysis of aggregate data, often generated using different sampling frames. While I enjoyed reading the paper, I would be grateful for an explanation why this is a cross sectional rather than an ecological study. This distinction is more than just academic as the primary objective of an ecological study is to generate new hypotheses. Results of ecological studies cannot imply causality.