Relation of rates of self referral to A&E departments to deprivation

doi:10.1136/bmj.317.7157.538

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Robust markers are needed of variations in case mix among practices

Sally Hull, Senior lecturer, department of general practice.,
Ian Rees Jones, Lecturer, department of geography.,
Kath Moser, Research officer, department of general practice.

Queen Mary and Westfield College, London E1 4NS
UMDS Department of General Practice, London SE11 6SP

EDITOR—Carlisle et al report an association between markers of social deprivation derived from the 1991 census and out of hours contacts with both general practice services and accident and emergency departments.1

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Rates of attendance at accident and emergency (A & E) department and outcomes for two general practices in Tower Hamlets, London

We undertook a related study in east London, based on 63 000 attendances by adults at accident and emergency departments.2 This showed that factors related to social deprivation accounted for 48% of the variation in total adult attendance rates between practices. This was so even in an area of consistently high deprivation where the practices' underprivileged area (Jarman) scores ranged from 30.4 to 62.1 (median value 42.5). In contrast to Carlisle et al, we included in the multivariate analysis explanatory variables relating to practice size and resources, since organisational factors are often cited as causes of high use of accident and emergency departments …