Effect of general practitioner hospitals on district general hospital bed use in the Highlands of Scotland.

Abstract

Objective: To examine hospital bed use by General Practices with and without access to General Practitioner beds.

Design: Information from the Contract Management System for General Medicine and Surgery, and from SMR returns for Geriatric Medicine and GP beds was used to compare hospital bed use in District General Hospitals (DGHs) and in General Practitioner beds for practices with and without access to GP beds. Age adjusted rates were calculated for overall use of each specialty.

Setting: All General Practices in the Highland Health Board area for December 1995-April 1997.

Results: Compared to practices with no access to GP beds, practices with access used 39.4% fewer bed days per 1000 patients for medical specialties; 18% fewer bed days for surgical specialties; 34.5% fewer bed days for geriatric medicine, and 4.9% fewer bed days for other DGH specialties. Taking into account GP bed day use, practices with access to GP beds used 6.1% more hospital bed days per 1000 patients than did practices with no access.

Conclusion: These findings largely replicate work in England that found substantial decreases in General Medical and Geriatric Medicine bed use in Practices with access to GP beds, combined with an overall increase in occupied bed day use of 6-8% per 1000 patients. The lower use of surgical beds was unexpected, and may reflect more flexible use of GP beds in the Highlands for observation or rehabilitation, possibly related to the far greater distances involved than in the English studies.