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• Response
  Sarah Purdy
  Published on: 23 November 2015
• Systematic review of features of primary care which affect unscheduled secondary care use: relevant evidence missed by the review
  Michael A Soljak
  Published on: 23 November 2015

• Published on: 23 November 2015

  Response

  • Sarah Purdy, Reader
  • Other Contributors:
    • Alyson Huntley

  Dear Editors

  We agree with Michael Soljak and colleagues that the studies he quotes in his response are helpful additions to the literature on the topic included in this systematic review.[1] As a result of this rapid response, we re-examined our searching and screening process and can confirm that two studies were neither picked up in our original searches nor through any of the iterative searching processe...

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  Dear Editors

  We agree with Michael Soljak and colleagues that the studies he quotes in his response are helpful additions to the literature on the topic included in this systematic review.[1] As a result of this rapid response, we re-examined our searching and screening process and can confirm that two studies were neither picked up in our original searches nor through any of the iterative searching processes of the systematic review. In order to understand why this was the case, we examined the Mesh terms associated with the papers and key terms in the titles and abstracts. We conclude that the most plausible explanation for not finding the Calderon-Larranga and Soljak publications is the lack of Mesh terms and key terms in the title and abstract concerning unscheduled/unplanned/emergency care.[2][3] The third publication by Bottle et al does have the MESH term of 'emergencies' and 'unplanned' in the title and abstract. However, it was indexed in October 2012 shortly after our searches were conducted.[4] The publication by Cowling et al 20135 was identified after the formal search phase as stated in the PRISMA diagram.[5] It was included as an additional resource in the finished review as we felt it added value. The other two studies referenced by Soljak and colleagues were post-date submission of the review. The area where the additional studies add most potential information is in access to care. The three cross sectional studies conducted in the UK show an association between one or other of two measures of access to primary care and reduced emergency admissions.[1][2][3] However, in response to the suggestion that we might wish to consider modifying our conclusions in the light of these papers, we feel they still stand. Across the range of factors examined in the systematic review we expressed concern that the majority of research found was observational and this limits conclusions about how to change systems and to inform policy.

  Sarah Purdy and Alyson Huntley

  References

  1.Huntley A, Lasserson D, Wye L, et al. Which features of primary care affect unscheduled secondary care use? A systematic review. BMJ Open 2014;4(5). 2.Calderon-Larranaga A, Carney L, Soljak M, et al. Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross- sectional study. Thorax 2011;66(3):191-96. 3.Soljak M, Calderon-Larranaga A, Sharma P, et al. Does higher quality primary health care reduce stroke admissions? a national cross-sectional study. British Journal of General Practice 2011;61(593):e801-e07. 4.Bottle A, Tsang C, Parsons et al. Association between patient and general practice characteristics and unplanned first-time admissions for cancer: observational study. Br J Cancer 2012 Oct 9; 107(8):1213-9. 5.Cowling TE, Cecil EV, Soljak MA, et al. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population- Based Study. PLoS ONE 2013;8(6):e66699.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 23 November 2015

  Systematic review of features of primary care which affect unscheduled secondary care use: relevant evidence missed by the review

  • Michael A Soljak, Clinical Research Fellow
  • Other Contributors:
    • Amaia Calderon-Larranaga, Elizabeth Cecil, Azeem Majeed

  Primary care sensitive conditions (PCSCs), management of which in primary care might affect risk of hospital admission, are an important aspect of current national health policies. Evidence on primary care factors affecting them is therefore an important issue. We are writing to query why three of our very relevant reports,1-3 which were published in fairly high impact journals (combined impact factor 15.49) were missed by the sy...

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  Primary care sensitive conditions (PCSCs), management of which in primary care might affect risk of hospital admission, are an important aspect of current national health policies. Evidence on primary care factors affecting them is therefore an important issue. We are writing to query why three of our very relevant reports,1-3 which were published in fairly high impact journals (combined impact factor 15.49) were missed by the systematic review of features of primary care which affect unscheduled secondary care use by Huntley et al.4 All three were published online at least before the review???s cut-off date of October 2012. We recognise that it is often more difficult to find research on health services using Medical Index Subject Heading (MeSH) terms, which moreover often use American terminology such as hospitalisations rather than hospital admissions. We certainly tried to include as many MeSH terms as allowed by the journal websites when we submitted them. As far as we can determine there were no exclusion criteria which might have affected our papers. Huntley et al also state in their Methods that in addition to their database searches ???reference lists of included papers were checked for further potentially eligible studies???. They reference another of our papers (Cowling et al5), which was not published until June 2013, well after their cut-off date. This quotes all three of our missed papers, which raises questions about the thoroughness of the authors??? checking processes. In their discussion, Huntley et al conclude that better access to primary care was associated with reduced use of emergency care in the USA and Canada, but that the relationship in European health systems is less clear with no clear overall patterns emerging. Including our three papers, all of which are national studies, might change this conclusion. We have included patient-reported access to primary care in all our studies, because we think it is an important risk factor, but Huntley et al do not mention it specifically. Moreover, we have subsequently published two other papers on other PCSCs which show similar associations with patient-reported access.6 7 This association has therefore been present in all the PCSCs we have studied at national level. We look forward to an explanation as to why these reports were missed by Huntley et al, and whether their findings might affect the conclusions of the review. References 1. Calder??n-Larra??aga A, Carney L, Soljak M, et al. Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study. Thorax 2011;66(3):191-96. 2. Bottle A, Tsang C, Parsons C, et al. Association between patient and general practice characteristics and unplanned first-time admissions for cancer: observational study. Br J Cancer 2012;107:1213-19. 3. Soljak M, Calderon-Larranaga A, Sharma P, et al. Does higher quality primary health care reduce stroke admissions? a national cross-sectional study. British Journal of General Practice 2011;61(593):e801-e07. 4. Huntley A, Lasserson D, Wye L, et al. Which features of primary care affect unscheduled secondary care use? A systematic review. BMJ Open 2014;4(5). 5. Cowling TE, Cecil EV, Soljak MA, et al. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study. PLoS ONE 2013;8(6):e66699. 6. Calder??n-Larra??aga A, Soljak M, Cecil E, et al. Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study. Diabetic Medicine 2014:10.1111/dme.12413. 7. Calder??n-Larra??aga A, Soljak M, Cowling TE, et al. Association of primary care factors with hospital admissions for epilepsy in England, 2004-10: national observational study. Seizure 2014(0):doi: 10.1016/j.seizure.2014.05.008.

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  Conflict of Interest:
  None declared.

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