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Identifying naturally occurring communities of primary care providers in the English National Health Service in London.

ABSTRACT: OBJECTIVES:Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that PCNs should represent 'natural' communities of general practices (GP practices) collaborating at scale and covering a geography that fits well with practices, other healthcare providers and local communities. Our study aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities. DESIGN:Retrospective observational study using Hospital Episode Statistics - patient-level administrative records of attendances to hospital. SETTING:General practices in the 32 Clinical Commissioning Groups of Greater London PARTICIPANTS: All adult patients resident in and registered to a GP practice in Greater London that had one or more outpatient encounters at NHS hospitals between 1st April 2017 and 31st March 2018. MAIN OUTCOME MEASURES:The allocation of GP practices in Greater London to PCNs based on the registrations of patients resident in each Lower Layer Super Output Area (LSOA) of Greater London. The population size and coverage of each proposed PCN. RESULTS:3 428 322 unique patients attended 1334 GPs in 4835 LSOAs in Greater London. Our model grouped 1291 GPs (96.8%) and 4721 LSOAs (97.6%) into 165 mutually exclusive PCNs. Median PCN list size was 53 490, with a lower quartile of 38 079 patients and an upper quartile of 72 982 patients. A median of 70.1% of patients attended a GP within their allocated PCN, ranging from 44.6% to 91.4%. CONCLUSIONS:With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital to recognise how PCNs represent their communities. Our method may be used by policymakers to understand the populations and geography shared between networks.

SUBMITTER: Clarke J

PROVIDER: S-EPMC7375630 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Identifying naturally occurring communities of primary care providers in the English National Health Service in London.

Clarke Jonathan J Beaney Thomas T Majeed Azeem A Darzi Ara A Barahona Mauricio M

BMJ open 20200720 7

<h4>Objectives</h4>Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that PCNs should represent 'natural' communities of general practices (GP practices) collaborating at scale and covering a geography that fits well with practices, other healthcare providers and local communities. Our study aims to identify natural communities of GP practices based on patient registrati ...[more]

PMID: 32690744

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Project description:BackgroundPatient awareness of CKD and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions. Understanding how patients may become aware of CKD is critical to their participation in healthy behaviors to slow CKD progression. We examined factors associated with the concordance of CKD awareness among patients and providers and hypothesized that concordance of CKD awareness would be influenced by social and demographic factors that impact communication, such as limited English proficiency (LEP) and health literacy.MethodsBetween July 2011 to July 2014, patients with CKD from three primary care clinics in a public healthcare delivery system were surveyed with questions regarding their health, including awareness of their CKD status. Chart review was performed to identify PCP recognition of CKD, defined as CKD listed anywhere in the problem list within nine months before patient enrollment into the study. We used logistic regression to determine the association between provider recognition and patient awareness of kidney disease among those patients with CKD, adjusting for patient demographics, co-morbidities, and provider training.ResultsThe study population (n = 152) had a mean age of 57.4 (SD 13), was 48.7% male and was racially/ethnically and linguistically diverse: 89.5% self-identified as Black, Hispanic, or Asian and 32.2% had LEP. Most patients had hypertension (89.5%) and diabetes (77.6%); mean eGFR was 66.1 ml/min/1.73m2 (SD 32.8). Positive concordance of CKD awareness was 42% (n = 64). Odds of positive concordance with their providers were much higher among patients with LEP compared to English speaking patients (adjusted odds ratio = 11.07, 95%CI 1.60-76.39).ConclusionsConcordance of CKD awareness among PCPs and their patients with CKD in one public delivery system was higher among patients with LEP. While speculative, this may be due to greater caution in provider communication about CKD with LEP patients.

Dataset Information

Identifying naturally occurring communities of primary care providers in the English National Health Service in London.

Publications

Identifying naturally occurring communities of primary care providers in the English National Health Service in London.

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