Chronic disease detection and access: does access improve detection, or does detection make access more difficult?

Background: The recorded detection of chronic disease by practices is generally lower than the prevalence predicted by population surveys. Aim: To determine whether patient-reported access to general practice predicts the recorded detection rates of chronic diseases in that setting. Design and setting: A cross-sectional study involving 146 general practices in Leicestershire and Rutland, England. Method: The numbers of patients recorded as having chronic disease (coronary heart disease, chronic obstructive pulmonary disease, hypertension, diabetes) were obtained from Quality and Outcomes Framework (QOF) practice disease registers for 2008-2009. Characteristics of practice populations (deprivation, age, sex, ethnicity, proportion reporting poor health, practice turnover, list size) and practice performance (achievement of QOF disease indicators, patient experience of being able to consult a doctor within 2 working days and book an appointment >2 days in advance) were included in regression models. Results: Patient characteristics (deprivation, age, poor health) and practice characteristics (list size, turnover, QOF achievement) were associated with recorded detection of more than one of the chronic diseases. Practices in which patients were more likely to report being able to book appointments had reduced recording rates of chronic disease. Being able to consult a doctor within 2days was not associated with levels of recorded chronic disease. Conclusion: Practices with high levels of deprivation and older patients have increased rates of recorded chronic disease. As the number of patients recorded with chronic disease increased, the capacity of practices to meet patients' requests for appointments in advance declined. The capacity of some practices to detect and manage chronic disease may need improving.