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In addition, multilevel multivariate analysis will be performed.
However, most of them lost their statistical significance in the multilevel multivariate analysis, including users/nurse ratio.
The multilevel multivariate analysis refers to regression analysis of patient outcomes nested within hospitals, with adjustment for both patient-level and hospital-level covariates [ 50].
In multilevel multivariate analysis, controlling for clustering by practice and confounding co-variates, factors independently associated with high attendance were not being in employment (OR = 2.39, CI = 1.15-4.94) and high levels of psychological distress (OR = 2.17, CI = 1.10-4.30).
Potentially confounding determinants, such as age, sex, comorbidity, life-expectance and quality of the patient record, were identified and differences in adverse event rates between groups were adjusted for potentially confounding determinants using multilevel multivariate analysis.
We have previously reported a similar association between complexity of consultation (patients wishing to discuss psychological or social problems plus or minus physical problems) and enablement in deprived areas in our original analysis of this study [ 16], but this previous work was descriptive and not subject to multilevel multivariate analysis.
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Multilevel, multivariate logistic regression analysis was therefore conducted using MLwiN 2.24 (Rasbash, Charlton, Browne, Healy, & Cameron, 2009) with three levels: client record, advisor and SSS.
Finally, more sophisticated multivariate analysis, including multilevel regression, will be used.
Subsequently, a multivariate analysis by multilevel logistic regression was conducted, to assess variables associated to appropriateness, in two categories, after stratification for hospital.
To check the main hypothesis all variables will be compared (t0-tk) by means of the ANOVA test with adequate post-hoc contrasts for normally distributed variables or the Kruskal-Wallis H test. Finally, different multivariate analysis including multilevel regression analysis will be included if required.
Residual diagnostics were performed for the multilevel multivariate models used in the analysis via plots of residual values for both the fixed and random effects.
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