Determinants of unplanned admissions in children: investigating the relationship between primary care quality and health service use with unplanned admissions in children
File(s)
Appendix - Permission
Author(s)
Cecil, Elizabeth
Type
Thesis
Abstract
Introduction:
High quality primary care is considered central to preventing avoidable health system waste such as
unplanned short stay admissions (SSA) for minor conditions and alleviating health inequality. Recent
policy changes in primary care (2004) may have impacted on provision, access and supply of GPs.
This provides an ideal opportunity to study its role on keeping children healthy in the community. I
aimed to quantify the impact of policy change; GP timeliness and access; and GP utilisation on
potentially preventable admissions and health disparities in children.
Methods:
My studies included a segmented population based trends study design and a retrospective cohort
design. I used national hospital and primary care administrative datasets, focusing on children aged
≤14 years between April 2000 and March 2013, in England. My primary outcome measures were SSA
rates (<2 days stay) for chronic conditions and infectious illness; my secondary outcome emergency
department (ED) visits. I investigated: the impact of 1) primary care policy change in 2004; 2)
patients’ reported access to their GP; and 3) primary care utilization on unplanned health service use
and reducing deprivation gradients.
Results:
There was a significant increase in the number of children being admitted with chronic conditions for
a short stay after primary care policy changes (11% rate increase in year of change), but not for
infectious illness. Children were less likely to visit EDs or be admitted for a chronic condition if their
GP offered better access. Better preventive care reduced children’s risk of an unplanned admission
and deprivation gradients were narrowed in children who regularly consulted their GP.
Conclusion:
Primary care plays a significant role in limiting use of urgent and unplanned health service use,
particularly for deprived children and those with chronic conditions. Investment in primary care is
vital in a time of epidemiological transition in children.
High quality primary care is considered central to preventing avoidable health system waste such as
unplanned short stay admissions (SSA) for minor conditions and alleviating health inequality. Recent
policy changes in primary care (2004) may have impacted on provision, access and supply of GPs.
This provides an ideal opportunity to study its role on keeping children healthy in the community. I
aimed to quantify the impact of policy change; GP timeliness and access; and GP utilisation on
potentially preventable admissions and health disparities in children.
Methods:
My studies included a segmented population based trends study design and a retrospective cohort
design. I used national hospital and primary care administrative datasets, focusing on children aged
≤14 years between April 2000 and March 2013, in England. My primary outcome measures were SSA
rates (<2 days stay) for chronic conditions and infectious illness; my secondary outcome emergency
department (ED) visits. I investigated: the impact of 1) primary care policy change in 2004; 2)
patients’ reported access to their GP; and 3) primary care utilization on unplanned health service use
and reducing deprivation gradients.
Results:
There was a significant increase in the number of children being admitted with chronic conditions for
a short stay after primary care policy changes (11% rate increase in year of change), but not for
infectious illness. Children were less likely to visit EDs or be admitted for a chronic condition if their
GP offered better access. Better preventive care reduced children’s risk of an unplanned admission
and deprivation gradients were narrowed in children who regularly consulted their GP.
Conclusion:
Primary care plays a significant role in limiting use of urgent and unplanned health service use,
particularly for deprived children and those with chronic conditions. Investment in primary care is
vital in a time of epidemiological transition in children.
Version
Open Access
Date Issued
2016-10
Date Awarded
2017-07
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Saxena, Sonia
Bottle, Alex
Sponsor
National Institute for Health Research
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)