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Children seen frequently out of hours in one general practice
J M Morrison1, H Gilmour, F Sullivan
1Department of General Practice, University of Glasgow, Woodside Health Centre.
Insights
Children from socially disadvantaged families, particularly those with lone mothers and lower educational attainment, more frequently use out-of-hours healthcare services for minor illnesses. Maternal education may reduce this usage.
Area of Science:
- Pediatrics
- General Practice
- Public Health
Background:
- Out-of-hours (OOH) healthcare services are crucial for urgent medical needs.
- Understanding factors influencing high utilization by specific pediatric groups is essential for resource allocation and targeted interventions.
Purpose of the Study:
- To identify the demographic, social, and behavioral factors associated with frequent use of OOH services by children under 10 years.
- To explore potential strategies for reducing unnecessary OOH visits.
Main Methods:
- A prospective study identified high users of OOH services.
- A case-control study compared 40 frequent users (children under 10) with 40 matched controls.
- Data collection included record searches, personal interviews, and vignette-based assessments of maternal response to illness.
Main Results:
- Children under 10 accounted for 19% of OOH visits, with 6% of children being high users.
- High users were significantly more likely to come from families with lone mothers, low maternal educational attainment, income support receipt, and housing instability.
- Mothers of high users showed a greater tendency to seek medical advice for minor childhood illnesses.
Conclusions:
- Frequent OOH service use in children is linked to greater social disadvantage and maternal tendency to seek medical advice for minor ailments.
- Enhancing maternal confidence in managing minor childhood illnesses through education may decrease reliance on OOH services.
Objective:
To identify reasons why some children receive more out of hours visits than most.
Design:
A one year prospective study to identify the study group. This was followed by a case-control study involving a record search and personal interviews.
Setting:
One three doctor urban general practice in West Lothian with 4812 patients.
Subjects:
40 children aged under 10 years identified as high users of the out of hours service (more than two visits a year) and 40 age and sex matched controls.
Main Outcome Measures:
Numbers of visits; social factors such as lone motherhood, low educational attainment; score for management response to clinical vignette.
Results:
147/756 (19%) out of hours visits in the study year were to children aged under 10 years; 109 (74%) to 41 children (6%). Problems seen were mainly minor, and little active management was required. Family and social factors which were significantly more common for the cases than for the controls included a lone mother (15 v 4), low educational attainment by the mother (25 v 14), receipt of income support (22 v 7), and non-ownership of the home (45 v 22) or a car (19 v 9). Mothers of the cases were more likely to choose to contact a doctor when presented with vignettes describing common childhood illnesses (median score for 16 vignettes 16.5 for cases v 14.5 for controls, Wilcoxon signed rank test, p = 0.01).
Conclusions:
Children seen more frequently than expected out of hours came from more socially disadvantaged families and their mothers were more likely to seek medical advice about minor childhood illness. Maternal education, to promote confidence in managing minor illness, may reduce their use of the out of hours service.