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Inequalities in access to a tertiary children's chronic pain service: a cross-sectional study
Matthew A Jay1, Richard F Howard1
1Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital, London, UK.
Insights
Children from deprived areas access tertiary chronic pain services less and attend fewer appointments. This suggests a social gradient in accessing specialized pediatric pain care, impacting health equity.
Area of Science:
- Pediatric Health Services Research
- Pain Management
- Health Equity
Background:
- Chronic pain in children is linked to lower socioeconomic status (SES).
- Understanding SES disparities in healthcare access is crucial for equitable care.
- Tertiary services aim to provide specialized management for complex pediatric pain.
Purpose of the Study:
- To characterize the socioeconomic status (SES) of children with chronic pain referred to a UK tertiary care service.
- To investigate the relationship between SES and access to, and utilization of, this specialized pediatric pain service.
Main Methods:
- Retrospective cross-sectional study of 737 children referred to a tertiary chronic pain service (2000-2014).
- Socioeconomic status (SES) assessed using the English Index of Multiple Deprivation.
- Geographic access (distance) and service utilization (appointment attendance) were analyzed.
Main Results:
- Fewer children from the most deprived areas (14%) were referred compared to the least deprived (25%).
- Referrals from deprived areas decreased with increasing distance from the service site.
- Children from deprived areas were less likely to attend scheduled appointments.
Conclusions:
- Contrary to expectations, children from more deprived areas were underrepresented in tertiary chronic pain services.
- A social gradient exists in accessing specialized pediatric pain care, influenced by area deprivation and distance.
- Lower appointment attendance among children from deprived areas highlights barriers to care and potential health inequities.
Background:
Poor health, including chronic pain, has been consistently shown to be associated with lower socioeconomic status (SES).
Objective:
To describe the SES of a clinical population of children with chronic pain referred to tertiary care in England, and to determine if access to, and utilisation of, the service is related to SES.
Patients And Methods:
Using a retrospective cross-sectional study design, all children referred to a tertiary chronic pain management service between 2000 and 2014 were included. SES was determined using the English Index of Multiple Deprivation for the area in which they lived. Distance from the study site, using Ordinance Survey National Grid coordinates, and service utilisation, from hospital records, were also calculated.
Results:
737 children were included. The proportion of patients referred from the most socially deprived areas was substantially lower (14%) than from the least deprived (25%). In addition, the proportion of patients from the most deprived areas fell with increasing distance from the study site. Patients from the most deprived areas were more likely not to attend hospital appointments.
Conclusions:
Contrary to expectations, there were fewer patients from the most deprived areas. The proportion of children from more deprived areas fell with increasing distance from the study site, and those children who were referred were less likely to attend scheduled appointments. Our results imply that there is a social gradient in access to tertiary services for children's chronic pain management.
