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Healthcare use for children with complex needs: using routine health data linked to a multiethnic, ongoing birth
Chrissy Frances Bishop1, Neil Small1, Roger Parslow2
1Faculty of Health Studies, University of Bradford, Bradford, UK.
Insights
Children with congenital anomalies (CA) require more healthcare services, particularly hospital care. Economically deprived children, with or without CA, also show higher hospital use, highlighting the need for better care coordination.
Area of Science:
- Pediatric Health
- Public Health
- Medical Sociology
Background:
- Congenital anomalies (CA) are a significant global cause of childhood disease and disability.
- Understanding the healthcare needs and delivery for children with CA is crucial but often limited.
- Existing research lacks comprehensive analysis of healthcare utilization patterns in this population.
Purpose of the Study:
- To analyze the healthcare needs of children with congenital anomalies (CA).
- To examine how healthcare is delivered to children with CA.
- To identify disparities in healthcare access and utilization based on socioeconomic factors.
Main Methods:
- Secondary analysis of the prospective 'Born in Bradford' birth cohort study data.
- Inclusion of linked primary care and hospital episode statistics for analysis.
- Utilized negative binomial regression to predict healthcare use and subanalysis of specialist referrals.
Main Results:
- Children with CA exhibited higher utilization of primary care, hospital services, and specialist referrals compared to children without CA.
- Children from economically deprived areas showed increased hospital admissions, irrespective of CA status.
- Higher maternal education correlated with reduced primary care and hospital service utilization.
Conclusions:
- Hospital services are highly utilized by children with CA and economically deprived children.
- The complex needs of children with CA necessitate multidisciplinary management and improved care coordination.
- Addressing socioeconomic disparities is vital for equitable healthcare delivery to children with CA.
Objectives:
Congenital anomaly (CA) are a leading cause of disease, death and disability for children throughout the world. Many have complex and varying healthcare needs which are not well understood. Our aim was to analyse the healthcare needs of children with CA and examine how that healthcare is delivered.
Design:
Secondary analysis of observational data from the Born in Bradford study, a large prospective birth cohort, linked to primary care data and hospital episode statistics. Negative binomial regression with 95% CIs was performed to predict healthcare use. The authors conducted a subanalysis on referrals to specialists using paper medical records for a sample of 400 children.
Setting:
Primary, secondary and tertiary healthcare services in a large city in the north of England.
Participants:
All children recruited to the birth cohort between March 2007 and December 2011. A total of 706 children with CA and 10 768 without CA were included in the analyses.
Primary And Secondary Outcome Measures:
Healthcare use for children with and without CA aged 0 to <5 years was the primary outcome measure after adjustment for confounders.
Results:
Primary care consultations, use of hospital services and referrals to specialists were higher for children with CA than those without. Children in economically deprived neighbourhoods were more likely to be admitted to hospital than consult primary care. Children with CA had a higher use of hospital services (β 1.48, 95% CI 1.36 to 1.59) than primary care consultations (β 0.24, 95% CI 1.18 to 0.30). Children with higher educated mothers were less likely to consult primary care and hospital services.
Conclusions:
Hospital services are most in demand for children with CA, but also for children who were economically deprived whether they had a CA or not. The complex nature of CA in children requires multidisciplinary management and strengthened coordination between primary and secondary care.
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