Related Experiment Video
Updated: Jan 22, 2026
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
How fair is our service? Evaluating access to specialist paediatric care
Francesca K Neale1, Edward J Armstrong1, Jonathan M Cohen2,3
1Medical School, University College London, London, UK.
Insights
Paediatric outpatient clinic access in our hospital generally reflects local socioeconomic status but shows disparities in tertiary clinics. Further evaluation of referral inequalities across regions is needed to ensure equitable care.
Area of Science:
- Health Services Research
- Paediatric Healthcare Access
- Socioeconomic Disparities in Health
Background:
- Equitable access to specialized paediatric healthcare is crucial for child health outcomes.
- Understanding socioeconomic factors influencing outpatient clinic referrals is essential for identifying health inequities.
- Previous studies indicate potential socioeconomic biases in healthcare access, necessitating local investigation.
Purpose of the Study:
- To evaluate the equity of access to various paediatric outpatient clinics within a hospital setting.
- To determine if patient socioeconomic status aligns with the local population demographics for different specialist clinics.
- To identify potential disparities in access, particularly for tertiary-level paediatric services.
Main Methods:
- Retrospective analysis of new patient referrals to eight paediatric outpatient clinics (allergy, asthma, epilepsy, general paediatrics, rapid access, chronic fatigue syndrome, diabetes, endocrine).
- Inclusion of 32,369 new patients referred between April 2007 and June 2018.
- Comparison of patient socioeconomic distribution (deprivation quintiles) with local population data and inpatient admission data.
Main Results:
- Local outpatient referrals generally mirrored the socioeconomic distribution of the local population and inpatient admissions.
- A small percentage (0.2%-2.5%) of local patients referred to general clinics resided in the least deprived quintile, while 43.5%-48.4% were from the most deprived quintile.
- Tertiary clinics demonstrated a significantly higher proportion of patients from the least deprived quintiles (15.9%-26.2%), suggesting potential access barriers for less affluent populations.
Conclusions:
- While local paediatric outpatient referrals broadly reflect the socioeconomic profile of the community, they may not align with the distribution of health needs.
- Tertiary paediatric clinics show a higher concentration of patients from more affluent areas, indicating potential referral inequalities.
- There is a need to investigate and address referral inequalities across healthcare networks and regions to ensure equitable access to specialized paediatric care.
Objective:
To assess equity of access to paediatric outpatient clinics in our hospital.
Design/Setting:
Retrospective analysis of consecutive accepted referrals to allergy, asthma, epilepsy, general paediatrics, rapid access, chronic fatigue syndrome, diabetes and endocrine outpatient clinics.
Patients:
32 369 new patients, April 2007 to June 2018.
Results:
Among local patients (58.1%) 0.2%-2.5% of patients referred to each clinic lived in the least deprived quintile, and 43.5%-48.4% in the most deprived quintile-similar to inpatient admissions and the local population. Tertiary clinics showed a much higher proportion of patients from the least deprived quintiles (15.9%-26.2%).
Conclusions:
Local outpatient referrals broadly reflected the socioeconomic distribution, although not necessarily the distribution of need, of our local population. A relatively high proportion of patients in tertiary clinics were from more affluent postcodes, highlighting the need for referral inequalities to be evaluated across networks or regions.
Related Concept Videos
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...
01:18Interdisciplinary Care: The Health Care Team-II
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:30Preventive Healthcare Services
01:22Standards of Care I
01:25Continuing Care