Emergency department presentations by children in remote Australia: a population-based study

Dossetor, Philippa Jane; Fitzpatrick, Emily FM; Glass, Kathryn M.; Douglas, Kirsty; Watkins, Rochelle; Oscar, June; Carter, Maureen; Harley, David; Jeffery, Heather; Elliott, Elizabeth J; Martiniuk, Alexandra LC

doi:10.21203/rs.2.20434/v1

Cited by 3 publications

(3 citation statements)

References 10 publications

(19 reference statements)

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“…These challenges are exacerbated in underserved populations i.e., minoritized and economically-deprived communities (2,3), by a range of socio-economic and cultural pressures that inhibit access and utilisation of primary or preventative health care services (4)(5)(6)(7). This has led to a widespread rise in children's attendances to emergency departments frequently due to conditions that could be more effectively treated in community settings (8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

Bird,

Harper,

Muslim

et al. 2024

Preprint

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ObjectiveTo explore the evidence for interventions that integrate child health and social care and support programmes and the impact they have on child health and wellbeing.Data sourcesThe Cochrane Library, Ovid Medline, Ovid Embase, Ovid Emcare, Ovid Health Management Information Consortium (HMIC) database, and Ovid Social Policy and Practice, Proquest Psychinfo and Ebscohost Cinahl.EligibilityPeer-reviewed original research that described an intervention integrating health care and social support or care interventions for children and young people (CYP) up to the age of 18 years in high-income countries. All databases were searched from inception to August 2023.Data extraction and synthesis16 studies were identified: 4 RCTs, 5 quantitative studies, 5 qualitative studies and 2 mixed methods studies. A narrative review and quality check of included studies was performed. Study heterogeneity meant a meta-analysis could not be completed.ResultsFive qualitative, five quantitative, two mixed methods and four randomised controlled trials were included. We identified three main models of delivering integrated health and social care services: targeted support for vulnerable groups, where the provision of packages of interventions focussed on target populations showed potential for decreasing the need for social support in the long-term but with limited evidence for reducing referrals into other services. They were more successful in meeting specific objectives such as lower rates of smoking, and reducing repeat pregnancies; collaborative health and social support were typically collocated services which improved collaborative working but with little impact on workload, job satisfaction, or service delivery; and school centred health and social care, which improved some aspects of CYP wellbeing and physical health but with concerns they added to teacher workload.ConclusionsIntegrated health and social support programmes offer promising solutions to addressing health inequity in children and young people in underserved populations. However, more robust and consistent study designs are needed to guide researchers and policy makers in their implementation and evaluation.What is already known on this topic.Integrated care that is equipped to mitigate at least some of the social determinants of health is considered key to improving health inequalities in children and young people in underserved populations.Despite increasing investment in integrating health and social support there is little evidence of which models of delivery are most effective in which circumstances nor of the precise impact on target groups and the wider healthcare system.What this study addsWe identified three models of integrating health and social support: Packages of interventions targeted at specific groups; Collaborative (and collocated) health and social support; and School-centered health and social care interventions.Results across the three models offered promise of improved care and support for the underserved, referral rates into other services tended to be lower and packages interventions achieved positive results for specific objectives. However, findings were inconsistent, drop-out rates were high, and there are concerns over sustainability without sufficient resources.How this study might affect research, practice and policyEmbedding iterative co-production in future research and interventions could improve engagement and outcomes and it’s important that further works explores their cost effectiveness and implications for other elements of health and care services.Appropriate resources and a longer-term commitment to promoting integrated health and social support is needed to fully understand the strengths and weaknesses of the offer and maximise the potential benefits.

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Section: Introductionmentioning

confidence: 99%

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

Bird,

Harper,

Muslim

et al. 2024

Preprint

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“…Indigenous Australians are hospitalised at 2.6 times the rate of non-Indigenous Australians [13]. Rates of hospitalisation and emergency department presentation for Indigenous children living in remote areas are high, often for potentially preventable skin, respiratory and gastrointestinal infections [8,14,15]. One in five Aboriginal and Torres Strait Islander children live with disability (22%), including sensory (12%), cognitive (9%), physical (5%) and psychosocial disability (4%) [16].…”

Section: Introductionmentioning

confidence: 99%

Health services for Aboriginal and Torres Strait Islander children in remote Australia: a scoping review

Dossetor

Freeman

Thorburn

et al. 2022

Preprint

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In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n=1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Gold standard models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.

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“…Hospitalisation rates are higher across all age groups of Indigenous compared to non-Indigenous Australians (11). Rates of hospitalisation and emergency department presentation for Indigenous children living in remote areas are high, often for potentially preventable skin, respiratory and gastrointestinal infections (8,15,16). Social determinants contribute to Indigenous health inequality and include poor nutrition, housing shortage, limited primary health care access, and disadvantage in income and education (17).…”

Section: Introductionmentioning

confidence: 99%

Health services for Indigenous children in remote Australia: a strategic literature review

Dossetor¹,

Thorburn²,

Oscar³

et al. 2021

Preprint

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Introduction: There is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. We aim to review the literature to describe health services and their use by children living in remote Australia, comparing them to best practice models to identify opportunities for improvements.Methods: Electronic-databases of medical literature were searched from Jan 1990 to Dec 2013. Grey literature was identified through investigation of websites, including local, state and national health departments. Essential information was extracted and summarised for papers meeting inclusion criteria for the review.Results: A total of 45 titles was identified in a strategic search of electronic medical databases and 47 in the grey literature. Strict inclusion and exclusion criteria applied. Data were extracted from 92 documents.Conclusions: Barriers exist to effective child health service delivery in remote Australia including availability and access. Existing services cannot meet demand. Gold standard models for service delivery incorporating community engagement and collaboration should be explored. Increased resources and focus on primary prevention and health promotion are essential.

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Emergency department presentations by children in remote Australia: a population-based study

Cited by 3 publications

References 10 publications

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

Health services for Aboriginal and Torres Strait Islander children in remote Australia: a scoping review

Health services for Indigenous children in remote Australia: a strategic literature review

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