Free Children’s Visits and General Practice Attendance

O’Callaghan, Michael; Zgaga, Lina; O'Ciardha, Darach; O’Dowd, Tom

doi:10.1370/afm.2229

Cited by 18 publications

(13 citation statements)

References 5 publications

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“…First, it might be reflective of increased pressure placed on already strained primary care system by increased demand and insufficient number of GPs to meet this demand. 10 Second, increased paediatric ED attendances are likely to contribute to ED overcrowding. When free GP care was expanded to children under 6 years of age in Ireland, no structural reorganisation or financial support was introduced for the upstream services, including ED.…”

Section: Discussionmentioning

confidence: 99%

“…9 At the same time, a 25% increase in GP attendances in this age group was reported. 10 There are clear indications that the Irish primary care system provided by GPs is already under pressure and may struggle to meet demand in the near future. [10][11][12] This might have implications for upstream health services, especially EDs, which often serve as substitutes for primary care, though not designed for this type of work.…”

Section: What This Study Adds?mentioning

confidence: 99%

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Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

Korotchikova¹,

Khalaf²,

Sheridan

et al. 2021

bmjpo

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ObjectivesTo examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years.DesignThis is a retrospective observational study that used a large administrative dataset.SettingThe study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive.ParticipantsChildren aged 0–15 years who attended CUH ED during the study period of 6 years (2012–2018) were included in this study (n=76 831).InterventionsFree GP care was expanded to all children aged 0–5 years in July 2015.Main outcome measuresPaediatric attendances to CUH ED were examined before (Time Period 1: July 2012–June 2015) and after (Time Period 2: July 2015–June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated.ResultsPaediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0–5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%.ConclusionThe expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Adds?mentioning

confidence: 99%

Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

Korotchikova¹,

Khalaf²,

Sheridan

et al. 2021

bmjpo

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“…It does not seem unreasonable to suggest that co-payment may have a role in reducing consultation rates with GPs. In fact, a small study conducted in eight general practice clinics found a rise of 9.4% in daytime attendance and 28.7% in out of hours attendances in the year after introduction of free care for children under six years [33]. A systematic review of 47 studies reported that when co-payment reduces consultation rates with GPs and reported no corresponding increase in hospitalisations as a result of co-payment [34].…”

Section: Discussionmentioning

confidence: 99%

What effect do point of care fees have on childhood consultations in general practice?

O’Regan

Cullen

O’Gorman

et al. 2018

BMC Health Serv Res

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BackgroundGeneral practice (GP) has historically been central to the prevention and treatment of childhood illnesses. In Ireland, this role has recently expanded with the introduction of free GP care for children aged under six years in 2015. The Republic of Ireland has the only health system in the European Union which does not offer universal coverage for primary care. This study aims to analyse general practice records to investigate the effect of point of care consultation fees on childhood attendances.MethodsGPs affiliated to the medical school (n = 72) were invited to participate. 100 children aged 1 to 14 years were randomly sampled from each. Data was collected on service utilisation in the previous 12 months, specifically: age, gender, eligibility for free care and whether they had consulted their GP in the 12 month period.ResultsSixty-four practices participated, producing data on 6007 eligible children. The median age of children was seven years; 3688(62%) were ‘fee-paying’. GMS patients aged under six years had a median of three consultations/year, with a quarter attending six times a year or more, while fee paying patients had a median of two consultations/year with a quarter attending four times a year or more.ConclusionsChildren eligible for free care attend more often with a subgroup attending very frequently. This study provides important information on the possible impact of fees on healthcare utilisation for countries considering co-payment.

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“…Following the introduction of free GP care for the under 6-year-old population, the magnitude of the increase in GP attendances has continued to be disputed, though recently published studies estimate an increase in attendance for this cohort in the region of 25%. 14 15 However, these findings are based on localised patient records 15 and survey responses to a longitudinal study of children 14 rather than a national sample of patient visit records. A study of attendances at 29 Irish EDs identified a 2% increase in GP referrals of children aged under 6 years to EDs 16 following the introduction of this policy.…”

Section: Introductionmentioning

confidence: 99%

Children’s unscheduled primary and emergency care in Ireland: a multimethod approach to understanding decision making, trends, outcomes and parental perspectives (CUPID): project protocol

et al. 2020

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IntroductionThe aim of this project is to determine the patterns, decision-making processes and parental preferences associated with unscheduled paediatric healthcare utilisation in Ireland. Unscheduled paediatric healthcare is outpatient care provided within primary care settings by general practitioners (GPs), emergency departments (EDs) located in paediatric and general hospitals, and out-of-hours services provided by cooperatives of GPs operating on a regional basis. This project will take a multimethod approach to analysing the utilisation of unscheduled paediatric healthcare nationally within the context of a significant change to the provision of healthcare for young children in Ireland—the introduction of free at the point of delivery GP care for all children aged under 6.Methods and analysisA multimethod approach consisting of three work packages will be employed. Using patient-level data, work package 1 will describe patterns of attendance at primary care, out-of-hours medical services and at EDs. Applying a difference-in-difference methodology, the impact of the introduction of free GP care for children under 6 on attendance will be assessed. Work package 2 will explore geospatial trends of attendance at EDs, identifying disparities in ED attendance by local area and demographic characteristics. Work package 3 will employ two discrete choice experiments to examine parental preferences for unscheduled paediatric healthcare and GP decision making when referring a child to the ED. The insights gained by each of the work packages individually and collectively will inform evidence-based health policy for the organisation of paediatric care and resource allocation.Ethics and disseminationEthical approval for this research has been granted by University College Dublin, The Irish College of General Practitioners and the five participating hospitals. Results will be disseminated via publication in peer-reviewed journals, national and international conferences, and to relevant stakeholders and interest groups.

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Free Children’s Visits and General Practice Attendance

Cited by 18 publications

References 5 publications

Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

What effect do point of care fees have on childhood consultations in general practice?

Children’s unscheduled primary and emergency care in Ireland: a multimethod approach to understanding decision making, trends, outcomes and parental perspectives (CUPID): project protocol

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