GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

Abstract

BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

Adult healthcare is associated with more emergency healthcare for young people with life-limiting conditions

“…Three groups of young people were of interest, as set out above: (i) those with life-limiting conditions, (ii) those with diabetes, and (iii) those with no known long-term conditions. Group membership depended on diagnoses in primary care, inpatient and outpatient records while aged 12–23 years: Young people were assigned to the life-limiting conditions group if any diagnosis in the HES records matched a previously developed International Classification of Diseases, 10th Edition 39 (ICD-10) coding framework 40 or if any diagnosis in primary care records matched a Read coding framework 41 derived from the ICD-10 coding framework. Young people were assigned to the diabetes group, if not in the life-limiting conditions group and if any diagnosis in the HES or primary care records matched ICD-10 or Read codes for diabetes, derived from a previously developed list of chronic conditions diagnoses 42 (see also Supplementary Material S1 ).…”

“…Young people were assigned to the life-limiting conditions group if any diagnosis in the HES records matched a previously developed International Classification of Diseases, 10th Edition 39 (ICD-10) coding framework 40 or if any diagnosis in primary care records matched a Read coding framework 41 derived from the ICD-10 coding framework.…”

Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data

“…Read codes (in primary care records) and International Classification of Diseases 10th Revision (ICD-10) (in inpatient and outpatient records) [ 38 ] were used to identify chronic and life-limiting conditions using previously developed coding frameworks [ 39 – 41 ] (also available from the corresponding author on request). Chronic conditions were identified using a previously developed coding framework in which chronic conditions were defined as any health problem likely (i.e.…”

Polypharmacy in Children and Young People With Life-limiting Conditions From 2000 to 2015: A Repeated Cross-sectional Study in England

“…LLCs were identified using a previously developed diagnostic coding framework that uses 777, 4-digit International Classification of Diseases Version (ICD)-10 codes and equivalent Read code diagnoses. 15,32 Diagnostic data recorded in CPRD and HES were used to identify the cohort. Membership into the cohort started at the first recorded diagnosis of a LLC.…”