Respiratory illness and healthcare utilization in children: the primary and secondary care interface

Abstract

Respiratory illness and healthcare utilization in children: the primary and secondary care interface. J.A. Cropper, T.L. Frank, P.I. Frank, M.L. Laybourn, P.C. Hannaford. #ERS Journals Ltd 2001. ABSTRACT: The aim of the present study was to quantify the healthcare utilization of a child population according to level of respiratory illness.A stratified random sample of 713 children was selected from respondents to a postal respiratory questionnaire, carried out in two general practice populations in 1993. Children were stratified into four groups according to the number of positive responses to five key questions. These groups were used as indicators of likelihood of asthma diagnosis. A search was made of these childrens9 practice records covering a 2-yr period, to include both primary and secondary healthcare.There was a significant increase across positive response groups in the proportion of children having primary and secondary care based consultations, particularly for respiratory conditions (p~0.001). There was also a significant increase in prescribing. Of those children considered to be "likely asthmatics" from their questionnaire responses, 8.1% (n~31) did not receive any primary or secondary care for a respiratory problem over the 2-yr period.As the likelihood of respiratory illness increased in this population, more demand was made upon resources for the treatment of respiratory illness. Quantification of this demand enables evidence based resource allocation decisions to be made. This method of quantification could be applied in other populations.

Economic Evaluations Alongside Efficient Study Designs Using Large Observational Datasets: the PLEASANT Trial Case Study

“…However, it is worth noting that a subset of English practices (reportedly 75%, representing 58% of all UK CPRD practices) have consented to participate in the CPRD linkage scheme, which includes linkage with HES data [13]. HES data were not included in this study because evidence from Cropper et al [45] suggests that the majority of contacts for children with asthma exacerbation would occur in primary care, and we assumed that secondary care contacts would be captured in CPRD in most cases. However, we recognise this as a limitation of the study, and we may have underestimated the costs of exacerbations that resulted in secondary care contacts.…”

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“…These variables were measured every 6 months from birth in the health administrative data. Hospitalization, ED visits, and outpatient physician visits covered the most important domains of respiratory‐related health resource use in the pediatric population …”

“…The final analysis included 729 children who were registered in the Ontario universal health care system for over 70% of the time and had at least two biannual follow-ups in administrative data between 0 and 3 years. [18][19][20] Information regarding hospitalizations, ED visits, and physician office visits were directly obtained from administrative data. Total health care costs were comprised of: acute episodes, such as hospitalizations, sameday surgery, and ED visits; long-term episodes, such as inpatient mental health; and billed outpatient claims such as physician visits, home care, and equipment.…”

Childhood asthma: healthcare resource utilisation in those with and without a diagnosis of the condition

“…Previous work has shown that primary and secondary healthcare utilisation increases as the number of symptoms/risk factors to key questions on a respiratory questionnaire rises. 15 This paper now quantifies the healthcare costs associated with these increases. As found by other studies, most care took place in the primary sector whereas most cost was associated with secondary care usage.…”