Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017

Abstract

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

Change in burden of disease in UK children and young people (0-24 years) over the past 20 years and estimation of potential burden in 2040: analysis using Global Burden of Disease (GBD) data

“…The past two decades have witnessed major changes in the lives of UK children and young people (CYP) and major increases in use of health services, particularly emergency services 1 . There have also been a number of broader changes in patterns of disease in these age-groups.…”

Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review

“…Low health literacy has been found to be a factor in parental overestimates of child illness severity, increased urgency for seeking care, and increased use of emergency services [6,7]. There has been an increase in the use of urgent hospital services by children and infants across England in the past decade, including for nonurgent presentations [8][9][10]. Emergency services are more frequently used by children and young people than adults [8,11].…”

“…A review of factors affecting these behaviors found a range of different reasons, including (among others): parents' uncertainty and lack of confidence around recognizing problematic symptoms or evaluating their child's condition; mistrust of, or previous negative experiences with, clinicians; concerns about wasting clinicians' time; and being perceived negatively by clinicians [20]. This demonstrates the need for better access to primary care services or community-based support for acute pediatric illness and efforts to improve parental health literacy and confidence in determining whether, or which, treatment services are appropriate when a child is ill and how best to manage acute childhood illnesses [1,10,13]. This is particularly relevant in the current context of the COVID-19 pandemic, which has increased the burden on health care services.…”

“…This demonstrates the need for better access to primary care services or community-based support for acute pediatric illness and efforts to improve parental health literacy and confidence in determining whether, or which, treatment services are appropriate when a child is ill and how best to manage acute childhood illnesses [ 1 , 10 , 13 ]. This is particularly relevant in the current context of the COVID-19 pandemic, which has increased the burden on health care services.…”

Community Pharmacy Minor Ailment Service (PMAS): An Untapped Resource for Children and Their Carers

“…Approximately 10% of infants attending an ED in a large district general hospital had no coded diagnosis and probably attended for minor illness and general advice only [9]. As this is a growing proportion of ED attendances, this puts a lot of demand on our health services [10]; greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings [11,12].…”