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Rezel-Potts E, Bowen C, Dunn KM, Jones CI, Gulliford MC, Morrison SC. Foot and ankle problems in children and young people: a population-based cohort study. Eur J Pediatr 2024; 183:3299-3307. [PMID: 38722334 PMCID: PMC11263380 DOI: 10.1007/s00431-024-05590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 07/23/2024]
Abstract
The aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for all CYP aged 0-18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as "musculoskeletal" (34%) and "unspecified pain" (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10-14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03). Conclusions: Consultations for foot and ankle problems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment. What is Known: • Foot and ankle problems can have considerable impact on health-related quality of life in children and young people (CYP). • There is limited data describing the nature and frequency of foot and ankle problems in CYP. What is New: • Foot and ankle consultations were higher in English general practice among CYP aged 10 to 14 years compared to other age groups, and higher among males compared to females. • The high proportion of unspecified diagnoses and repeat consultations suggests there is need for greater integration between general practice and allied health professionals in community-based healthcare settings.
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Affiliation(s)
- Emma Rezel-Potts
- School of Life Course and Population Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Catherine Bowen
- Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Kate M Dunn
- School of Medicine, Centre for Musculoskeletal Health Research, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christopher I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, BN1 9PS, UK
| | - Martin C Gulliford
- School of Life Course and Population Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Stewart C Morrison
- School of Life Course and Population Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK.
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Alturkistani A, Beaney T, Greenfield G, Costelloe CE. Patient portal registration and healthcare utilisation in general practices in England: a longitudinal cohort study. BJGP Open 2024; 8:BJGPO.2023.0106. [PMID: 38128967 DOI: 10.3399/bjgpo.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/18/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patient portals introduced in most of England's general practices since 2015 have the potential to improve healthcare efficiency. There is a paucity of information on the use of patient portals within the NHS general practices and the potential impact on healthcare utilisation. AIM To investigate the association between patient portal registration and care utilisation (measured by the number of general practice consultations) among general practice patients. DESIGN & SETTING A longitudinal analysis using electronic health record data from the Clinical Practice Research Datalink (CPRD). METHOD We analysed patients registered for patient portals (n = 284 666), aggregating their consultations 1 year before and 1 year after registration. We ran a multilevel negative binomial regression model to examine patient portal registration's association with face-to-face and remote consultations. RESULTS Patients who registered to the portal had a small decrease in the total number of face-to-face consultations after registering to the patient portal (incidence rate ratio = 0.93, 95% confidence interval [CI] = 0.93 to 0.94). Patients who registered to the portal had an increase in the total number of remote consultations after registering to the portal (incidence rate ratio = 1.16, 95% CI = 1.15 to 1.18). CONCLUSION The study found minor changes in consultation numbers post-patient portal registration, notably with an increase in remote consultations. While causality between portal registration and consultation number remains unclear, the potential link between patient portal use and healthcare utilisation warrants further investigation, especially within the NHS, where portal impacts are not well-studied. Detailed portal utilisation data could clarify this relationship.
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Affiliation(s)
- Abrar Alturkistani
- Department of Primary Care and Public Health, Global Digital Health Unit, Imperial College London, London, UK
| | - Thomas Beaney
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ceire E Costelloe
- Health Informatics, Division of Clinical Studies, Institute of Cancer Research, London, UK
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Faitna P, Hargreaves DS, Neale FK, Kenny SE, Viner RM, Aylin PP, Bottle A, Ashley P. The impact of the COVID-19 pandemic on 397 631 elective dental admissions among the under-25s in England: a retrospective study. J Public Health (Oxf) 2024:fdae058. [PMID: 38702840 DOI: 10.1093/pubmed/fdae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 02/13/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND COVID-19 caused widespread disruptions to health services worldwide, including reductions in elective surgery. Tooth extractions are among the most common reasons for elective surgery among children and young people (CYP). It is unclear how COVID-19 affected elective dental surgeries in hospitals over multiple pandemic waves at a national level. METHODS Elective dental tooth extraction admissions were selected using Hospital Episode Statistics. Admission trends for the first 14 pandemic months were compared with the previous five years and results were stratified by age (under-11s, 11-16s, 17-24s). RESULTS The most socioeconomically deprived CYP comprised the largest proportion of elective dental tooth extraction admissions. In April 2020, admissions dropped by >95%. In absolute terms, the biggest reduction was in April (11-16s: -1339 admissions, 95% CI -1411 to -1267; 17-24s: -1600, -1678 to -1521) and May 2020 (under-11s: -2857, -2962 to -2752). Admissions differed by socioeconomic deprivation for the under-11s (P < 0.0001), driven by fewer admissions than expected by the most deprived and more by the most affluent during the pandemic. CONCLUSION Elective tooth extractions dropped most in April 2020, remaining below pre-pandemic levels throughout the study. Despite being the most likely to be admitted, the most deprived under-11s had the largest reductions in admissions relative to other groups.
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Affiliation(s)
- Puji Faitna
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, W6 8RP, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP, UK
| | - Simon E Kenny
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, L14 5AB, UK
- NHS England and NHS Improvement, London, SE1 8UG, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7BE, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute Great Ormond Street Institute of Child Health Population Policy and Practice, London, WC1N 1EH, UK
| | - Paul P Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP, UK
| | - Alex Bottle
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP, UK
| | - Paul Ashley
- Eastman Dental Institute, University College London, London, WC1E 6DE, UK
- School of Life and Medical Sciences, University College London, London, W1T 7NF, UK
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4
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Faitna P, Harwood R, Kenny SE, Viner RM, Aylin PP, Hargreaves DS, Bottle A. Impact of the COVID-19 pandemic on the clinical management trends for acute appendicitis among the under-25s: a retrospective study. Arch Dis Child 2024; 109:339-346. [PMID: 38325911 PMCID: PMC10958286 DOI: 10.1136/archdischild-2023-326313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To describe the COVID-19 pandemic's impact on acute appendicitis management on children and young people (CYP). DESIGN Retrospective cohort study. SETTING All English National Health Service hospitals. PATIENTS Acute appendicitis admissions (all, simple, complex) by CYP (under-5s, 5-9s, 10-24s). EXPOSURE Study pandemic period: February 2020-March 2021. Comparator pre-pandemic period: February 2015-January 2020. MAIN OUTCOME MEASURES Monthly appendicectomy and laparoscopic appendicectomy rate trends and absolute differences between pandemic month and the pre-pandemic average. Proportions of appendicitis admissions comprising complex appendicitis by hospital with or without specialist paediatric centres were compared. RESULTS 101 462 acute appendicitis admissions were analysed. Appendicectomy rates fell most in April 2020 for the 5-9s (-18.4% (95% CI -26.8% to -10.0%)) and 10-24s (-28.4% (-38.9% to -18.0%)), driven by reductions in appendicectomies for simple appendicitis. This was equivalent to -54 procedures (-68.4 to -39.6) and -512 (-555.9 to -467.3) for the 5-9s and 10-24s, respectively. Laparoscopic appendicectomies fell in April 2020 for the 5-9s (-15.5% (-23.2% to -7.8%)) and 10-24s (-44.8% (-57.9% to -31.6%) across all types, which was equivalent to -43 (-56.1 to 30.3) and -643 (-692.5 to -593.1) procedures for the 5-9s and 10-24s, respectively. A larger proportion of complex appendicitis admissions were treated within trusts with specialist paediatric centres during the pandemic. CONCLUSIONS For CYP across English hospitals, a sharp recovery followed a steep reduction in appendicectomy rates in April 2020, due to concerns with COVID-19 transmission. This builds on smaller-sized studies reporting the immediate short-term impacts.
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Affiliation(s)
- Puji Faitna
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Rachel Harwood
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Simon E Kenny
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
- National Clinical Director for Children and Young People, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Paul P Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, UK
| | - Alex Bottle
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Bentley SE, Garg P, Gudes O, Hurwitz R, Vivekanandarajah S, So LYL. Access to child developmental assessment services in culturally and linguistically diverse metropolitan Sydney: a retrospective cohort analysis. BMC Health Serv Res 2024; 24:342. [PMID: 38486262 PMCID: PMC10941404 DOI: 10.1186/s12913-024-10800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Despite the increasing prevalence of neurodevelopmental disorders (NDD), data regarding access to child development services have remained limited globally. Long wait times are a major barrier to developmental assessments, impacting on care and outcomes. The aim is to retrospectively analyse the demographic profile and prioritisation of patients seen at a child developmental assessment service (CDAS) in a vulnerable region of Sydney, and explore factors affecting wait times. METHODS Data was collated and analysed for 2354 patients from 2018 to 2022. Socio-Economic Indexes for Areas (SEIFA) were collated from the Australian Bureau of Statistics. Descriptive statistics were used for demographic data and various statistical methods were used to analyse the relationships and impact of factors likely to affect wait lists. RESULTS The median age was 51 months (IQR41-61) and males comprised 73.7% of the cohort. 64% of children were from culturally and linguistically diverse backgrounds (CALD) and 47% lived in the most disadvantaged suburbs. The median wait time was 302.5 days (IQR175-379) and 70% of children were seen within 12 months. CALD patients and children over 5-years had shorter wait times. Most children with Global Developmental Delay (GDD) were from the lowest four SEIFA deciles and waited longer for an appointment. 42.6% were seen within the priority allocated time or sooner. Children with ASD and/or severe GDD were prioritised to be seen earlier. Overall, the study could not demonstrate any difference in the wait times according to the prioritisation groups. CONCLUSION This study provides insights into the profile, prioritisation processes and wait lists of children seen by CDAS in South Western Sydney with high rates of social vulnerability and presents an argument to discuss benchmarking targets with service providers. It identifies the need to prioritise children living in suburbs with socioeconomic disadvantage and refine prioritisation and data collection processes to improve wait times.
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Affiliation(s)
- Sibella E Bentley
- The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
- University of Notre Dame Australia School of Medicine, Sydney, Australia.
| | - Pankaj Garg
- Department of Community Paediatrics, South Western Sydney Local Health District Health Services Building Level 3, Liverpool, NSW, 2170, Australia
- Department of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Ori Gudes
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Romy Hurwitz
- Department of Community Paediatrics, South Western Sydney Local Health District Health Services Building Level 3, Liverpool, NSW, 2170, Australia
| | - Sinthu Vivekanandarajah
- Department of Community Paediatrics, South Western Sydney Local Health District Health Services Building Level 3, Liverpool, NSW, 2170, Australia
| | - Lydia Y L So
- Department of Community Paediatrics, South Western Sydney Local Health District Health Services Building Level 3, Liverpool, NSW, 2170, Australia
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Yang J, Andersen KM, Rai KK, Tritton T, Mugwagwa T, Tsang C, Reimbaeva M, McGrath LJ, Payne P, Backhouse B, Mendes D, Butfield R, Wood R, Nguyen JL. Health Care Resource Utilization and Costs Associated With COVID-19 Among Pediatrics Managed in the Community or Hospital Setting in England: A Population-based Cohort Study. Pediatr Infect Dis J 2024; 43:209-216. [PMID: 38113517 DOI: 10.1097/inf.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although COVID-19 morbidity is significantly lower in pediatrics than in adults, the risk of severe COVID-19 may still pose substantial health care resource burden. This study aimed to describe health care resource utilization (HCRU) and costs associated with COVID-19 in pediatrics 1-17 years old in England. METHODS A population-based retrospective cohort study of pediatrics with COVID-19 using Clinical Practice Research Datalink (CPRD Aurum) primary care data and, where available, linked Hospital Episode Statistics Admitted Patient Care secondary care data. HCRU and associated costs to the National Health Service were stratified by age, risk of severe COVID-19 and immunocompromised status, separately for those with and without hospitalization records (hospitalized cohort: COVID-19 diagnosis August 2020-March 2021; primary care cohort: COVID-19 diagnosis August 2020-January 2022). RESULTS This study included 564,644 patients in the primary care cohort and 60 in the hospitalized cohort. Primary care consultations were more common in those 1-4 years of age (face-to-face: 4.3%; telephone: 6.0%) compared with those 5-11 (2.0%; 2.1%) and 12-17 years of age (2.2%; 2.5%). In the hospitalized cohort, mean (SD) length of stay was longer [5.0 (5.8) days] among those 12-17 years old (n = 24) than those 1-4 [n = 15; 1.8 (0.9) days] and 5-11 years old [n = 21; 2.8 (2.1) days]. CONCLUSIONS Most pediatrics diagnosed with COVID-19 were managed in the community. However, hospitalizations were an important driver of HCRU and costs, particularly for those 12-17 years old. Our results may help optimize the management and resource allocation of COVID-19 in this population.
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Affiliation(s)
- Jingyan Yang
- From the Pfizer Inc, New York City, New York
- Institute for Social and Economic Research and Policy, Columbia University, New York City, New York
| | | | - Kiran K Rai
- Adelphi Real World, Bollington, United Kingdom
| | | | | | | | | | | | - Poppy Payne
- Adelphi Real World, Bollington, United Kingdom
| | | | | | | | - Robert Wood
- Adelphi Real World, Bollington, United Kingdom
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Becker A, Nguyen H, Becker M, Wood A, Lawrenson R. Changing patterns of otitis media in the Waikato region during the COVID-19 pandemic. J Prim Health Care 2023; 15:224-229. [PMID: 37756244 DOI: 10.1071/hc23026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/11/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Acute otitis media (AOM) is a common condition of children encountered in general practice. A proportion of children develop otitis media with effusion (OME), which may require tympanostomy and ventilation tube insertion. Aim The aim of the study was to compare the incidence of AOM in Māori and New Zealand (NZ) European children in general practice and the referral practices to secondary care for tympanostomy and ventilation tube insertion. Methods The study was conducted in two parts: (1) an analysis of the incidence of AOM and OME in a rural Waikato general practice (Ōtorohanga) with a high Māori population over a 2-year period; and (2) an analysis of all referrals to the otorhinolaryngology (ORL) department at Waikato District Health Board and tympanostomy and ventilation tube insertion by this service over the same period. Results The incidence of AOM was similar in Māori compared with NZ European children. The incidence declined significantly between 2019 and 2020 and 50% of children with AOM were treated with antibiotics. Referral rates to the ORL department were greater for Māori compared with NZ European children as were tympanostomy and ventilation tube insertion rates. Discussion Although AOM is common, OME was rarely diagnosed. The clinical guidelines regarding antibiotic use for common conditions are not being readily adopted and further research is needed into this matter. The COVID-19 pandemic had a substantial effect on demand both in general practice and in the hospital sector. This may have been due to a reduction in the incidence of AOM or due to system changes caused by the pandemic.
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Affiliation(s)
- Andre Becker
- Otago Medical School, The University of Otago, Wellington, New Zealand
| | - Ha Nguyen
- Medical Research Centre, School of Health, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
| | - Michael Becker
- Otorohanga Medical, 13 Kakamutu Road, Otorohanga, New Zealand
| | - Andrew Wood
- Te Whatu Ora, Health New Zealand (Waikato); and Department of Surgery, FMHS, University of Auckland, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, School of Health, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand; and Te Whatu Ora, Health New Zealand (Waikato)
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Vestesson EM, De Corte KLA, Crellin E, Ledger J, Bakhai M, Clarke GM. Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study. JMIR Public Health Surveill 2023; 9:e44944. [PMID: 37129943 DOI: 10.2196/44944] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). OBJECTIVE This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. METHODS We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. RESULTS Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. CONCLUSIONS The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.
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Affiliation(s)
- Emma Maria Vestesson
- The Health Foundation, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Jean Ledger
- National Health Service England, London, United Kingdom
| | - Minal Bakhai
- National Health Service England, London, United Kingdom
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9
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Quinn LM, Rashid R, Narendran P, Shukla D. Screening children for presymptomatic type 1 diabetes. Br J Gen Pract 2023; 73:36-39. [PMID: 36543557 PMCID: PMC9799351 DOI: 10.3399/bjgp23x731709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lauren M Quinn
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham
| | - Rajeeb Rashid
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow; Consultant Paediatric Diabetologist, Children's & Young People's Diabetes Service, Royal Hospital for Children, Glasgow
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham; Consultant Diabetologist, Department of Diabetes, University Hospitals of Birmingham, Birmingham
| | - David Shukla
- Clinical Research Lead for Primary Care (West Midlands), National Institute for Health and Care Research; Clinical Research Fellow, Institute of Applied Health Research, University of Birmingham, Birmingham
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10
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Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DS. Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study. BMJ Open 2022; 12:e060961. [PMID: 35940830 PMCID: PMC9364042 DOI: 10.1136/bmjopen-2022-060961] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING All National Health Service (public) hospitals in England. PARTICIPANTS All people in England aged <25 years. OUTCOME MEASURES Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kimberley A Foley
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Simon Kenny
- National Clinical Director, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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11
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Impact of COVID-19 on primary care contacts with children and young people in England - context please. Br J Gen Pract 2022; 72:318. [PMID: 35773018 DOI: 10.3399/bjgp22x720101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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12
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Author response. Br J Gen Pract 2022; 72:318. [PMID: 35772991 DOI: 10.3399/bjgp22x720113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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13
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Seven days in medicine: 8-14 June 2022. BMJ 2022; 377:o1448. [PMID: 35710125 DOI: 10.1136/bmj.o1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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