Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017
Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017
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DOI：
10.1136/bmjopen-2019-033761
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发表时间：
2020-01-01
期刊：
影响因子：
2.9
通讯作者：
Saxena, Sonia
中科院分区：
文献类型：
--
作者：
Ruzangi, Judith;Blair, Mitch;Saxena, Sonia
目的描述在2007年至2017年主要初级保健改革后的十年中，英国15岁以下儿童使用紧急护理和计划医院服务的初级保健使用的变化。方法我们使用来自临床实践研究数据链的链接数据来研究儿童的初级保健咨询和医院护理的使用，包括急诊科（艾德）就诊、急诊和择期入院以及门诊专家就诊。结果2007年4月1日至2017年3月31日，在1 484 455名15岁以下儿童中，有7 604 024名全科医生（GP）咨询，981 684名艾德就诊，287 719名急诊住院，2 253 533名门诊就诊和194 034名择期住院。2017年，除婴儿外，所有年龄段的标准化全科医生咨询率下降（-1.0%/年）至每1000名儿童年1864人，2017年婴儿增加1%/年至每1000名儿童年6722人。2017年，艾德就诊率每年增加1.6%，达到每1000名儿童年369人，婴儿的就诊率每年增加3.9%（2017年为每1000名儿童年780人）。急诊入院率稳步上升3%/年，达到每1000名儿童年86人，2017年门诊就诊率上升到每1000名儿童年724人。结论在过去的十年中，由于国家卫生服务的初级保健改革，全科医生的咨询率下降了所有的儿童，婴儿除外。所有年龄段的儿童，特别是婴儿，使用医院急诊和门诊护理的人数都有所增加。这些变化表明，需要为有幼儿的家庭提供更好的专家和社区支助。
Objective To 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 2017 Design Population-based retrospective cohort study. Methods We 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. Results Between 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. Conclusions Over 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.