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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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King T, Hui GC, Muschialli L, Shafran R, Ritchie B, Hargreaves DS, Heyman I, Griffiths H, Bennett S. Mental health interventions for children and young people with long-term health conditions in Children and Young People's Mental Health Services in England. Clin Child Psychol Psychiatry 2023:13591045231216134. [PMID: 38041611 DOI: 10.1177/13591045231216134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND Almost a quarter of children and young people (CYP) in England have a long-term health condition (LTC), which increases the risk of developing mental health difficulties. There is a lack of understanding regarding the routine provision and efficacy of mental health interventions for CYP with LTCs within Children and Young People's Mental Health Services (CYPMHS). METHODS This study analysed national service-reported data in England from two secondary datasets. Data were submitted by services between 2011 and 2019. We evaluated data on the presence or absence of a serious physical health or neurological issue, and which interventions were offered. RESULTS A total of 789 CYP had serious physical health issues and 635 had neurological issues. The most common interventions delivered to CYP in either group have some evidence in the literature. Most CYP showed improvements across a range of outcomes. CONCLUSIONS This study found that prevalence rates and psychological intervention and outcome data were widely under-reported across both datasets, posing questions about their utility for this population. Such data would benefit from triangulation with data from other sources to understand pathways of care for these young people and the extent to which clinical datasets underreport the number of CYP with LTCs.
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Affiliation(s)
- Thomas King
- UCL Great Ormond Street Institute of Child Health, London
| | - Gladys Cm Hui
- UCL Great Ormond Street Institute of Child Health, London
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London
| | - Benjamin Ritchie
- Child Outcomes Research Consortium (CORC), The Kantor Centre of Excellence, London
| | - Dougal S Hargreaves
- Houston Reader in Paediatrics and Population Health, Mohn Centre for Children's Health and Wellbeing, School of Public Health, Imperial College London, London
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London
| | | | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, London
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Otis M, Barber S, Green Hofer S, Straus J, Kay M, Hargreaves DS, Hayhoe B, Anokye N, Lennox L, Nicholls D. Evaluating the implementation and impact of a new model of care for integrating children and young people's acute mental healthcare in a paediatric setting: a protocol for a realist, mixed-methods approach. BMJ Open 2023; 13:e067074. [PMID: 36669846 PMCID: PMC9872460 DOI: 10.1136/bmjopen-2022-067074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The mental health of children and young people in the UK has been declining and has continued to worsen throughout the pandemic, leading to an increase in mental health-related emergencies. In response, the Best for You programme was developed as a new service designed to integrate mental healthcare for children and young people between acute hospital and community services. The programme is comprised of four new services: a rapid assessment young people's centre with dual-trained staff, a co-located day service offering family-based care,a digital hub, designed to integrate with the fourth element of the model, namely community support and mental health services. This evaluation protocol aims to assess the development, implementation and outcomes of the Best for You programme and develops a scalable model that could be implemented in other parts of the National Health Service (NHS). METHODS AND ANALYSIS This mixed-methods realist evaluation aims to delineate the components of the system to assess their interdependent relationships within a wider context. Data collection will include interviews, participant observations, focus groups and the collection of local quantitative healthcare data. The research will be conducted across four phases. Phase 1-captures the development of the underlying programme theory. Phase 2-a process evaluation testing the programme theory. Phase 3- an outcome and economic evaluation. Phase 4-consolidation of learning from phases 1-3 to identify barriers, facilitators and wider contextual factors that have shaped implementation drawing on the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION Ethical approval for the evaluation was received from the NHS local ethics committee. Embedded within the evaluation is a formative review to feedback and share learning with stakeholders to scale-up the programme. Findings from this study will be disseminated in peer-reviewed journals as well as presentations to be useful to service user organisations and networks.
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Affiliation(s)
- Michaela Otis
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Susan Barber
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Stuart Green Hofer
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | | | | | - Dougal S Hargreaves
- NIHR ARC Northwest London, London, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Nana Anokye
- NIHR ARC Northwest London, London, UK
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Dasha Nicholls
- NIHR ARC Northwest London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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Foley KA, Maile EJ, Bottle A, Neale FK, Viner RM, Kenny SE, Majeed A, Hargreaves DS, Saxena S. How did the covid-19 pandemic affect lower respiratory tract infections in young children in England? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Social distancing policies to reduce transmission of covid-19 also reduced children's exposures to endemic respiratory viruses. We aimed to examine the impact of the covid-19 pandemic on lower respiratory tract infections in under 5s presenting to primary care in England.
Methods
Longitudinal trends analysis using electronic health records from a nationally representative primary care database. Our target population was children aged <5 years registered with a primary care practice from January 2015 to March 2021.
Our main outcome was total weekly contacts with primary care for a lower respiratory tract infection (LRTI). We defined three pandemic phases from March 2020 - March 2021: i) first national lockdown (late March to early June 2020), ii) childcare settings reopened and second national lockdown with schools open (mid-June to mid-December 2020) and iii) third national lockdown with schools closed (late December 2020 to end of March 2021). We compared outcomes during each of the three phases with corresponding calendar weeks during pre-pandemic years 2015 to 2019.
Results
Our study population included 843 020 children <5 years who had 1 076 181 contacts with primary care for LRTIs. During the first phase (first lockdown) there were falls of 79.3% (95% CI: 73.6 to 84.5) from an average of 28 547 primary care contacts for LRTI in 2015 - 2019 to 5915 in 2020; there was a 78.9% (95% CI: 73.7 to 83.9) fall in phase two (childcare settings reopened and second lockdown) from 107 873 to 22 792 contacts; and a 77.7% (95% CI: 73.5 to 81.4) fall in phase three (third lockdown) from 57 200 to 12 764 contacts.
Conclusions
Children under 5 in England had fewer contacts with primary care for LRTIs during the covid-19 pandemic. This change likely reflects lower prevalence of respiratory illness due to fewer social contacts. This may impact on future health service use as these children have had less exposure, and therefore may have less immunity, to respiratory diseases.
Key messages
• Children under 5 had fewer contacts with primary care for lower respiratory tract infections during the covid-19 pandemic in England likely due to the restrictions in place to reduce social contacts.
• The falls in lower respiratory tract infections during the covid-19 pandemic in under 5s may mean they have less immunity to respiratory viruses which may impact upon their future health service use.
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Affiliation(s)
- KA Foley
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - EJ Maile
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - A Bottle
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - FK Neale
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - RM Viner
- Population, Policy & Practice Department, UCL Great Ormand Street Institute of Child Health , London, UK
| | - SE Kenny
- Department of Women’s and Children’s Health, Alder Hey Children’s NHS Foundation Trust , Liverpool, UK
- NHS England and NHS Improvement, NHS , London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - DS Hargreaves
- Mohn Centre for Children’s Health, Imperial College London , London, UK
| | - S Saxena
- Department of Primary Care and Public Health, Imperial College London , London, UK
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Ram B, Foley KA, van Sluijs E, Hargreaves DS, Viner RM, Saxena S. Developing a core outcome set for physical activity interventions in primary schools: a modified-Delphi study. BMJ Open 2022; 12:e061335. [PMID: 36180126 PMCID: PMC9528589 DOI: 10.1136/bmjopen-2022-061335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To develop a core outcome set (COS) for physical activity interventions in primary schools. DESIGN Modified-Delphi study. SETTING The UK and international. PARTICIPANTS 104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8-9 years) from 1 London primary school. INTERVENTIONS Physical activity interventions. METHODS Four-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a two-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a nine-point Likert Scale from 'not important' to 'critical': a>70% participant threshold identified the outcomes rated 'critical' to measure, and outcomes important to children were identified through a workshop; and (4) a stakeholder meeting to achieve consensus of the outcomes to include in the COS. RESULTS In total, 74 studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains were established: 'physical activity and health' (16 outcomes), 'social and emotional health' (22 outcomes) and 'educational performance' (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. In total, 13 outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the COS: five outcomes for physical activity and health (diet (varied and balanced), energy, fitness, intensity of physical activity, sleep (number of hours)); seven outcomes for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, well-being); and two outcomes for educational performance (concentration, focus). CONCLUSIONS We have developed the first COS for physical activity interventions in primary schools in consultation with those interested in the development and application of an agreed standardised set of outcomes. Future studies including these outcomes will reduce heterogeneity across studies. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative registration number 1322; Results.
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Affiliation(s)
- Bina Ram
- Primary Care and Public Health, Imperial College London, London, UK
| | | | - Esther van Sluijs
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Dougal S Hargreaves
- Primary Care and Public Health, Imperial College London, London, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, Imperial College London, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Maile EJ, Singh R, Black GB, Blair M, Hargreaves DS. Back to the future? Lessons from the history of integrated child health services in England. Future Healthc J 2022; 9:183-187. [DOI: 10.7861/fhj.2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beaney T, Clarke J, Woodcock T, McCarthy R, Saravanakumar K, Barahona M, Blair M, Hargreaves DS. Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London. BMJ Open 2021; 11:e050847. [PMID: 34921075 PMCID: PMC8685945 DOI: 10.1136/bmjopen-2021-050847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership. DESIGN A retrospective cohort study. SETTING Routinely collected primary and secondary healthcare data in Northwest London from the Discover database. PARTICIPANTS 378 309 CYP aged 0-15 years registered to a general practice in Northwest London with 1 full year of follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES Assignment of each participant to a segment defined by seven healthcare variables representing primary and secondary care attendances, and description of utilisation patterns by segment. Predictors of segment membership described by age, sex, ethnicity, deprivation and LTCs. RESULTS Participants were grouped into six segments based on healthcare utilisation. Three segments predominantly used primary care, two moderate utilisation segments differed in use of emergency or elective care, and a high utilisation segment, representing 16 632 (4.4%) children accounted for the highest mean presentations across all service types. The two smallest segments, representing 13.3% of the population, accounted for 62.5% of total costs. Younger age, residence in areas of higher deprivation and the presence of one or more LTCs were associated with membership of higher utilisation segments, but 75.0% of those in the highest utilisation segment had no LTC. CONCLUSIONS This article identifies six segments of healthcare utilisation in CYP and predictors of segment membership. Demographics and LTCs may not explain utilisation patterns as strongly as in adults, which may limit the use of routine data in predicting utilisation and suggest children have less well-defined trajectories of service use than adults.
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Affiliation(s)
- Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
| | - Jonathan Clarke
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
- Department of Mathematics, Imperial College London, London, UK
| | - Thomas Woodcock
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
| | - Rachel McCarthy
- North West London Collaboration of Clinical Commissioning Groups, London, UK
| | | | - Mauricio Barahona
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
- Department of Mathematics, Imperial College London, London, UK
| | - Mitch Blair
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
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Reyes BD, Hargreaves DS, Creese H. Early-life maternal attachment and risky health behaviours in adolescence: findings from the United Kingdom Millennium Cohort Study. BMC Public Health 2021; 21:2039. [PMID: 34749702 PMCID: PMC8577004 DOI: 10.1186/s12889-021-12141-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background Early uptake of multiple risky behaviours during adolescence, such as substance use, antisocial and sexual behaviours, can lead to poor health outcomes without timely interventions. This study investigated how early-life maternal attachment, or emotional bonds between mothers and infants, influenced later risky behaviours in adolescence alongside other potential explanatory pathways using the United Kingdom Millennium Cohort Study. Methods Total maternal attachment scores measured at 9 months using the Condon (1998) Maternal Postnatal Attachment Scale compared higher and lower attachment, where mothers in the lowest 10th percentile represented lower attachment. Multiple risky behaviours, defined as two or more risky behaviours (including smoking cigarettes, vaping, alcohol consumption, illegal drug use, antisocial behaviour, criminal engagement, unsafe sex, and gambling), were scored from 0 to 8 at age 17. Five multivariate logistic regression models examined associations between maternal attachment and multiple risky behaviours among Millennium Cohort Study members (n = 7796). Mediation analysis sequentially adjusted for blocks of explanatory mechanisms, including low attachment mechanisms (multiple births, infant prematurity, sex, breastfeeding, unplanned pregnancy and maternal age at birth), maternal depression, and social inequalities (single-parent status, socioeconomic circumstance by maternal education and household income) at 9 months and poor adolescent mental health at 14 years. Results Children of mothers with lower maternal attachment at 9 months had 23% increased odds of multiple risky behaviours at 17 years (OR: 1.23, 95% CI: 1.00–1.50) in the unadjusted baseline model. All five explanatory blocks attenuated baseline odds. Low attachment mechanisms attenuated 13%, social inequalities 17%, and poor mental health 17%. Maternal depression attenuated the highest proportion (26%) after fully adjusting for all factors (30%). Conclusions Lower maternal attachment in early life predicted increased adolescent multiple risky behaviours. Almost a third of the excess risk was attributable to child, maternal and socioeconomic factors, with over a quarter explained by maternal depression. Recognising the influence of early-life risk factors on adolescent health could innovate current policies and interventions addressing multiple risky behaviour uptake affecting health inequalities across the life course. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12141-5.
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Affiliation(s)
- Beatrice D Reyes
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK.
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Hanna Creese
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
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Ram B, Chalkley A, van Sluijs E, Phillips R, Venkatraman T, Hargreaves DS, Viner RM, Saxena S. Impact of The Daily Mile on children's physical and mental health, and educational attainment in primary schools: iMprOVE cohort study protocol. BMJ Open 2021; 11:e045879. [PMID: 34049916 PMCID: PMC8166593 DOI: 10.1136/bmjopen-2020-045879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION School-based active mile initiatives such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting physical activity recommendations. The iMprOVE Study aims to examine the impact of TDM on children's physical and mental health and educational attainment throughout primary school. METHODS AND ANALYSIS: iMprOVE is a longitudinal quasi-experimental cohort study. We will send a survey to all state-funded primary schools in Greater London to identify participation in TDM. The survey responses will be used for non-random allocation to either the intervention group (Daily Mile schools) or to the control group (non-Daily Mile schools). We aim to recruit 3533 year 1 children (aged 5-6 years) from 77 primary schools and follow them up annually until the end of their primary school years. Data collection taking place at baseline (children in school year 1) and each primary school year thereafter includes device-based measures of moderate-to-vigorous physical activity (MVPA) and questionnaires to measure mental health (Strengths and Difficulties Questionnaire) and educational attainment (ratings from 'below expected' to 'above expected levels'). The primary outcome is the mean change in MVPA minutes from baseline to year 6 during the school day among the intervention group compared with controls. We will use multilevel linear regression models adjusting for sociodemographic data and participation in TDM. The study is powered to detect a 10% (5.5 min) difference between the intervention and control group which would be considered clinically significant. ETHICS AND DISSEMINATION Ethics has been approved from Imperial College Research Ethics Committee, reference 20IC6127. Key findings will be disseminated to the public through research networks, social, print and media broadcasts, community engagement opportunities and schools. We will work with policy-makers for direct application and impact of our findings.
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Affiliation(s)
- Bina Ram
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Anna Chalkley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Tishya Venkatraman
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
- Department for Education, London, UK
| | - Russell M Viner
- Institute of Child Health, University College London, London, UK
| | - Sonia Saxena
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
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Hassanzadeh R, Klaber R, Watson M, Holden B, Majeed A, Hargreaves DS. Data-driven, integrated primary and secondary care for children: moving from policy to practice. J R Soc Med 2021; 114:63-68. [PMID: 33118869 PMCID: PMC7879004 DOI: 10.1177/0141076820968781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roya Hassanzadeh
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Robert Klaber
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London W6 8RP, UK
| | - Mando Watson
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London W6 8RP, UK
| | - Ben Holden
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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13
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Neale FK, Christie D, Hargreaves DS, Segal TY. Illness duration, mood and symptom impact in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis? Arch Dis Child 2020; 105:911-912. [PMID: 31196908 DOI: 10.1136/archdischild-2018-316720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | - Deborah Christie
- Department of Child and Adolescent Psychological Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Terry Y Segal
- Department of Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
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14
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Viner RM, Hargreaves DS. Trajectories of change in childhood obesity prevalence across local authorities 2007/08-2015/16: a latent trajectory analysis. J Public Health (Oxf) 2020; 41:724-731. [PMID: 30476176 DOI: 10.1093/pubmed/fdy205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We investigated differing trajectories of childhood obesity prevalence amongst English local authorities (LAs). METHODS Data on prevalence of childhood obesity (BMI ≥ 95th centile) for Reception year and Year 6 for 150 LAs in England from 2006/07 to 2015/16 were obtained from the National Child Measurement Programme (NCMP). Latent class mixture modelling (LCCM) was used to identify classes of change in obesity prevalence. RESULTS In Reception, most LAs showed little change across the period (Class 1; stable, moderate obesity prevalence;84%), with a smaller group with a high prevalence that fell thereafter (Class 2; high but falling obesity prevalence; 16%). In Year 6 we identified three classes: moderate obesity prevalence (Class 3; 43%); high and rising obesity prevalence (Class 2; 36%); and stable low obesity prevalence (Class 1; 21%). Greater LA deprivation and higher LA proportion of non-white ethnicity increased risk of being in Class 2 (Reception) or Class 2 or 3 (Year 6) compared with Class 1. CONCLUSIONS The prevalence of childhood obesity in LAs in England follow a small number of differing trajectories that are influenced by LA deprivation and ethnic composition. LAs following a stable low obesity trajectory for Year 6 are targets for further investigation.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, UCL Institute of Child Health, London 30 Guilford St., London, UK
| | - Dougal S Hargreaves
- Population, Policy and Practice Programme, UCL Institute of Child Health, London 30 Guilford St., London, UK
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15
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Ruzangi J, Blair M, Cecil E, Greenfield G, Bottle A, Hargreaves DS, Saxena S. Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017. BMJ Open 2020; 10:e033761. [PMID: 32371509 PMCID: PMC7228511 DOI: 10.1136/bmjopen-2019-033761] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Judith Ruzangi
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Elizabeth Cecil
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Alex Bottle
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care & Public Health, Imperial College London, London, UK
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Affiliation(s)
- Heidi Makrinioti
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1PG, UK.
| | - Mando Watson
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1PG, UK
| | - Andrew Bush
- Division of Medicine, Imperial College, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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17
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Foley KA, Venkatraman T, Ram B, Ells L, van Sluijs E, Hargreaves DS, Greaves F, Taghavi Azar Sharabiani M, Viner RM, Bottle A, Saxena S. Protocol for developing a core outcome set for evaluating school-based physical activity interventions in primary schools. BMJ Open 2019; 9:e031868. [PMID: 31852702 PMCID: PMC6937029 DOI: 10.1136/bmjopen-2019-031868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Primary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children's physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardised. METHODS AND ANALYSIS Our aim is to develop a COS for studies of school-based physical activity interventions. We will achieve this by undertaking a four-stage process:(1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritise outcomes through a two-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents), where stakeholders rate the importance of each outcome on a 9-point Likert scale (consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7%-9% and 15% or less scoring 1 to 3); (4) achieve consensus on a final COS in face-to-face meetings with a sample of stakeholders and primary school children. ETHICS AND DISSEMINATION We have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative (COMET) number: 1322.
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Affiliation(s)
- Kimberley A Foley
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Tishya Venkatraman
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Bina Ram
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Louisa Ells
- Centre for Public Health Research, Teesside University, Middlesbrough, North Yorkshire, UK
| | | | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Science and Strategic Information, Public Health England, London, UK
| | | | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Alex Bottle
- 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
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18
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Neale FK, Armstrong EJ, Cohen JM, Segal TY, Hargreaves DS. How fair is our service? Evaluating access to specialist paediatric care. Arch Dis Child 2019; 104:1105-1107. [PMID: 31300409 DOI: 10.1136/archdischild-2019-317254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess equity of access to paediatric outpatient clinics in our hospital. DESIGN/SETTING Retrospective analysis of consecutive accepted referrals to allergy, asthma, epilepsy, general paediatrics, rapid access, chronic fatigue syndrome, diabetes and endocrine outpatient clinics. PATIENTS 32 369 new patients, April 2007 to June 2018. RESULTS Among local patients (58.1%) 0.2%-2.5% of patients referred to each clinic lived in the least deprived quintile, and 43.5%-48.4% in the most deprived quintile-similar to inpatient admissions and the local population. Tertiary clinics showed a much higher proportion of patients from the least deprived quintiles (15.9%-26.2%). CONCLUSIONS Local outpatient referrals broadly reflected the socioeconomic distribution, although not necessarily the distribution of need, of our local population. A relatively high proportion of patients in tertiary clinics were from more affluent postcodes, highlighting the need for referral inequalities to be evaluated across networks or regions.
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Affiliation(s)
| | | | - Jonathan M Cohen
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK.,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Terry Y Segal
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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19
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Ravaghi V, Hargreaves DS, Morris AJ. Persistent Socioeconomic Inequality in Child Dental Caries in England despite Equal Attendance. JDR Clin Trans Res 2019; 5:185-194. [PMID: 31487468 DOI: 10.1177/2380084419872136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite a decline in the prevalence of dental caries among children in England and ongoing arrangements for the provision of free dental care up to the age of 18 y, there is limited information on the pattern and trend of socioeconomic inequalities in dental caries and dental attendance. METHODS We estimated the magnitude of deprivation-related inequalities for dental caries and dental attendance in young children, using publicly available data and 2 regression-based summary measures of inequalities: slope index of inequality and relative index of inequality. RESULTS We found no significant absolute or relative inequalities in dental attendance across English areas in the past decade, while there were persistent absolute and relative inequalities in dental caries. Socioeconomic inequalities in dental caries decreased between 2007 and 2012; thereafter, the relative inequalities increased. CONCLUSIONS The apparent widening inequality in child dental caries in England despite equal access to dental care is a challenge for policy makers. KNOWLEDGE TRANSFER STATEMENT While caries prevalence among English children has declined over the past decade, there has been an increase in socioeconomic inequalities in oral health despite there being no inequality in dental attendance. This has implications for the development of oral health strategy and planning dental services.
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Affiliation(s)
- V Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - D S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - A J Morris
- School of Dentistry, University of Birmingham, Birmingham, UK
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20
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Hargreaves DS, Arora S, Viveiro C, Hale DR, Ward JL, Sherlaw-Johnson C, Viner RM, Dunkley C, Cross JH. Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study. Lancet Child Adolesc Health 2019; 3:627-635. [PMID: 31281027 DOI: 10.1016/s2352-4642(19)30201-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Concerns have been raised about variation in care quality and outcomes among children and young people with epilepsies in England. We aimed to investigate the association between quality of paediatric care, hospital admissions, and all-cause deaths among epilepsy patients. METHODS In this longitudinal data linkage study of paediatric epilepsy services in England, we linked unit-level data from round 1 (2009-11) and round 2 (2013-14) of the Epilepsy12 national clinical audit, with death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics. We investigated the association between unit-level performance in involving a paediatrician with epilepsy expertise, an epilepsy specialist nurse, and a paediatric neurologist (where appropriate) in round 1 and the proportion of adolescents (aged 10-18 years) with epilepsy admitted to each unit who subsequently died during the study period (April 1, 2009, to March 31, 2015). We also investigated whether change in Epilepsy12 performance between the two audit rounds was associated with changes in the standardised ratio of observed-to-expected unplanned epilepsy admissions over the same period. FINDINGS In 99 units with data for the analyses relating to paediatricians with epilepsy expertise and epilepsy specialist nurses, 134 (7%) of 1795 patients died during the study period, 88 (5%) of whom died after the transition to adult service. In 55 units with data for the analyses relating to paediatric neurologists, 79 (7%) of 1164 patients died, 54 (5%) of whom did so after the transition. In regression models adjusting for population, unit, and hospital activity characteristics, absolute reductions in total mortality risk (6·4 percentage points, 95% CI 0·1-12·7) and mortality risk after transition (5·7 percentage points, 0·6-10·8) were found when comparing units where all versus no eligible patients were seen by a paediatric neurologist. Units where all eligible patients were seen by a paediatric neurologist were estimated to have absolute reductions of 4·6 percentage points (0·3-8·9) in total mortality and of 4·6 percentage points (1·2-8·0) in post-transition mortality, compared with units where no or some eligible patients were seen by a paediatric neurologist. There was no significant association between performance on being seen by an epilepsy specialist nurse or by a paediatrician with epilepsy expertise and mortality. In units where access to an epilepsy specialist nurse decreased, the standardised ratio of epilepsy admissions increased by a mean of 0·21 (0·01-0·42). INTERPRETATION Among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services. Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions. FUNDING The Health Foundation.
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Affiliation(s)
- Dougal S Hargreaves
- Department of Primary Care & Public Health, Imperial College London, London, UK; Nuffield Trust, London, UK.
| | - Sandeepa Arora
- Department of Primary Care & Public Health, Imperial College London, London, UK; Nuffield Trust, London, UK
| | | | - Daniel R Hale
- Department of Psychology, Heriot Watt University, Edinburgh, UK
| | - Joseph L Ward
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Russell M Viner
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Colin Dunkley
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton In Ashfield, UK
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK
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21
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Hargreaves DS, Lemer C, Ewing C, Cornish J, Baker T, Toma K, Saxena S, McCulloch B, McFarlane L, Welch J, Sparrow E, Kossarova L, Lumsden DE, Cheung CRLH. Measuring and improving the quality of NHS care for children and young people. Arch Dis Child 2019; 104:618-621. [PMID: 29720493 PMCID: PMC6589454 DOI: 10.1136/archdischild-2017-314564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Dougal S Hargreaves
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK,Nuffield Trust, London, UK
| | - Claire Lemer
- General Paediatrics, Evelina London Children’s Hospital, London, UK,NHS England, London, UK
| | - Carol Ewing
- Department of Paediatrics, Royal Manchester Children’s Hospital, Manchester, UK,Royal College of Paediatrics and Child Health, London, UK
| | | | | | | | | | | | | | - Jack Welch
- RCPCH & Us Children, Young People and Families Network, London, UK
| | - Emma Sparrow
- Royal College of Paediatrics and Child Health, London, UK
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22
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Pitchforth J, Fahy K, Ford T, Wolpert M, Viner RM, Hargreaves DS. Mental health and well-being trends among children and young people in the UK, 1995-2014: analysis of repeated cross-sectional national health surveys. Psychol Med 2019; 49:1275-1285. [PMID: 30201061 PMCID: PMC6518382 DOI: 10.1017/s0033291718001757] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/26/2018] [Accepted: 06/12/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is a growing concern about the mental health of children and young people (CYP) in the UK, with increasing demand for counselling services, admissions for self-harm and referrals to mental health services. We investigated whether there have been similar recent trends in selected mental health outcomes among CYP in national health surveys from England, Scotland and Wales. METHODS Data were analysed from 140 830 participants (4-24 years, stratified into 4-12, 13-15, 16-24 years) in 36 national surveys in England, Scotland and Wales, 1995-2014. Regression models were used to examine time trends in seven parent/self-reported variables: general health, any long-standing health condition, long-standing mental health condition; Warwick-Edinburgh Mental Wellbeing Score (WEMWBS), above-threshold Strengths and Difficulties Questionnaire Total (SDQT) score, SDQ Emotion (SDQE) score, General Health Questionnaire (GHQ) score. RESULTS Across all participants aged 4-24, long-standing mental health conditions increased in England (0.8-4.8% over 19 years), Scotland (2.3-6.0%, 11 years) and Wales (2.6-4.1%, 7 years) (all p < 0.001). Among young children (4-12 years), the proportion reporting high SDQT and SDQE scores decreased significantly among both boys and girls in England [SDQE: odds ratio (OR) 0.97 (0.96-0.98), p < 0.001] and girls in Scotland [SDQE: OR 0.96 (0.93-0.99), p = 0.005]. The proportion with high SDQE scores (13-15 years) decreased in England [OR 0.98 (0.96-0.99), p = 0.006] but increased in Wales [OR 1.07 (1.03-1.10), p < 0.001]. The proportion with high GHQ scores decreased among English women (16-24 years) [OR 0.98 (0.98-0.99), p = 0.002]. CONCLUSIONS Despite a striking increase in the reported prevalence of long-standing mental health conditions among UK CYP, there was relatively little change in questionnaire scores reflecting psychological distress and emotional well-being.
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Affiliation(s)
- Jacqueline Pitchforth
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Katie Fahy
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Tamsin Ford
- University of Exeter Medical School, Heavitree Road, Exeter EX1 2LU, UK
| | - Miranda Wolpert
- Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU, UK
| | - Russell M. Viner
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Dougal S. Hargreaves
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Nuffield Trust, London, UK
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23
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Struijs JN, Hargreaves DS. Turning a crisis into a policy opportunity: lessons learned so far and next steps in the Dutch early years strategy. Lancet Child Adolesc Health 2019; 3:66-68. [PMID: 30660207 DOI: 10.1016/s2352-4642(18)30384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Jeroen N Struijs
- Netherlands National Institute for Public Health and Environment, Bilthoven, Netherlands; Department of Public Health and Primary Care, Campus The Hague, Leiden University Medical Center, The Hague, Netherlands
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London W6 6RP, UK.
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24
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Cecil E, Bottle A, Ma R, Hargreaves DS, Wolfe I, Mainous AG, Saxena S. Impact of preventive primary care on children's unplanned hospital admissions: a population-based birth cohort study of UK children 2000-2013. BMC Med 2018; 16:151. [PMID: 30220255 PMCID: PMC6139908 DOI: 10.1186/s12916-018-1142-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Universal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC. METHODS We followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not. RESULTS Overall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged < 1 year), preschool (1-4 years) and primary school (5-9 years) children, respectively. Lack of preventive care was associated with more unplanned admissions. Infants with incomplete vaccination had increased risk for all unplanned admissions (HR 1.89, 1.79-2.00) and vaccine-preventable admissions (HR 4.41, 2.59-7.49). Infants lacking development checks had higher risk for unplanned admission (HR 4.63, 4.55-4.71). These associations persisted across childhood. Children who had higher consulting rates with primary care providers also had higher risk of unplanned admission (preschool children: HR 1.17, 1.17-1.17). One third of all unplanned admissions (62,154/183,530) were for ACS infectious illness. Children with chronic ACS conditions, asthma, diabetes or epilepsy had increased risk of unplanned admission (HR 1.90, 1.77-2.04, HR 11.43, 8.48-15.39, and HR 4.82, 3.93-5.91, respectively). These associations were modified in children who consulted more in primary care. CONCLUSIONS A high uptake of preventive primary care from birth is associated with fewer unplanned and ACS admissions in children. However, the clustering of poor health, a lack of preventive care uptake, and social deprivation puts some children with comorbid conditions at very high risk of admission. Strengthening immunisation coverage and preventive primary care in countries with poor UHC could potentially significantly reduce the health burden from hospital admission in children.
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Affiliation(s)
- Elizabeth Cecil
- Department of Primary Care and Public Health, Imperial College London Charing Cross Campus, London, W6 8RP, UK.
| | - Alex Bottle
- Department of Primary Care and Public Health, Imperial College London Charing Cross Campus, London, W6 8RP, UK
| | - Richard Ma
- Department of Primary Care and Public Health, Imperial College London Charing Cross Campus, London, W6 8RP, UK
| | | | - Ingrid Wolfe
- Department of Primary Care and Public Health Sciences, King's College London, London, England
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London Charing Cross Campus, London, W6 8RP, UK
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Arora S, Cheung CR, Sherlaw-Johnson C, Hargreaves DS. Use of age-specific hospital catchment populations to investigate geographical variation in inpatient admissions for children and young people in England: retrospective, cross-sectional study. BMJ Open 2018; 8:e022339. [PMID: 29991633 PMCID: PMC6082474 DOI: 10.1136/bmjopen-2018-022339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To develop a method for calculating age-specific hospital catchment populations (HCPs) for children and young people (CYP) in England. To show how these methods allow geographical variation in hospital activity to be investigated and addressed more effectively. DESIGN Retrospective, secondary analysis of existing national datasets. SETTING Inpatient care of CYP (0-18 years) in England. PARTICIPANTS Hospital Episode Statistics (HES) data were accessed for all inpatient admissions (elective and emergency) for CYP from birth to 18 years, 364 days, for 2011/2012-2014/2015. In 2014/2015, 857 112 admissions were analysed, from an eligible population of approximately 11.9 million CYP. OUTCOME MEASURES For each hospital Trust, the catchment population of CYP was calculated; Trust-level admission rates per thousand per year were then calculated for admissions due to (1) any diagnostic code, (2) primary diagnosis of epilepsy and (3) epilepsy listed as primary diagnosis or comorbidity. RESULTS Estimated 2014/2015 HCPs for CYP ranged from 268 558 for Barts Health NHS Trust to around 30 000 for the smallest acute general paediatric services and below 10 000 for many Trusts providing specialist services. As expected, the composition of HCPs was fairly consistent for age breakdown but levels of deprivation varied widely. After standardising for population characteristics, admission rates with a primary diagnosis of epilepsy ranged from 14.3 to 157.7 per 100 000 per year (11.0-fold variation) for Trusts providing acute general paediatric services. All-cause admission rates showed less variation, ranging from 4033 to 11 681 per 100 000 per year (2.9-fold variation). CONCLUSIONS Use of age-specific catchment populations allows variation in hospital activity to be linked to specific teams and care pathways. This provides an evidence base for initiatives to tackle unwarranted variation in healthcare activity and health outcomes.
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Affiliation(s)
- Sandeepa Arora
- Research team, The Nuffield Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - C Ronny Cheung
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
- Public Health England Child and Maternal Health Intelligence Network, London, UK
| | | | - Dougal S Hargreaves
- Research team, The Nuffield Trust, London, UK
- Population, Policy & Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Hargreaves DS, Sizmur S, Pitchforth J, Tallett A, Toomey SL, Hopwood B, Schuster MA, Viner RM. Children and young people's versus parents' responses in an English national inpatient survey. Arch Dis Child 2018; 103:486-491. [PMID: 29434020 PMCID: PMC5916103 DOI: 10.1136/archdischild-2017-313801] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/28/2017] [Accepted: 12/14/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Despite growing interest in children and young people's (CYP) perspectives on healthcare, they continue to be excluded from many patient experience surveys. This study investigated the feasibility of, and additional information gained by, measuring CYP experiences of a recent hospital admission. DESIGN Cross-sectional analysis of national survey data. SETTING Inpatients aged 8-15 years in eligible National Health Service hospitals, July-September 2014. PARTICIPANTS 6204 parents/carers completed the parent section of the survey. The CYP section of the survey was completed by CYP themselves (n=3592), parents (n=849) or jointly (n=1763). MAIN OUTCOME MEASURES Pain relief, involvement, quality of staff communication, perceived safety, ward environment, overall experience. ANALYSES Single-measures intraclass correlations (ICCs) were used to assess the concordance between CYP and parent responses about the same inpatient episode. Multilevel logistic regression models, adjusted for individual characteristics, were used to compare the odds of positive responses when the CYP section of the survey was completed by parents, by CYP themselves or jointly. RESULTS The CYP section of the survey was completed independently by 57.8% of CYP. Agreement between CYP and parent responses was reasonably good for pain relief (ICC=0.61 (95% CI 0.58 to 0.63)) and overall experience (ICC=0.70 (95% CI 0.68 to 0.72)), but much lower for questions comparing professionals' communication with CYP and with their parents (ICC range=0.28 (95% CI 0.24 to 0.32) to 0.51 (95% CI 0.47 to 0.54)). In the regression models, CYP were significantly less likely than parents to report feeling safe (adjusted OR (AOR)=0.54 (95% CI 0.38 to 0.76)), involvement in decisions (AOR=0.66 (95% CI 0.46 to 0.94)) or adequate privacy (AOR=0.68 (95% CI 0.52 to 0.89)). CONCLUSIONS Including CYP (8-15 years) in patient experience surveys is feasible and enhances what is known from parents' responses.
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Affiliation(s)
- Dougal S Hargreaves
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK,The Nuffield Trust, London, UK
| | | | - Jacqueline Pitchforth
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sara L Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, UK
| | | | - Mark A Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, UK,Kaiser Permanente School of Medicine, Pasadena, USA
| | - Russell M Viner
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Viner RM, Hargreaves DS. A forward view for child health: integrating across the system to improve health and reduce hospital attendances for children and young people. Arch Dis Child 2018; 103:117-118. [PMID: 29102963 DOI: 10.1136/archdischild-2017-314032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Russell M Viner
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, UK.,Children & Young People's Programme, Healthy London Partnerships, London, UK
| | - Dougal S Hargreaves
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, UK
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Viner RM, Blackburn F, White F, Mannie R, Parr T, Nelson S, Lemer C, Riddell A, Watson M, Cleugh F, Heys M, Hargreaves DS. The impact of out-of-hospital models of care on paediatric emergency department presentations. Arch Dis Child 2018; 103:128-136. [PMID: 29074734 DOI: 10.1136/archdischild-2017-313307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/12/2017] [Accepted: 08/19/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the potential impact of enhanced primary care and new out-of-hospital models (OOHMs) on emergency department (ED) presentations by children and young people (CYP). DESIGN Observational study. PATIENTS & SETTING Data collected prospectively on 3020 CYP 0-17.9 years from 6 London EDs during 14 days by 25 supernumerary clinicians. CYP with transient acute illness, exacerbation of long-term condition (LTC), complex LTC/disability and injury/trauma were considered manageable within OOHM. OOHMs assessed included nurse-led services, multispecialty community provider (MCP), primary and acute care system (PACS) plus current and enhanced primary care. MEASURES Diagnosis, severity; record of investigations, management and outcome that occurred; objective assessment of clinical need and potential alternative management options/destinations. RESULTS Of the patients 95.6% had diagnoses appropriate for OOHM. Most presentations required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%). One thousand two hundred and ninety-one (42.75%) required no investigations and 1007 (33.3%) were provided only with reassurance. Of the presentations 42.2% were judged to have been totally avoidable if the family had had better health education.Of the patients 26.1% were judged appropriate for current primary care (community pharmacy or general practice) with 31.5% appropriate for the combination of enhanced general practice and community pharmacy. Proportions suitable for new models were 14.1% for the nurse-led acute illness team, MCP 25.7%, GP federation CYP service 44.6%, comprehensive walk-in centre for CYP 64.3% and 75.5% for a PACS. CONCLUSIONS High proportions of ED presentations by CYP could potentially be managed in new OOHMs or by enhancement of existing primary care.
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Affiliation(s)
- Russell M Viner
- Healthy London Partnerships, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Randy Mannie
- Financial Strategy, NHS England (London Region), London, UK
| | | | | | - Claire Lemer
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Mando Watson
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health, London, UK
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Dreyer K, Williamson RAP, Hargreaves DS, Rosen R, Deeny SR. Associations between parental mental health and other family factors and healthcare utilisation among children and young people: a retrospective, cross-sectional study of linked healthcare data. BMJ Paediatr Open 2018; 2:e000266. [PMID: 30094348 PMCID: PMC6069921 DOI: 10.1136/bmjpo-2018-000266] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify the degree to which parental diagnosis of depression or other long-term conditions, parental health-seeking behaviours and household factors were associated with a healthcare utilisation among children and young people (CYP) (0-15 years). DESIGN Retrospective, cross-sectional study of electronic health records, from 25 252 patients registered at a large, London-based primary care provider. The associations between children's healthcare utilisation and the characteristics of the child, their parents/carers and their household structure were examined using multivariable regression. RESULTS Controlling for parental utilisation, parental depression (vs not) was significantly associated with increased healthcare utilisation for CYP. Odds ratios for CYP with siblings=1.41 (95% CI 1.10 to 1.80) for emergency department (ED) attendances, 1.67 (95% CI 1.32 to 2.11) for outpatient appointments, 1.47 (95% CI 1.07 to 2.03) for inpatient admission, and rate rato=1.28 (95% CI 1.04 to 1.78) for general practitioner (GP) consultations.After adjusting for child and parental characteristics, parental general practice attendance (+1 from mean) was predictive of increased CYP general practice attendance, rate ratio 1.07 (95% CI 1.06 to 1.08) for CYP with siblings. Parental ED attendance also increased the risk of CYP ED attendance, with OR 1.27 (95% CI 1.12 to 1.44) for CYP with siblings. CONCLUSIONS Parental depression is associated with increased utilisation of ED, outpatient and inpatient services by CYP, as well as with increased GP consultations among adolescents. Our results demonstrate that healthcare utilisation by CYP is associated with the health-seeking behaviour of adults in their household.
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Viner RM, Hargreaves DS, Ward J, Bonell C, Mokdad AH, Patton G. The health benefits of secondary education in adolescents and young adults: An international analysis in 186 low-, middle- and high-income countries from 1990 to 2013. SSM Popul Health 2017; 3:162-171. [PMID: 29302611 PMCID: PMC5742637 DOI: 10.1016/j.ssmph.2016.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022] Open
Abstract
Background The health benefits of secondary education have been little studied. We undertook country-level longitudinal analyses of the impact of lengthening secondary education on health outcomes amongst 15-24 year olds. Methods Exposures: average length of secondary and primary education from 1980 to 2013. Data/Outcomes: Country level adolescent fertility rate (AFR), HIV prevalence and mortality rate from 1989/90 to 2013 across 186 low-, middle- and high-income countries. Analysis: Longitudinal mixed effects models, entering secondary and primary education together, adjusted for time varying GDP and country income status. Longitudinal structural marginal models using inverse probability weighting (IPW) to take account of time varying confounding by primary education and GDP. Counterfactual scenarios of no change in secondary education since 1980/1990 were estimated from model coefficients for each outcome. Findings Each additional year of secondary education decreased AFR by 8.4% in mixed effects models and 14.6% in IPW models independent of primary education and GDP. Counterfactual analyses showed the proportion of the reduction in adolescent fertility rate over the study period independently attributable to secondary education was 28% in low income countries. Each additional year of secondary education reduced mortality by 16.9% for 15-19 year and 14.8% for 20-24 year old young women and 11.4% for 15-19 year and 8.8% for 20-24 year old young men. Counterfactual scenarios suggested 12% and 23% of the mortality reduction for 15-19 and 20-24 year old young men was attributable to secondary education in low income countries. Each additional year of secondary education was associated with a 24.5% and 43.1% reduction in HIV prevalence amongst young men and women. Interpretation The health benefits associated with secondary education were greater than those of primary education and were greatest amongst young women and those from low income countries. Secondary education has the potential to be a social vaccine across many outcomes in low and middle income countries. Greater primary education is associated with health benefits. Studies suggest that education may have causal effects on health. The health benefits of secondary education are greater than for primary education.
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Affiliation(s)
- Russell M Viner
- UCL Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK
| | | | - Joseph Ward
- UCL Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Ali H Mokdad
- Institute of Health Metrics & Evaluation, 2301 Fifth Ave., Suite 600, Seattle, WA 98121, USA
| | - George Patton
- Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd, Parkville, Vic 3052, Australia
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Viner RM, Hargreaves DS, Motta JVDS, Horta B, Mokdad AH, Patton G. Adolescence and Later Life Disease Burden: Quantifying the Contribution of Adolescent Tobacco Initiation From Longitudinal Cohorts. J Adolesc Health 2017; 61:171-178. [PMID: 28734324 DOI: 10.1016/j.jadohealth.2017.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Adolescence is a time of initiation of behaviors leading to noncommunicable diseases (NCDs). We use tobacco to illustrate a novel method for assessing the contribution of adolescence to later burden. METHODS Data on initiation of regular smoking during adolescence (10-19 years) and current adult smoking were obtained from the 1958 British Birth Cohort, the U.S. National Longitudinal Study of Adolescent Health (Add Health), the Pelotas 1982 Birth Cohort, and the Victorian Adolescent Health Cohort Study. We estimated an "adolescent attributable fraction" (AAF) by calculating the proportion of persisting adult daily smoking initiated < age 20 years. We used findings to estimate AAFs for >155 countries using contemporary surveillance data. RESULTS In the 1958 British Birth Cohort, 81.6% of daily smokers at age 50 years initiated < age 20 years, with a risk ratio of 6.1 for adult smoking related to adolescent initiation. The adjusted AAF was 69.1. Proportions of smokers initiating <20 years, risk ratio, and AAFs were 83.3%, 7.0%, and 70.4% for Add Health; 75.5%, 3.7%, and 50.2% in Victorian Adolescent Health Cohort Study; and 70.9%, 5.8%, and 56.9% in Pelotas males and 89.9%, 6.4%, and 75.9% in females. Initiation <16 years resulted in the highest AAFs. Estimated AAFs globally ranged from 35% in China to 76% in Argentina. CONCLUSIONS The contribution of adolescent smoking initiation to adult smoking burden is high, suggesting a need to formulate and implement effective actions to reduce smoking initiation in adolescents. Similar trends in other NCD risks suggest that adolescents will be central to future efforts to control NCDs.
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Affiliation(s)
- Russell M Viner
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, United Kingdom.
| | - Dougal S Hargreaves
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, United Kingdom
| | | | - Bernardo Horta
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Nambiar B, Shaw J, Hargreaves DS, Colbourn T, McKillop A, Sheridan N, Gray CS, Carswell P, Wodchis WP, Denis JL, Baker GR, Connolly M, Kenealy T. AbstractsUnderstanding the impact of a QI intervention on newborn mortality in 3 central districts in Malawi: a post-hoc theory-based evaluationAdvancing Implementation Science for Quality and Safety in Primary Health Care: The Integrated Care for Older Adults with Complex Health Needs Study (iCOACH). BMJ Qual Saf 2017. [DOI: 10.1136/bmjqs-2017-006696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionA recent WHO multi-country study on maternal and newborn health concluded that there was no evidence of an association between high coverage with essential interventions and reduced mortality in health care facilities, or improvement in other outcomes.1 According to Horton the missing ingredient in this relation is quality of care.2 Quality improvement in healthcare has adopted techniques mainly from industries such as manufacturing and has been used widely in Europe and US. However, evidence of success of these techniques in healthcare is not very conclusive, especially in low and middle-income countries. There have been limited efforts to critically analyse the techniques used in quality improvement interventions. One of the main challenges in evaluating quality improvement is the complexity of the interventions themselves and the complex nature of the systems in which they are implemented. Robust evidence regarding quality improvement interventions for resource poor settings is generally lacking.The MaiKhanda trial looked at the effect of QI interventions and community women's groups on maternal and newborn mortality in 3 central districts in Malawi.3 The impact evaluation measuring effect on newborn mortality for the QI interventions, using a cluster RCT approach, remained inconclusive. We use a Theory-Based Evaluation (TBE) approach to understand why improvement interventions undertaken by MaiKhanda for new-born care did not show an effect. Absence of effect could be attributed to a failure of theory, a failure of implementation, an evaluation failure or a combination of these.Our primary objective was to understand the mechanisms by which the QI interventions worked (or not) and explore the interaction between the various factors that mediated the lack of effect on neonatal mortality that was observed in the cluster randomized control trial.MethodsOur research strategy consisted of developing a post-hoc Theory of Change, consolidating and synthesizing all the available evidence using an appropriate framework, and analysing the program and implementation theory using theory based approaches to evaluation.Data synthesis was conducted using the Consolidate Framework for Implementation Research (CFIR).4 The synthesis takes into consideration the various reports and documents accumulated through the life of the project and complements the process evaluation studies conducted during the same period. In doing so, it draws a picture of the intervention with a multi-dimensional perspective, which provides insights into the evolution of the project. The framework is very comprehensive covering 5 major domains and a range of constructs, not all of which were included in our study. As this was post-hoc analysis, the choice of constructs was based on the availability of data rather than prioritizing the key constructs to consider.CFIR helps to produce structured and comprehensive data that is then used for analysing the program theory in relation to the intervention outcome. The program theory thus generated for the MaiKhanda intervention is compared with the program theories of the Michigan Keystone Project, which used similar collaborative methods to successfully reduce their central venous line blood stream infections in 106 participating ICUs.5 The rationale for such a comparison is that while the interventions per se are very unique and specific to their context, the program theories underlying the use of collaborative methods in both the interventions is the same and therefore comparable. Theories offer a higher level of abstraction that can be comparable across different settings.6
ResultsThe key finding from analysis of the program theory is that similar intervention strategies that triggered successful mechanisms for improvement in the Keystone Project failed to generate such mechanisms in MaiKhanda project.The Model for Improvement used in MaiKhanda was built around Deming's improvement theory7 and Roger's diffusion of innovation theory.8 The former theory considers improvement as a product of subject matter knowledge and profound knowledge. Subject matter knowledge on essential and emergency newborn care was generally lacking among health care providers in Malawi. Similarly, understanding variations within the health systems is an acquired skill. While the implementing partners, provided ample opportunities for the Malawian health system to learn the Institute for Healthcare Improvement (IHI) model for improvement, in general, QI teams lacked capacity to collate data and analyse the variations between the health facilities. QI was a fairly new concept in Malawi and MaiKhanda's attempts to embed it within existing health system was limited by challenges of the health systems context, MaiKhanda's own organizational transition and QI and clinical capacity of health care providers.The main challenge for MaiKhanda was to simultaneously implement and sustain the various change packages it had introduced in the different facilities. While there were isolated instances of successful intervention activities within MaiKhanda, it did not build enough momentum to generate mechanisms across a critical mass of the facilities that would eventually result in improved newborn outcomes. This can be attributed to the implementation strength, context and complexity of MaiKhanda's interventions. This is explored further using the implementation theory.Implementation was based on diffusion theories where better performing facilities were to act as role models for other facilities to emulate. The cRCT design for measuring impact evaluation required a random allocation of the improvement facilities and this conflicted with innovation diffusion theories, which prescribed a gradual organic spread of the interventions by strategically engaging the innovators and early adapters.Limitations of the evaluation design notwithstanding, the implementation strength characterized by the dose, duration, intensity and specificity of the intervention was sub-optimal.Implementation strength is not the only factor triggering an intervention mechanism and cannot be measured independent of the intervention complexity or the intervention context. For example, MaiKhanda struggled to show an effect of its interventions, despite having a long pre-intervention period to refine its interventions, while the Michigan study produced results within 18 month period. This could be because of other factors related to intervention complexity such as the long implementation chain for intervention delivery, the subjective perception of the agency (QI teams) regarding QI and contextual factors such as organizational readiness, the health systems context, QI team capacity to deliver QI interventions and MaiKhanda's own internal capacity.Human agency is at the heart of implementation and the intervention required a continuous and prolonged time and effort, than was anticipated, to engage and train the health facility QI teams on the improvement model.One of the key factors affecting the uptake of strategies was MaiKhanda's positioning within the health system and the degree of influence it could exert on other actors. This factor has a significant role to play in country where projects are donor supported and perhaps also donor driven. The period of the intervention also saw MaiKhanda going through a period of rapid organizational transition, which affected intervention implementation on the ground. Furthermore, MaiKhanda's own understanding of QI concepts was evolving gradually and this coupled with its long implementation chain, influenced the subjective understanding of the QI teams regarding QI concepts. Health facility staff also lacked the necessary skills and knowledge related to management of newborn health.Limited resources within the health facilities meant that gains achieved in some aspects of the intervention could not be sustained in the long run. External contextual factors such as fuel shortages contributed to poor implementation. Changes in policy such as government ban on TBAs, affected intervention uptake and resulted in an increase in health facility deliveries, overwhelming the already under-resourced staff capacity in the health facilities. It is conceivable that quality improvement was not on top of their priority list. But, ‘motivation’ to be involved in QI Collaboratives remained high. In resource constrained settings, ‘motivation’ can be influenced by the lure of personal incentives (such as per diems for attending workshops and meetings) as much as individual's commitment to broader social gains (ie reduction in newborn case fatality rates in their facility). The improvement model was competing against other existing models and it was difficult to get enough stakeholder commitment to the prescribed model as there were huge expectations fuelled by the poverty and poor governance structures and a culture of “perdiemitis” was prevalent in Malawian health care system.9
DiscussionAs is evident from the study, a single research method will not be able to provide justice to evaluation of a complex set of factors that influence newborn outcomes. We propose a research strategy that includes developing a Theory of Change, followed by evaluation of the program theory, measuring implementation strength, analysing implementation theory and comparing this in relation to the outcomes of the intervention observed through the impact evaluation. The results arising from such a comprehensive evaluation will contribute to the growth of improvement science with the accumulation of knowledge and explanation rather than being just a bedrock of observational facts.More generally, we propose that design, implementation and evaluation of QI activities, particularly in resource-poor settings, should consider five key principles i.e it should include whole systems thinking, accountability, participatory approach, should be evidence-based and adapt innovative methods.10
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Hargreaves DS, Struijs JN, Schuster MA. US Children And Adolescents Had Fewer Annual Doctor And Dentist Contacts Than Their Dutch Counterparts, 2010-12. Health Aff (Millwood) 2017; 34:2113-20. [PMID: 26643632 DOI: 10.1377/hlthaff.2015.0709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Children and adolescents in the United States have been found to be less healthy than their counterparts in other high-income countries. The contribution of pediatric health care use to health outcomes--either as an independent determinant or as a mediator of wider social factors--is not well understood. We found that, compared to their peers in the Netherlands, US children and adolescents had fewer annual doctor and dental contacts in 2012. In both countries, poorer health status was reported among low-income compared to high-income children; however, this status was accompanied by greater or equal number of doctor and dental contacts among low-income Dutch children compared to their higher-income Dutch peers. By contrast, low-income US children had 28-65 percent fewer care episodes than high-income US children. Further research is needed to investigate the potential impact of greater equity and use of pediatric services on US health outcomes. Possible policy responses might include a focus on improving the quality, coverage, and benefits of health insurance, as well as on the workforce implications of providing high-quality pediatric care to all.
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Affiliation(s)
- Dougal S Hargreaves
- Dougal S. Hargreaves is an associate professor in the Population, Policy, and Practice program at the Institute of Child Health, University College London, in England
| | - Jeroen N Struijs
- Jeroen N. Struijs is a senior researcher in the Department of Quality of Care and Health Economics at the National Institute of Public Health and the Environment (RIVM), in Bilthoven, the Netherlands
| | - Mark A Schuster
- Mark A. Schuster is the William Berenberg Professor of Pediatrics at Harvard Medical School and chief of the Division of General Pediatrics and vice chair for health policy in the Department of Medicine at Boston Children's Hospital, in Massachusetts
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Nambiar B, Hargreaves DS, Morroni C, Heys M, Crowe S, Pagel C, Fitzgerald F, Pinheiro SF, Devakumar D, Mann S, Lakhanpaul M, Marshall M, Colbourn T. Improving health-care quality in resource-poor settings. Bull World Health Organ 2016; 95:76-78. [PMID: 28053367 PMCID: PMC5180347 DOI: 10.2471/blt.16.170803] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/31/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bejoy Nambiar
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, England
| | - Dougal S Hargreaves
- Great Ormond Street Institute of Child Health, University College London, London, England
| | - Chelsea Morroni
- Institute for Women's Health, University College London, London, England
| | - Michelle Heys
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, England
| | - Sonya Crowe
- Clinical Operational Research Unit, University College London, London, England
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, England
| | - Felicity Fitzgerald
- Great Ormond Street Institute of Child Health, University College London, London, England
| | | | - Delan Devakumar
- Centre for Infectious Disease Epidemiology, University College London, London, England
| | - Sue Mann
- Institute for Women's Health, University College London, London, England
| | - Monica Lakhanpaul
- Great Ormond Street Institute of Child Health, University College London, London, England
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, England
| | - Tim Colbourn
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, England
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Bali A, Hargreaves DS, Cowman J, Lakhanpaul M, Dunkley C, Power M, Cross JH. Integrated care for childhood epilepsy: ongoing challenges and lessons for other long-term conditions. Arch Dis Child 2016; 101:1057-1062. [PMID: 27221818 DOI: 10.1136/archdischild-2015-309794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/03/2022]
Abstract
Epilepsy care has been identified as a major global issue-and there are many recognised concerns in the UK for children and young people with the condition. A proposed new model could help to increase multisector integration, facilitate better outcomes and offer lessons for improving care of other long-term conditions.
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Affiliation(s)
- Amit Bali
- Young Epilepsy, Lingfield, Surrey, UK
| | | | | | - Monica Lakhanpaul
- Integrated Children, Young People and Maternal Health Programme, UCL Partners, London, UK
| | - Colin Dunkley
- Sherwood Forest Hospitals NHS Foundation Trust, King's Mill Hospital, Nottinghamshire, UK
| | | | - J Helen Cross
- The Prince of Wales's Chair of Childhood Epilepsy and Honorary Consultant in Paediatric Neurology, UCL - Institute of Child Health, Great Ormond Street Hospital, London & Young Epilepsy, Lingfield, Surrey, UK
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Hargreaves DS, Williams B, Straw F, Gregorowski A, Yassaee A, Devakumar D. Fifteen-minute consultation: public health for paediatricians-adolescent public health. Arch Dis Child Educ Pract Ed 2016; 101:258-63. [PMID: 27378521 DOI: 10.1136/archdischild-2015-309890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/08/2016] [Indexed: 11/03/2022]
Abstract
Paediatricians have a key role to play in ensuring a holistic, integrated approach is taken to meeting adolescent health needs. There is increasing evidence that failure to do so can lead to poor healthcare experience, avoidable ill health and increased need for healthcare services, both in the short term and in adult life. This article aims to guide paediatricians in answering the questions 'How well are the public health and clinical needs of the adolescent population in my area being met? And how can we improve?'
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Affiliation(s)
- Dougal S Hargreaves
- Population, Policy & Practice Programme, UCL Institute of Child Health, London, UK
| | - Bhanu Williams
- Department of Paediatrics, Northwick Park Hospital, London North West Hospitals NHS Trust, London, UK
| | - Fiona Straw
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Anna Gregorowski
- Department of Paediatrics and Adolescent Medicine, University College London Hospital Foundation Trust, London, UK Department of Adolescent Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Arrash Yassaee
- Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Delan Devakumar
- Institute for Epidemiology and Health Care, University College London, London, UK
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Affiliation(s)
| | - Claire Lemer
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Elspeth Webb
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dougal S Hargreaves
- Department of Population, Policy & Practice Programme, UCL Institute of Child Health, London, UK
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Hargreaves DS, Greaves F, Levay C, Mitchell I, Koch U, Esch T, Denny S, Frich JC, Struijs J, Sheikh A. Comparison of Health Care Experience and Access Between Young and Older Adults in 11 High-Income Countries. J Adolesc Health 2015. [PMID: 26205758 DOI: 10.1016/j.jadohealth.2015.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Young adults (18-24 years) frequently report poorer health care access and experience than older adults. We aimed to investigate how differences between young and older adults vary across 11 high-income countries. METHODS A total of 20,045 participants from 11 high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, United States) participating in the Commonwealth Fund 2013 International Health Policy Survey. We compared young adults (18-24 years) with older adults (25-34; 35-49; 50-64; 65+ years) on three aspects of health care: overall satisfaction, cost barriers to access, and four indicators of consultation quality relating to adequate information, time, involvement, and explanation. RESULTS Across all participants, young adults reported significantly worse overall satisfaction (63.6% vs. 70.3%; p < .001) and more frequent cost barriers (21.3% vs. 15.2%; p < .001) than older adults. Country-level analyses showed that young adults reported lower overall satisfaction than older adults in five of 11 countries (Australia, Canada, Norway, Switzerland, United States) and more frequent cost barriers in six of 11 countries (Canada, France, Germany, Switzerland, Norway, United States). In five countries (Australia, Canada, France, Norway, Switzerland), most patient experience indicators were less positive among young adults than those among older adults. In three countries (Netherlands, New Zealand, United Kingdom), there was no significant difference between young and older adults on any indicator. CONCLUSIONS Associations between age and health care access/experience varied markedly between countries, suggesting that poor access and experience among young adults is not inevitable and may be amenable to policy/practice interventions.
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Affiliation(s)
- Dougal S Hargreaves
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Population, Policy & Practice Programme, UCL Institute of Child Health, London, United Kingdom.
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Charlotta Levay
- Department of Business Administration, Lund University, Lund, Sweden
| | - Imogen Mitchell
- Department of Medicine, Australian National University, Canberra Hospital, Canberra, Australia
| | - Ursula Koch
- Institute for Primary Care, University of Zürich, UniversitätsSpital Zürich, Zürich
| | - Tobias Esch
- Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Simon Denny
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jan C Frich
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Jeroen Struijs
- National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Aziz Sheikh
- Centre for Population Health Sciences, Medical School, Edinburgh, United Kingdom
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Hargreaves DS, Elliott MN, Viner RM, Richmond TK, Schuster MA. Unmet Health Care Need in US Adolescents and Adult Health Outcomes. Pediatrics 2015; 136:513-20. [PMID: 26283778 DOI: 10.1542/peds.2015-0237] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescence is a formative period when health care services have a unique opportunity to influence later health outcomes. Unmet health care need in adolescence is known to be associated with poor contemporaneous health outcomes; it is unknown whether it predicts poor adult health outcomes. METHODS We used nationally representative data from 14 800 subjects who participated in Wave I (mean age: 15.9 years [1994/1995]) and Wave IV (mean age: 29.6 years [2008]) of the National Longitudinal Study of Adolescent to Adult Health. Logistic regression models were used to estimate the association between unmet health care need in adolescence and 5 self-reported measures of adult health (fair/poor general health, functional impairment, time off work/school, depressive symptoms, and suicidal ideation). Models were adjusted for baseline health, insurance category, age, gender, race/ethnicity, household income, and parental education. RESULTS Unmet health care need was reported by 19.2% of adolescents and predicted worse adult health: fair/poor general health (adjusted odds ratio [aOR]: 1.27 [95% confidence interval (CI): 1.00-1.60]); functional impairment (aOR: 1.52 [95% CI: 1.23-1.87]); depressive symptoms (aOR: 1.36 [95% CI: 1.13-1.64]); and suicidal ideation (aOR: 1.30 [95% CI: 1.03-1.68]). There was no significant association between unmet health care need and time off work/school (aOR: 1.13 [95% CI: 0.93-1.36]). Cost barriers accounted for only 14.8% of unmet health care need. The reason for unmet need was not significantly related to the likelihood of poor adult health outcomes. CONCLUSIONS Reported unmet health care need in adolescence is common and is an independent predictor of poor adult health. Strategies to reduce unmet adolescent need should address health engagement and care quality, as well as cost barriers to accessing services.
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Affiliation(s)
- Dougal S Hargreaves
- Division of General Pediatrics, Department of Medicine, and Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom;
| | | | - Russell M Viner
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Hale DR, Patalay P, Fitzgerald-Yau N, Hargreaves DS, Bond L, Görzig A, Wolpert M, Stansfeld SA, Viner RM. School-level variation in health outcomes in adolescence: analysis of three longitudinal studies in England. Prev Sci 2015; 15:600-10. [PMID: 23793374 DOI: 10.1007/s11121-013-0414-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
School factors are associated with many health outcomes in adolescence. However, previous studies report inconsistent findings regarding the degree of school-level variation for health outcomes, particularly for risk behaviours. This study uses data from three large longitudinal studies in England to investigate school-level variation in a range of health indicators. Participants were drawn from the Longitudinal Study of Young People in England, the Me and My School Study and the Research with East London Adolescent Community Health Survey. Outcome variables included risk behaviours (smoking, alcohol/cannabis use, sexual behaviour), behavioural difficulties and victimisation, obesity and physical activity, mental and emotional health, and educational attainment. Multi-level models were used to calculate the proportion of variance in outcomes explained at school level, expressed as intraclass correlations (ICCs) adjusted for gender, ethnicity and socio-economic status of the participants. ICCs for health outcomes ranged from nearly nil to .28 and were almost uniformly lower than for attainment (.17-.23). Most adjusted ICCs were smaller than unadjusted values, suggesting that school-level variation partly reflects differences in pupil demographics. School-level variation was highest for risk behaviours. ICCs were largely comparable across datasets, as well as across years within datasets, suggesting that school-level variation in health remains fairly constant across adolescence. School-level variation in health outcomes remains significant after adjustment for individual demographic differences between schools, confirming likely effects for school environment. Variance is highest for risk behaviours, supporting the utility of school environment interventions for these outcomes.
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Affiliation(s)
- Daniel R Hale
- General and Adolescent Pediatrics, Institute of Child Health, UCL, 30 Guilford St, London, WC1N 1EH, UK,
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Bensted R, Hargreaves DS, Lombard J, Kilkelly U, Viner RM. Comparison of healthcare priorities in childhood and early/late adolescence: analysis of cross-sectional data from eight countries in the Council of Europe Child-friendly Healthcare Survey, 2011. Child Care Health Dev 2015; 41:160-5. [PMID: 24962262 PMCID: PMC4283976 DOI: 10.1111/cch.12169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2014] [Indexed: 11/26/2022]
Abstract
AIMS To investigate healthcare priorities among children (≤ 12 years), early adolescents (13-15 years) and late adolescents (16-18 years). METHODS A total of 2023 respondents from eight European countries rated the importance of nine healthcare factors. The relative importance of these factors was compared within and between age groups, using mean score differences and logistic regression. RESULTS The most important item for all age groups was being listened to. Children rated pain control and the presence of parents more important than either understanding the doctor or being able to ask questions. Among adolescents, these differences disappeared for pain control and were reversed for parental presence. The changes in relative priorities between childhood and adolescence remained significant after adjusting for sex, long-standing illness and nationality (all P < 0.001). CONCLUSION Healthcare priorities evolve significantly between childhood and early adolescence. However, being listened to is the most important priority at all ages.
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Affiliation(s)
- R Bensted
- Royal Free London NHS Foundation TrustUK
| | | | - J Lombard
- University College CorkCork, Ireland
| | | | - R M Viner
- UCL Institute of Child HealthLondon, UK
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42
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Affiliation(s)
- Dougal S Hargreaves
- General & Adolescent Paediatrics Unit, UCL Institute of Child Health, London, United Kingdom; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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Viner RM, Hargreaves DS, Coffey C, Patton GC, Wolfe I. Deaths in young people aged 0-24 years in the UK compared with the EU15+ countries, 1970-2008: analysis of the WHO Mortality Database. Lancet 2014; 384:880-92. [PMID: 24929452 DOI: 10.1016/s0140-6736(14)60485-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concern is growing that mortality and health in children and young people in the UK lags behind that of similar countries. METHODS We analysed death registry data provided to the WHO Mortality Database to compare UK mortality for children and young people aged 0-24 years with that of European Union member states (before May, 2004, excluding the UK, plus Australia, Canada, and Norway [the EU15+ countries]) from 1970 to 2008 using the WHO World Mortality Database. We grouped causes of death by Global Burden of Disease classification: communicable, nutritional, or maternal causes; non-communicable disorders; and injury. UK mortality trends were compared with quartiles of mortality in EU15+ countries. We used quasi-likelihood Poisson models to explore differences between intercepts and slopes between the UK and the EU15+ countries. FINDINGS In 1970, UK total mortality was in the best EU15+ quartile (<25th centile) for children and young people aged 1-24 years, with UK infant mortality similar to the EU15+ median. Subsequent mortality reductions in the UK were smaller than were those in the EU15+ countries in all age groups. By 2008, total mortality for neonates, infants, and children aged 1-4 years in the UK was in the worst EU15+ quartile (>75th centile). In 2008, UK annual excess mortality compared with the EU15+ median was 1035 deaths for infants and 134 for children aged 1-9 years. Mortality from non-communicable diseases in the UK fell from being roughly equivalent to the EU15+ median in 1970 to the worst quartile in all age groups by 2008, with 446 annual excess deaths from non-communicable diseases in the UK (280 for young people aged 10-24 years) in 2008. UK mortality from injury remained in the best EU15+ quartile for the study period in all age groups. INTERPRETATION The UK has not matched the gains made in child, adolescent, and young adult mortality by other comparable countries in the 40 years since 1970, particularly for infant deaths and mortality from non-communicable diseases, including neuropsychiatric disorders. The UK needs to identify and address amenable social determinants and health system factors that lead to poor health outcomes for infants and for children and young people with chronic disorders. FUNDING None.
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Affiliation(s)
| | | | - Carolyn Coffey
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, VIC, Australia
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, VIC, Australia
| | - Ingrid Wolfe
- King's College London, Evelina London Children's Hospital, London, UK
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Abstract
OBJECTIVE To investigate patterns and trends of adolescent (10-19 years) inpatient activity in England by sex, disease category, and admitting speciality. DATA 9 632 844 Finished Consultant Episodes (FCEs) from English patients aged 1-19 between 1999/2000 and 2010/2011 (Hospital Episode Statistics data). ANALYSES Age trends by sex and major International Classification of Disease 10 (ICD10) chapter; differences in activity rates by age and sex; inpatient activity trends over the past decade, disaggregated by sex, admitting speciality and ICD10 chapter. RESULTS Adolescent female patients account for more activity than girls aged 1-9 (139.4 vs 107.2 FCEs/1000). Female inpatient activity increases significantly between age 10 (70.9 FCEs/1000) and 19 (281.7 FCES/1000, of which non-obstetric care accounts for 155.9 FCEs/1000). Male activity increases much less during adolescence, with lower overall rates among adolescents than younger children (93.7 vs 142.9 FCEs/1000). Between 1999 and 2010, total adolescent inpatient activity increased faster among adolescents (10-19 years) (+14.2%) than younger children (1-9 years) (+11.0%). Adolescent FCEs/1000 increased by 12.8%, including higher rates admitted under Paediatrics (+47.5%) and Paediatric Surgery (+23.2%). Adolescents were admitted across a range of specialities. CONCLUSIONS These data challenge the belief that adolescents are a healthy group who rarely use inpatient services. In England, use of inpatient services is higher among female patients aged 10-19 years than those aged 1-9 years, while adolescent activity has increased faster than for younger children over the past 11 years. Improving service quality for adolescents will require engagement of the many different teams that care for them.
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Affiliation(s)
- Dougal S Hargreaves
- Department of General & Adolescent Paediatrics, UCL Institute of Child Health, London, UK,Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Russell M Viner
- Department of General & Adolescent Paediatrics, UCL Institute of Child Health, London, UK
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Hargreaves DS, James D, Goddings AL, McVey D, Viner RM. Distinct patterns of health engagement among adolescents and young adults in England: implications for health services. Perspect Public Health 2014; 134:81-4. [PMID: 24503917 DOI: 10.1177/1757913913519770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To compare levels of health engagement between adolescents, young adults and older adults and to investigate the association between health engagement and key health outcomes at different ages. METHODS Using the Healthy Foundations study (2008), the responses to three previously validated questions on health engagement were analysed by age group; adolescents (12-15 years; N=452), young adults (16-24 years; N=785) and older adults (25-74 years; N=4136). Logistic regression was used to calculate the odds ratio of poor health outcomes among participants with low versus high health engagement. RESULTS Feeling in control of one's own health decreased from adolescence (mean score 79.3 (95% CI 77.6,81.0)), through young adulthood (74.6 (73.1,76.1)) into older adulthood (72.2 (71.5,72.9)). In contrast, perceived involvement in health showed a U-shaped trajectory: (adolescents 72.0 (70.2,73.7), young adults 68.6 (67.1,70.1), older adults 73.8(73.1,74.5)), as did perceived importance of health (adolescents 75.0 (73.1,76.9), young adults 62.9 (61.0,64.8), older adults 77.1 (76.4,77.8)). Not feeling involved in health was more strongly associated with poor general health among adolescents (OR 1.81 (1.41,2.32)) than older adults (OR 1.19 (1.11,1.28)). Not feeling in control of health was only associated with poorer general health among young adults (OR 2.33 (1.93,2.83)) and older adults (OR 2.26 (2.10,2.44)). In contrast, lack of control over health was most strongly associated with physical inactivity among adolescents (OR 1.99 (1.49,2.66)) but this was also significant in young adults (OR 1.25 (1.06,1.48)) and older adults (OR 1.11 (1.04,1.19)). CONCLUSION Young adults feel less involved in their health and rate health a less important priority than adolescents and older adults. Involvement is more strongly linked to key health behaviours among under 25s than older adults.
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Abstract
OBJECTIVE To investigate trends in health inequality among children and young people between 1999 and 2009, using outcomes consistent with the current NHS reforms. DESIGN/DATA Secondary analysis of participants aged 0-24 in the Health Surveys for England (HSE) undertaken in 1999, 2004, 2006 and 2009. MAIN OUTCOME MEASURES Changes in the absolute and relative risks of four health outcomes by deprivation tertiles, based on occupation of the head of household: self/parent-reported general health; presence of a long-standing illness (LSI); obesity; smoking. RESULTS No indicator showed a reduction in relative or absolute inequality between 1999 and 2009. For children (0-12 years), the relative risk comparing the most and least deprived tertiles increased significantly for poor general health (1999:1.6 (95% CI 1.2 to 2.2); 2009:3.9 (2.4 to 6.2), while the absolute difference in LSI prevalence(%) increased from 1.3 (-2.9 to 5.5) to 7.4 (3.6 to 11.4). Among young people (13-24 years), the absolute difference in LSI prevalence increased from -5.9 (-10.9 to -1.1) to 3.1 (-4.1 to 10.7). Absolute inequality in having tried smoking among children aged 8-15(%) increased significantly in the first half of the decade before decreasing in the second half (1999:3.3 (-1.1 to 7.7); 2004:14.1 (9.6 to 18.8); 2009:4.1 (0.1 to 8.8)). However, the increase in absolute inequality for smoking prevalence among young adults (16-24 years) was maintained throughout the decade (1999:-7.0 (-15.6 to 1.3); 2004:11.6 (3.7 to 20.0); 2009:8.2 (-0.3 to 16.9)). CONCLUSIONS The national programme between 1999 and 2009 was not successful in reducing inequality in four key indicators of health status and future health risk among children and young people. Some inequality measures for general health, LSI prevalence and smoking increased over this time.
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Affiliation(s)
- Dougal S Hargreaves
- General and Adolescent Paediatrics Unit, UCL Institute of Child Health, , London, UK
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Abstract
Aims: In 2010, the English Department of Health launched a radical new public health
strategy, which sees individual factors, such as self-esteem, as the key to improving
all aspects of young people’s health. This article compares the strength of association
between key adolescent health outcomes and a range of individual and social factors Methods: All participants aged 12–15 in the nationally representative 2008 Healthy Foundations
survey were included. Six individual factors related to self-esteem, confidence and
personal responsibility, and seven social factors related to family, peers, school and
local area were investigated. Single-factor and multivariable logistic regression models
were used to calculate the association between these factors and seven health outcomes
(self-reported general health, physical activity, healthy eating, weight, smoking,
alcohol intake, illicit drug use). Odds ratios were adjusted for gender, age and
deprivation. Results: Individual factors such as self-esteem were associated with general health, physical
activity and healthy eating. However, the influence of family, peers, school and local
community appear to be equally important for these outcomes and more important for
smoking, drug use and healthy weight. Conclusion: Self-esteem interventions alone are unlikely to be successful in improving adolescent
health, particularly in tackling obesity and reducing substance misuse.
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Hargreaves DS, Sizmur S, Viner RM. Do young and older adults have different health care priorities? Evidence from a national survey of English inpatients. J Adolesc Health 2012; 51:528-32. [PMID: 23084177 DOI: 10.1016/j.jadohealth.2012.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/18/2012] [Accepted: 05/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This article compares the inpatient experience of young versus older adults, and assesses the relative importance of different aspects of health care in these two groups. PARTICIPANTS The study comprised adult inpatients in 161 English hospitals. METHODS Standardized scores were calculated covering overall care and eight domains of patient experience (consistency, respect, involvement, nursing, doctors, cleanliness, pain control, and privacy). Values for young and older adults were compared. Additionally, Fisher r-to-z transformation was used to assess age differences in the strength of correlation between overall care and individual care domains. RESULTS Young people reported a poorer experience across all aspects of inpatient care (p < .01). Compared with older adults, young men's overall care rating was more strongly correlated to pain control, and young women's to respect and doctors' characteristics (p < .05). CONCLUSIONS These findings provide a quantitative national-level evidence base regarding young people's priorities in inpatient care.
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Affiliation(s)
- Dougal S Hargreaves
- General and Adolescent Paediatrics Unit, University College London Institute of Child Health, London, UK.
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Hargreaves DS, Djafari-Marbini A. OP01 Did Health Inequality Increase in English Children and Young People between 1999 and 2009? Evidence from two Cross-Sectional Surveys and Inpatient Activity Data. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVES To investigate what data are available on the National Health Service (NHS) experience of children and young people (0-24 years), and how their experience compares with that of older patients. DESIGN AND DATA SELECTION: Review of 38 national surveys undertaken or planned between 2001 and 2011, identified by the Department of Health (2010). Detailed analysis performed on the most recent completed surveys covering primary, inpatient and emergency care, and children's services. RESULTS Patients under 16 were included in 1/38 national surveys, comprising <0.6% of over 10 million respondents. The majority of young people aged 16-24 reported a positive experience of NHS care. However, satisfaction was lower than in older adults. 80.7% of 16-24 year olds reported good emergency department care, compared with 89.2% of older adults (Emergency Department Survey 2008, N=49 646, OR=0.51, 95% CI 0.47 to 0.55, p<0.001). In the Inpatient Survey 2009, 86.5% of 16-24 year olds reported good care, compared with 92.7% of older adults, (N=69 348, OR=0.51, 95% CI 0.45 to 0.57, p< 0.001). Satisfaction with primary care was reported by 83% of 18-24 year olds, compared with 90% of older adults (GP Patient Survey 2009-10 (N=2 169 718, OR=0.52, 95% CI 0.51 to 0.53, p<0.001). Young people also reported a poorer experience than older adults for their perceived involvement in care, having confidence and trust in their doctor and being treated with respect and dignity. CONCLUSIONS Despite the current focus on services for young people and the importance of patients' views in improving services, the voice of under 16s is not included in most national surveys. Despite high levels of overall satisfaction, young adults report a poorer experience of care than older adults.
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Affiliation(s)
- Dougal S Hargreaves
- Department of General and Adolescent Paediatrics, UCL Institute of Child Health, 30 Guilford St, London WC1N 3EH, UK.
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