Breathing pattern disorders (dysfunctional breathing) characteristics and outcomes of children and young people attending a secondary care respiratory clinic

BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

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Secondary care specialist visits made by children and young people prescribed antidepressants in primary care: a descriptive study using the QResearch database

BMC Medicine ◽

10.1186/s12916-020-01560-7 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Ruth H. Jack ◽

Rebecca M. Joseph ◽

Carol Coupland ◽

Debbie Butler ◽

Chris Hollis ◽

...

Keyword(s):

Primary Care ◽

Young People ◽

Secondary Care ◽

Descriptive Study ◽

Children And Young People ◽

Care Specialist

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Categorising high-cost high-need children and young people

Archives of Disease in Childhood ◽

10.1136/archdischild-2021-321654 ◽

2021 ◽

pp. archdischild-2021-321654

Author(s):

Nikita Punjabi ◽

Kathryn Marszalek ◽

Thomas Beaney ◽

Rakhee Shah ◽

Dasha Nicholls ◽

...

Keyword(s):

Young People ◽

Social Services ◽

Secondary Care ◽

Health Spending ◽

Healthcare Utilisation ◽

Research Unit ◽

Practice Research ◽

Research Database ◽

Services Research ◽

Children And Young People

ObjectivesTo describe the characteristics of high-cost high-need children and young people (CYP) (0–24 years) in England.MethodsRetrospective observational study using data from the Clinical Practice Research Database linked to Hospital Episode Statistics in 2014/2015 and 2015/2016. Healthcare utilisation of primary and secondary care services were calculated, and costs were estimated using Healthcare Resource Group for secondary care and Personal Social Services Research Unit for primary care. High-cost high-need CYP were defined as the top 5% of users by cost.Results3891 of 73 392 CYP made up the top 5% that were classified as high-cost high-need, and this group accounted for 54% of total annual costs. In this population, 7.3% were males <5 years and 11.0% were females 20–24 years. Inpatient care (acute) accounted for 63% of known spending in high-cost high-need patients. Total mean monthly cost per patient was 22.7 times greater in the high-cost high-need group compared with all other patients (£4417 vs £195). 29% of CYP in the high-cost high-need group in 2014/2015 were also classified as high-cost high-need in the following year.ConclusionsThese findings indicate the importance of further understanding and anticipating trends in CYP health spending to optimise care, reduce costs and inform new models of care. This includes integrated services, a further look into societal factors in reducing health inequalities and a particular focus of mental health services, the demand of which increases with age.

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Primary, secondary care and mortality data-linked to identify the prevalence of cerebral palsy in children and young people

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.794 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Bethan Carter ◽

Hywel Jones ◽

Jackie Bethell ◽

Ting Wang ◽

Sarah Rees ◽

...

Keyword(s):

Young People ◽

Secondary Care ◽

Chronic Conditions ◽

Hospital Admissions ◽

Mortality Data ◽

Care Hospital ◽

Children And Young People ◽

Period Prevalence ◽

Primary Care Hospital ◽

Clinical Records

IntroductionEvaluations of healthcare utilisation for children and young people (CYP) with chronic conditions, are increasingly relying upon routinely collected healthcare data to estimate healthcare burden and inform national policy and practice. However, chronic conditions are not consistently or accurately recorded making it difficult to conduct valid epidemiological analyses. Objectives and ApproachWe explored routinely collected healthcare datasets of 2,122,914 CYP in the English Clinical Practice Research Dataset (CPRD) and 1,636,252 CYP in the Welsh Secure Anonymous Information Linkage (SAIL) databank to identify patients with CP (an exemplar of a chronic neurodisability) from diagnosis coding (G80-83.3). Linked primary care, hospital admission outpatient and mortality data were searched from birth and populations of CYP aged 0-25 years between 2004 and 2014 with and without CP were identified. We detected the ascertainment sources and compared the results from CPRD and SAIL. In a sample of cases G80-83 codes were validated against clinical records. Results England: Some 7,500 cases of CP were identified (period prevalence: 3.5 per 1000 CYP). Of those, 36.6% were identified from hospital admissions; 20.6% from GP data, 42.0% were in both datasets with 0.8% from outpatient/ONS mortality data. Wales: Some 5,400 cases of CP were identified (period prevalence: 3.3 per 1000 CYP). Of those, 38.6% were identified from hospital admissions, 25.3% from GP data, 36.0% were in both datasets, and 0.1% from mortality/outpatient datasets. 729/877(83.1%) cases coded as G80-83 in secondary care case notes were validated cases of CP leaving 16.9% that were incorrectly coded. Approximately 70% of G80 cases were recorded as G80.8-9 (CP other/unspecified). Roughly 30% of cases were only coded as CP on one occasion within the primary and secondary care datasets. Conclusion/ImplicationsSimilar proportions of CP cases were identified in the two datasets giving similar period prevalences. Inconsistent and incorrect coding will affect the accuracy of these figures and precludes any analysis by disease type/severity. Improved coding of chronic conditions is needed before accurate healthcare analysis of routine data can be undertaken.

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Trends in antidepressant prescriptions in children and young people in England, 1998–2017: protocol of a cohort study using linked primary care and secondary care datasets

Evidence-Based Mental Health ◽

10.1136/ebmental-2019-300097 ◽

2019 ◽

Vol 22 (3) ◽

pp. 129-133 ◽

Cited By ~ 3

Author(s):

Ruth H Jack ◽

Chris Hollis ◽

Carol Coupland ◽

Richard Morriss ◽

Roger David Knaggs ◽

...

Keyword(s):

Primary Care ◽

Young People ◽

Secondary Care ◽

Selective Serotonin Reuptake Inhibitors ◽

Large Population ◽

Population Based ◽

Population Based Study ◽

Children And Young People ◽

Antidepressant Prescription ◽

Trends Over Time

IntroductionIncreasing numbers of children and young people (CYP) are receiving prescriptions for antidepressants. This is the protocol of a study aiming to describe the trends and variation in antidepressant prescriptions in CYP in England, and to examine the indications for the prescriptions recorded and whether there was contact with secondary care specialists on or around the time of the first antidepressant prescription.Methods and analysisAll eligible CYP aged between 5 and 17 years in 1998–2017 from the QResearch primary care database will be included. Incidence and prevalence rates of any antidepressant prescription in each year will be calculated. We will examine four different antidepressant classes: selective serotonin reuptake inhibitors, tricyclic and related antidepressants, serotonin and norepinephrine reuptake inhibitors and other antidepressants, as well as for individual drugs. Linked primary and secondary care data (hospital episode statistics) in the year before and up to 6 months after the first antidepressant prescription will be examined for CYP whose first antidepressant prescription was in 2006–2017. Whether there were records of indications and being seen by psychiatric or paediatric specialists will be identified. Trends over time and differences by region, deprivation and ethnicity will be examined using Poisson regression.DiscussionThis large, population-based study will give an up-to-date picture of antidepressant prescribing in CYP and identify any variation. Understanding what indications are recorded when CYP are being prescribed antidepressants, and whether this was done in partnership with secondary care specialists, will provide evidence of whether appropriate guidelines are being followed.

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