The online version of this article (https://doi.org/10.1186/s12916-018-1142-3) contains supplementary material, which is available to authorized users.
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.
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.
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.
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.
Additional file 1: Table S1. Read codes identifying preventive care consultations and children with a coded diagnosis of an ambulatory care sensitive condition. Table S2. Ambulatory care sensitive admission ICD-10 codes. Table S3. International Classification of Disease version 10 (ICD-10) diagnoses for prematurity/low birth weight. Table S4. ICD-10 diagnoses for congenital disease. Table S5. Covariates and outcomes in children with full versus censored follow-up. Table S6. Adjusted hazard ratios for unplanned admission stratified by full versus censored follow-up in infants. Table S7. Association of preventive primary care, comorbidity and social factors on risk of unplanned hospital admission in using a random intercept model clustering by GP practice. (DOCX 107 kb)12916_2018_1142_MOESM1_ESM.docx
Additional file 2: A supplementary file detailing the methodology used for creating the birth cohort; the preventive care consultations and illness consultations. (DOCX 24 kb)12916_2018_1142_MOESM2_ESM.docx
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- Impact of preventive primary care on children’s unplanned hospital admissions: a population-based birth cohort study of UK children 2000–2013
Dougal S. Hargreaves
Arch G. Mainous III
- BioMed Central
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