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.
Subject(s)
Ambulatory Care Facilities/organization & administration , Delivery of Health Care, Integrated/standards , Emergency Service, Hospital , Health Services Accessibility/organization & administration , Primary Health Care , Adolescent , Ambulatory Care Facilities/economics , Child , Child, Preschool , Delivery of Health Care, Integrated/economics , Emergency Service, Hospital/economics , Emergency Service, Hospital/statistics & numerical data , Female , Health Services Accessibility/economics , Humans , Infant , Infant, Newborn , Male , Primary Health Care/economics , Primary Health Care/statistics & numerical data , Prospective StudiesSubject(s)
Child Health Services/organization & administration , Child Health , Delivery of Health Care, Integrated/organization & administration , Primary Health Care , Child , Child Health Services/economics , Cost-Benefit Analysis , Delivery of Health Care, Integrated/economics , Humans , Quality Improvement , Secondary CareABSTRACT
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?'
Subject(s)
Adolescent Health Services , Pediatrics , Public Health , Adolescent , Humans , Needs Assessment , Physician's RoleABSTRACT
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.
Subject(s)
Delivery of Health Care, Integrated , Epilepsy/therapy , Adolescent , Child , Child Health Services/organization & administration , Child Health Services/standards , Global Health , Health Policy , Humans , Long-Term Care/organization & administration , Long-Term Care/standards , Models, Theoretical , Quality Improvement , Treatment Outcome , United KingdomABSTRACT
In 2011, the Department of Health (England) will publish revised You're Welcome criteria. This is the first comprehensive attempt to define good quality health services for young people (11-19 years) and provide a self-assessment tool applicable to all adolescent health services. It builds on a growing understanding of the distinctiveness and importance of adolescent health, and the demands placed on adolescent health services. This article reviews changing understandings of the nature of adolescence, including physical, psychological and social transition, evolving patterns of morbidity and mortality, adolescence as part of a life-course approach to health and health behaviours, and the specific needs of young people when using health services. We describe key features of the You're Welcome criteria and discuss the views of young people and professionals involved in revising them, as well as relevant published literature. Lastly, we discuss how the perspective of social paediatrics may be useful in guiding professionals towards a more holistic approach to adolescent care in the future.