Department of Primary Care & Public Health, Imperial College London, London, UK
Department of Primary Care & Public Health, Imperial College London, London, UK.
BMJ Open. 2020 May 5;10(5):e033761. doi: 10.1136/bmjopen-2019-033761.
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.
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.
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.
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.
描述 2007 年至 2017 年期间，在主要初级保健改革后的十年中，英格兰不满 15 岁的儿童与使用紧急护理和计划内医院服务相关的初级保健使用变化情况。
基于人群的回顾性队列研究。
我们使用临床实践研究数据链接（Clinical Practice Research Datalink）中的关联数据，研究了儿童的初级保健咨询以及对医院护理的使用情况，包括急诊部（ED）就诊、紧急和择期住院以及专科门诊就诊。
在 2007 年 4 月 1 日至 2017 年 3 月 31 日期间，在 1484455 名不满 15 岁的儿童中，有 7604024 次全科医生（GP）就诊、981684 次 ED 就诊、287719 次紧急住院、2253533 次专科门诊就诊和 194034 次择期住院。除婴儿外，所有年龄组的 GP 就诊率标准化后每年下降 1.0%，至 2017 年为每 1000 儿童年 1864 次；而婴儿的 GP 就诊率每年增加 1.0%，至 2017 年达到每 1000 儿童年 6722 次。2017 年 ED 就诊率每年增加 1.6%，达到每 1000 儿童年 369 次，其中婴儿的就诊率上升更为明显，为每年 3.9%，达到每 1000 儿童年 780 次。紧急住院率稳步上升，每年上升 3%，达到每 1000 儿童年 86 次，门诊就诊率上升至每 1000 儿童年 724 次。
在国民保健制度初级保健改革后的过去十年中，除婴儿外，所有儿童的 GP 就诊率都有所下降。所有年龄段的儿童对医院急诊和门诊服务的使用率都有所上升，尤其是婴儿。这些变化表明，需要为有年幼子女的家庭提供更好的获取途径和提供专家和社区支持。
