Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
Department of Emergency Medicine, Cork University Hospital, Cork, Ireland.
BMJ Paediatr Open. 2021 Feb 17;5(1):e000862. doi: 10.1136/bmjpo-2020-000862. eCollection 2021.
To examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years.
This is a retrospective observational study that used a large administrative dataset.
The study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive.
Children aged 0-15 years who attended CUH ED during the study period of 6 years (2012-2018) were included in this study (n=76 831).
Free GP care was expanded to all children aged 0-5 years in July 2015.
Paediatric attendances to CUH ED were examined before (Time Period 1: July 2012-June 2015) and after (Time Period 2: July 2015-June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated.
Paediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0-5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%.
The expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.
研究科克大学医院（Cork University Hospital，CUH）在向 6 岁以下儿童免费提供全科医生（general practitioner，GP）服务扩大之前和之后，儿科就诊者的特征。
这是一项回顾性观察性研究，使用了大型行政数据集。
该研究在爱尔兰主要的三级转诊中心进行，服务总人口超过 110 万。它是一家公立医院，由医疗服务行政部门拥有和管理。
本研究纳入了在研究期间（2012-2018 年）到 CUH 急诊科就诊的 0-15 岁儿童（n=76831）。
2015 年 7 月，免费 GP 服务扩大到所有 0-5 岁儿童。
在向 6 岁以下儿童扩大免费 GP 服务之前（时间段 1：2012 年 7 月至 2015 年 6 月）和之后（时间段 2：2015 年 7 月至 2018 年 6 月），CUH 急诊科的儿科就诊情况。研究了 GP 转诊率和住院入院率的变化。
CUH 急诊科儿科就诊人数从时间段 1 的 35819 例增加到时间段 2 的 41012 例（增加 14.5%）。6 岁以下儿童通过 GP 转诊到 CUH 急诊科就诊的比例在时间段 2 增加了 8%以上（从 10148 例增加到 14028 例）。尽管所有到 CUH 急诊科就诊并住院的儿童人数在时间段 2 有所增加（从 8704 例增加到 9320 例）；通过 GP 转诊并随后住院的 0-5 岁儿童比例下降了 3%以上。
免费 GP 服务的扩大对上游卫生服务利用有影响，例如急诊科就诊人数增加，政策制定者应考虑并为其成本买单。
