Improved primary care does not prevent the admission of children to hospital

Abstract

In Nottingham Health District a study has been carried out whose aims were: (1) to compare acute paediatric medical admissions in 1985 with those in 1975 and to relate any differences to changes in services; (2) to measure the numbers of preventable admissions, working on the hypothesis that this would give an indication of the performance of community services. A structured questionnaire was completed with parents, and information obtained from notes of all children admitted with acute medical problems during October 1985. Results were compared with a similar study undertaken in 1975 by Wynne and Hull1 on children from the same catchment area. Further information for all health districts in Trent Region was obtained from Hospital Activity Analysis data relating to these 10 years. There has been a 100% increase in children's admissions in Nottingham, with similar increases throughout Trent Region. Apart from ingestions, there are increases in every diagnostic category, with a 6-fold increase in the admission rate for lower respiratory tract problems, mostly asthma and wheeze. Only 9% were classified as 'social admissions'. The idea of certain admissions being preventable is not a useful concept. Improvements in primary care have not been accompanied by a fall in hospital admissions.