Exploring the health and service utilisation of general practice patients with a history of adverse childhood experiences (ACEs): an observational study using electronic health records

Abstract

Objectives: To examine the relationships between adverse childhood experiences (ACEs), chronic health and health service utilisation among a sample of general practice patients.

Design: Cross-sectional observational study using anonymised data from electronic health records for 763 patients.

Setting: Four general practices in northwest England and North Wales.

Outcome measures: Patient demographic data (age, gender); body mass index; self-reported smoking status; self-reported ACEs; diagnosis of chronic health conditions; current mental health problems; total number of service contacts and repeat medication use in the previous 6 months.

Results: A history of ACEs (experiencing abuse or neglect as a child, and/or growing up in a household characterised by violence, substance use, mental health problems or criminal behaviour) was strongly independently associated with current mental health problems, smoking and chronic obstructive pulmonary disease, showing a dose-response relationship with level of ACE exposure. Medication use and contact were significantly greater among patients with high ACE exposure (≥4 ACEs), compared with those with no ACEs. However, contrary to findings from population studies, health service utilisation was not significantly different for patients with increased ACE exposure (1-3 ACEs) and their ACE-free counterparts.

Conclusions: Findings highlight the contribution ACEs make to unequal distributions of risk to health and well-being and patterns of health service use in the UK.

Keywords: adverse events; mental health; primary care; public health.

Figure 1

High health service utilisation, shown by level of ACE exposure. ACE, adverse childhood experience. *Total number of face-to-face and telephone consultations in the past 6 months > practice mean. **Total number of items on current repeat prescription > practice mean.