Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

Abstract

Objectives: 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.

Design: This is a retrospective observational study that used a large administrative dataset.

Setting: 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.

Participants: 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).

Interventions: Free GP care was expanded to all children aged 0-5 years in July 2015.

Main outcome measures: 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.

Results: 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%.

Conclusion: 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.

Keywords: data collection; health services research.

Figure 1

Number of all CUH ED paediatric attendances (0–15 years) by age: July 2012–June 2015 and July 2015–June 2018. CUH, Cork University Hospital; ED, emergency department.

Figure 2

Number of annual CUH ED paediatric attendances through GP and non-GP referrals in children 0–5 (panel A) and 6–15 (panel B) years of age: July 2012–June 2018. CUH, Cork University Hospital; ED, emergency department; GP, general practitioner.

Figure 3

Spline plots of the relationship between ED attendance being a GP referral and time of attendance (time as spline explanatory variable). The model was adjusted for age, discharge destination, presentation day and attendance time. (A) Included all children (0–15 years); (B) restricted to children aged 0–5 years; (C) restricted to children aged 6–15 years. ED, emergency department; GP, general practitioner.

Figure 4

Predictive margins with 95% CIs of the probability of ED attendance being a GP referral with an interaction term between attendance period and age group (0–5 and 6–15 years). The model was adjusted for discharge destination, presentation day and time of attendance. ED, emergency department; GP, general practitioner.

Figure 5

Predictive margins with 95% CIs of the probability of ED attendance being through a GP referral with an interaction term between SYOA (categorical) and attendance period (July 2012–June 2015 and July 2015–June 2018). The model was adjusted for discharge destination, time of attendance and presentation date. ED, emergency department; GP, general practitioner; SYOA, single year of age.

Figure 6

Predictive margins with 95% CIs of the probability of ED attendance by children (0–15 years) being a GP referral across single year of age: July 2012–June 2018. This model included an interaction term between SYOA (continuous) and year of attendance, and was adjusted for discharge destination, presentation day and time of attendance. ED, emergency department; GP, general practitioner; SYOA, single year of age.

Figure 7

Predictive margins with 95% CIs of the probability of ED attendance by children (0–15 years), that came through a GP referral, resulting in a hospital admission across single year of age: July 2012–June 2015 and July 2015–June 2018. This analysis was restricted to patients with a GP referral only (n=42 584). This model included an interaction term between children’s age and attendance period (July 2012–June 2015 and July 2015–June 2018), and was adjusted for presentation day and time of attendance. ED, emergency department; GP, general practitioner.