The Impact of Socioeconomic Inequalities on Community Paediatrician Time Allocation
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The Impact of Socioeconomic Inequalities on Community Paediatrician Time AllocationChristopher H. GrantUniversity of Glasgow(John O’Dowd, Lucy Reynolds, Alan Boyd NHS Greater Glasgow & Clyde)
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Background to Study• Scale of child poverty in Scotland• Widely accepted belief that deprivation impacts
on service use• Existing knowledge from the literature:
▫ Socioeconomic factors are powerful predictors of consultation patterns (Carr-Hill et al)
▫ Deprivation significantly influences referral rates from primary care (Hippisley-Cox et al)
▫ Disability more common in disadvantaged children (Hirsch et al)
▫ Childhood consultation rates increase from SC I & II – IV & V (Saxena et al)
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Our Study•Quantify the impact of age & socioeconomic
status on community paediatrician time allocation in relation to disability
•Current literature:▫Primary care▫Adult population▫Consultation rates v. time allocation
• Insufficient evidence informs RAMs•Our study uses existing appointment methods
to quantify total allocated time resource
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Methods
•Data extracted from the Community Paediatric Information Glasgow (CPIG) database
•Appointments made with community paediatricians for 0-19 year olds with disability or developmental concerns across the historic Greater Glasgow area
•Total number of clinic appointments scheduled during 2009 regardless of attendance
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Methods (Continued)
•Mid-year population estimates derived from the Small Area Population Estimates▫ GRO Scotland 2008
•Age specific contact rates per head of population were calculated
•Analysed by deprivation quintile according to the SIMD 2009 based on the patient’s postcodes
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Results
•Crude scheduled contact rate was 154.2 per 10,000 children per year
•Highest contact rate (430.7) was children aged 0-4 in the most deprived quintile, Q1
•Lowest contact rate (9) was young people aged 15-19 in the most affluent quintile, Q5
•Age & socioeconomic status impact significantly on contact rates & resource use
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Age Standardised Contact Rates per 10,000 by SIMD Quintile in Greater Glasgow
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Contact Rates per 10,000 Residents by SIMD Quintile & Age in Greater Glasgow
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Discussion
•The four-five fold gradient seen across Greater Glasgow can be explained by three major contributory factors:▫ Prevalence of need within the community▫ Inequality sensitive practice▫ Incidence of non-attendance &
cancellation within the population
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Next Steps
•Quantify how many were new vs. returns vs. DNAs vs. cancellations▫ Prevalence of non-attendance &
cancellation in the most deprived is unknown
•Possibility that cancellations were filled▫ Limited impact on findings
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Conclusion
•Key messages:▫ Socioeconomic deprivation has a profound
impact on community paediatric time resource in relation to disability & developmental concerns
▫ The variation in service time allocation should be incorporated into future models of resource allocation
▫ We believe a similar gradient may exist across other services for children
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Thank You