From inception, the delivery of NHS primary care services has been based upon the principle of universal healthcare. Despite this, health inequity (differences in opportunities, including access to health care services) via socio-economic status, gender, age, ethnicity, disability, or geographical location, can lead to poorer experiences and health outcomes for some groups of health care users (health inequality).
This study forms part of a mixed methods investigation into the ability of children and young people (CYP) to access primary care services, exploring:
Qualitative study
1. What do CYP, parents and health professionals perceive as the facilitators and barriers to CYP accessing
primary care services?
2. Do these vary by:
a. particular groups?
b. conditions for which CYP seek help?
Quantitative study (this application)
1. Are the following characteristics of CYP patients (or those of their families), associated with differences in primary care service use?
a. Ethnicity
b. Migration status
c. Deprivation
d. Geographic location
2. Do any associations vary with the type of primary care service
3. Are differences in primary care service use associated with poorer health outcomes in the affected CYP patient populations?
This study will improve the understanding of health inequalities in terms of patient characteristics, healthcare service access, health conditions and health outcomes. Coupled with evidence on the facilitators and barriers to primary care access for the relevant populations, this study will support the development of effective policies ensuring that the founding aspirations for the NHS are met and maintained.
We aim to understand the characteristics associated with unmet need in primary care use among CYP in the UK, why this unmet need occurs, and how these services could better support affected groups. The study will investigate differences in primary care service use by CYP in the UK in relation to ethnic background, migration status, and exposure to deprivation.
The study cohort will include eligible CYP (aged 0-24 years), classified for ethnicity (White British, White Non-British, Mixed, Asian/Asian British, Black/Black British, Other), international migration status (“definite”, probable”, “possible”; Read code list grouping), and for deprivation based upon quintiles from the linked patient level Index of Multiple Deprivation (IMD) dataset.
Regression models of exposure-outcome effect pathways, will be used to estimate the effects of each exposure relative to the relevant control group (CYP of White British ethnicity, non-migrant status, or the least deprived IMD quintile), with results reported by gender and age.
Primary outcomes will be comprised of primary care use measured in terms of general practice (GP) consultations (total or by staff type), prescriptions issued, and outpatient attendances (CPRD and linked OPD). Secondary outcomes used to evaluate CYP health outcomes, will be based upon measures of hospital-based and emergency care use (inpatient and A&E admissions; linked HES-APC and A&E datasets). Potential confounders (e.g., birthweight, preterm birth, Rural-Urban classification) for service use and health measures will be included in the models for the given exposure-outcome scenario.
Establishing which CYP are not having their needs met in primary care, will help in forming recommendations for improvements in the provision of primary care services for CYP from disadvantaged and marginalised groups. Reductions in inequalities will improve both health outcomes for CYP and overall public health service efficiency.
Primary Outcomes:
Primary care and outpatient service use (CPRD/OPD records):
a. GP attendances (all consultations)
b. GP consultations by staff type (e.g. practice nurse visits)
c. Number of unique prescriptions
d. Outpatient attendances
Secondary Outcomes:
Other health care service use (linked HES records):
a. Inpatient admissions (HES-APC)
b. Accident and emergency attendances (HES-A&E)
Pia Hardelid - Chief Investigator - University College London ( UCL )
Kevin Herbert - Corresponding Applicant - University College London ( UCL )
gene feder - Collaborator - University of Bristol
Jenny Wooman - Collaborator - University College London ( UCL )
Linda Wijlaars - Collaborator - University College London ( UCL )
Ruth Gilbert - Collaborator - University College London ( UCL )
Stephen Morris - Collaborator - University of Cambridge
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification