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Title: Exploring the use of emergency healthcare services by parents who access care on behalf of pre-school children
Author: Bowen, Leah
ISNI:       0000 0004 5923 6552
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2015
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Introduction Previous research has reported a rise in short-stay paediatric hospital admissions. Speculation has suggested that these admissions are often for self-limiting conditions and that failings in primary care have influenced growing demand. Methods A mixed-methods approach included a review of the current literature and analysis of Hospital Episodes Statistics. These two components formed the quantitative foundation to the project, revealing disease areas most often associated with hospital admissions in children under five years- old. A thematic synthesis of qualitative studies explored parents' views about minor illness and addressed how the concerns parents have when faced with an unwell child translate into actions around care-seeking. Finally a qualitative interview study conducted in the Children's Emergency Department investigated how paediatric clinicians make decisions regarding the treatment of children attending with episodes of minor respiratory disease. Results Respiratory illnesses were found to be the most common reason for admission in the underfives. Many admissions were made under emergency circumstances, involving children from minority ethnic groups. Parents were able to correctly identify illness in their children but had difficulty assessing severity, which triggered the request for care. Primary care factors were often responsible for influencing the families' decision to access emergency care. Clinicians did not believe that admissions rates were alarming but instead suggested that attendances contributed to the greatest demand on the Emergency Department. Clinicians were found to use the resources available in the CED to balance risk and effectively manage children with equivocal respiratory conditions. These resources were believed to be unavailable in primary care suggesting that not all episodes of acute respiratory illness are appropriate for community management. Discussion Short-stay paediatric admissions were considered to be clinically appropriate, ensuring patient safety. The issue of paediatric urgent-care use is complex and ED attendances may be where the true burden originates. Future research should focus on attendances at emergency departments in order to identify primary care solutions.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available