Do practice-based preventive child health services affect the use of hospitals? A cross-sectional study of hospital use by children in east London

Background. Acute paediatric admissions have risen steadily over the past 2 0 years. During the same period practice-based child health clinics have in creased, although provision is less common in areas of deprivation where ho spital use is greatest Aim. To investigate the contribution of practice-based, preventive child he alth services to rates of hospital utilisation in children under five years of age. Method A cross-sectional retrospective study examining practice variations in paediatric acute admissions, outpatient referrals, and accident and emer gency (A&E) department attendances in the East London and the City Health a uthority, including all 164 practices in the inner-city boroughs of Hackney , Newham, Tower Hamlets, and the City of London. The main outcome measures were practice-based paediatric hospital attendance rates, for discrete age and sex bands, for the year to 31 March 1996. Results. Hospital use varied with age and sex, with the rates being highest for the youngest children and for boys. The median A&E attendance rate (in cluding reattendances) for boys up to one year of age was 897 per thousand children per practice. In east London, 62% of practices are registered for child health surveillance and 71% provide a child health clinic. Practice a pproval for child health surveillance, and The provision of child health cl inics, did not account for differences between practices in hospital use, b ut proportionally greater health visiting hours were significantly related to lower rates of emergency hospital admission by young children. Multivari ate analyses revealed that up to 23% of the Variation between practice admi ssion rates could be explained by health visiting hours. Conclusions. We found significant associations between the amount of health visiting time available to the practice population and rates of acute admi ssion and outpatient referral among children up to five years of age. These findings suggest that increasing health visitor provision could contribute to lower paediatric emergency admission and outpatient referral rates. A s mall change would have a significant effect, particularly among the younges t children, given that during the study year 10 000 children under two year s of age in east London were either admitted or referred to hospital.