Factors associated with recurrent hospitalization in chronically ill children and adolescents

Objectives: To determine factors associated with recurrent hospitalization in children with chronic illnesses in the Barwon Region. Methodology: Patients with four or more admissions to the Geelong Hospital children's ward over a 12-month period were identified. Their records were reviewed and the opinions of involved staff (medical, nursing, psychiatry, psychology, and social work) were sought. Multidisciplinary discussions wer e held to identify factors precipitating or maintaining the need for hospit alization. The numbers, illnesses and profiles of those admitted recurrentl y were compared with the data from the Barwon Paediatric Consultation Profi le from the same period, and with those patients seen by the local counsell ing service for young people with chronic illnesses. Results: Twenty-seven children had four or more admissions over the 12 mont hs; these represent 0.05% of the child population regionally, or 2% of thos e with chronic illness. They account for 8.7% of hospital admissions and 16 % of inpatient days. Two-thirds (18/27) had major psychosocial issues large ly responsible for their admissions. A checklist was formulated of importan t medical, family, social, psychological, developmental, and institutional considerations. The most frequently identified psychosocial issues were med ical dependency, psychological or medical problems affecting other family m embers, family and medical disparity regarding the treatment agenda, the la ck of more intensive community supports, and medical controversy regarding best management. Conclusions: Ongoing medicalization and medical dependency, driven both by staff and families, can perpetuate recurrent hospitalization. Further aware ness and training in these issues and development of community resources wi ll be necessary if this process is to be changed.