BackgroundIn 2016, one in three older people in the UK were living alone. These patients often have complex health needs and require additional clinical and non-clinical support. This study aimed to analyse the association between living alone and health care utilisation in older patients.MethodsWe conducted a retrospective cohort study of 1447 patients over the age of 64, living in 1275 households who were registered at a large general practice in South East London. The utilisation of four different types of health care provision were examined in order to explore the impact of older patients living alone on health care utilisation.ResultsAfter adjusting for patient demographics and clinical characteristics, living alone was significantly associated with a higher probability of utilising emergency department and general practitioner services, with odds ratios of 1.50 (95% confidence interval [CI] 1.16 to 1.93) and 1.40 (95% CI 1.04 to 1.88) respectively.ConclusionsLiving alone has an impact on health care service utilisation for older patients. We show that general practice data can be used to identify older patients who are living alone, and general practitioners are in a unique position to identify those who could benefit from additional clinical and non-clinical support. Further research is needed to understand the mechanism driving higher utilisation for those patients who live alone.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0939-4) contains supplementary material, which is available to authorized users.

ObjectiveTo identify the degree to which parental diagnosis of depression or other long-term conditions, parental health-seeking behaviours and household factors were associated with a healthcare utilisation among children and young people (CYP) (0–15 years).DesignRetrospective, cross-sectional study of electronic health records, from 25 252 patients registered at a large, London-based primary care provider. The associations between children’s healthcare utilisation and the characteristics of the child, their parents/carers and their household structure were examined using multivariable regression.ResultsControlling for parental utilisation, parental depression (vs not) was significantly associated with increased healthcare utilisation for CYP. Odds ratios for CYP with siblings=1.41 (95% CI 1.10 to 1.80) for emergency department (ED) attendances, 1.67 (95% CI 1.32 to 2.11) for outpatient appointments, 1.47 (95% CI 1.07 to 2.03) for inpatient admission, and rate rato=1.28 (95% CI 1.04 to 1.78) for general practitioner (GP) consultations.After adjusting for child and parental characteristics, parental general practice attendance (+1 from mean) was predictive of increased CYP general practice attendance, rate ratio 1.07 (95% CI 1.06 to 1.08) for CYP with siblings. Parental ED attendance also increased the risk of CYP ED attendance, with OR 1.27 (95% CI 1.12 to 1.44) for CYP with siblings.ConclusionsParental depression is associated with increased utilisation of ED, outpatient and inpatient services by CYP, as well as with increased GP consultations among adolescents. Our results demonstrate that healthcare utilisation by CYP is associated with the health-seeking behaviour of adults in their household.

Background: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multimorbidity is understudied. Aim: To test whether co-residence with a multimorbid person (compared with a non-multimorbid co-resident) is associated with utilisation and cost of primary, community and secondary health care and formal social care. Design and Setting: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged 50+ in two-person households in 2016-2018. Methods: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink. Results: Over 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. Conclusions: Care utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and community service input across household members.

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30% of the times junior doctors (SHO) were given the opportunity to intubate in comparison to 3% earlier. Confidence in BVM ventilation among SHOs and intubation among registrars are significantly high in the repeat survey, due to continued teaching and simulation training. Conclusions Effective simulation, training, education and perseverance in change in practice improved the intubation in neonates in DGH and confidence of doctors and nurses working in the unit. Improvement is likely to improve outcome of the babies.