How fair is our service? Evaluating access to specialist paediatric care

Neale, Francesca K; Armstrong, Edward J; Cohen, Jonathan; Segal, Terry; Hargreaves, Dougal

doi:10.1136/archdischild-2019-317254

Cited by 4 publications

(2 citation statements)

References 2 publications

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“…CYP within our study were similar to those presenting to other specialist ME/CFS centres in the UK in terms of gender and symptomology, with pain, headaches and co-existing low mood being the most common features reported [ 20 , 21 , 22 ]. However, previous work has demonstrated that that whilst our local outpatient referrals broadly reflected the socioeconomic distribution, tertiary clinics showed a much higher proportion of patients from more affluent postcodes [ 23 ]. Further, our results may not be generalisable to other settings, such as primary care.…”

Section: Discussionmentioning

confidence: 99%

Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS

Hiremath

Doukrou

Flannery

et al. 2022

IJERPH

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Purpose of the study: There is limited published data on treatment or outcomes of children and young people (CYP) with moderate or severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Here, we describe outcomes of moderate and severe ME/CFS in CYP treated in a tertiary adolescent service. This information is useful when planning services for CYP and families affected by moderate/severe ME/CFS and to guide future management trials and commissioning decisions. Study Design: A retrospective review was conducted of medical records of the 27 CYP who received ward-based treatment in 2015. Notes were retrospectively reviewed to assess progress in four markers of wellbeing over the period of treatment: (i) mobility, (ii) education, (iii) sleep and (iv) involvement in social/recreational activities. Results: A total of 23/27 (85%) showed improvement in one or more domains over their period of ward-based therapy. 19/27 (70%) of patients showed improvement in physical ability. In 15/23 patients (65%), there was an improvement in ability to access education, in 12/24 (50%) sleep improved, and 16/27 (59%) demonstrated an improvement in socialising/ability perform recreational activities. Conclusion/Implications: A multidisciplinary hospital-based rehabilitation programme for moderate and severe ME/CFS was associated with improvement in at least one area of wellbeing in 85% of the CYP we reviewed. These data may be used as a baseline to evaluate the impact of other models of delivering care for this patient group. It may be useful when considering other groups such as those affected by Post-COVID Syndrome.

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Section: Discussionmentioning

confidence: 99%

Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS

Hiremath

Doukrou

Flannery

et al. 2022

IJERPH

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“…Patients living in large urban centers with socioeconomic advantages in both Canada and the United States wait less than rural and socially deprived counterparts. 40 Many of the innovations prompted by the COVID-19 pandemic may help to narrow this disparity; however, the need for access to internetready devices and high-speed internet may still pose a challenge for socioeconomically disadvantaged populations. 10,31,37 During the initial months of the COVID-19 pandemic, clinicians and patients struggled to access timely care to common allergen procedures, such as allergen immunotherapy (AIT).…”

Section: Effectivementioning

confidence: 99%

What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care

Abrams

Singer

Shaker

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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The coronavirus disease 2019 pandemic has forever changed how we view health care service delivery. Although there are undoubtedly some unintended consequences that will result from current health care service reallocation, it provides a unique opportunity to consider how to deliver quality care currently, and after the pandemic. In the context of lessons learned, moving forward some of what was previously routine could remain reserved for more exceptional circumstances. To determine what is "routine," what is "essential," and what is "exceptional," it is necessary to view medical decisions within the paradigm of highquality care. The Institute for Healthcare Improvement definition of the dimensions of quality is based on whether the care is safe, effective, patient-centered, timely, efficient, and equitable. This type of stewardship has been applied to many interventions already deemed unnecessary by organizations such as the Choosing Wisely initiative, but the coronavirus disease 2019 pandemic provides a lens from which to consider other aspects of care. The following will provide examples from Allergy/Immunology that outline how we can reconsider what quality means in the postecoronavirus disease health care system.

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Population child health: understanding and addressing complex health needs

et al. 2020

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Advances in paediatric care mean that more children with complex medical problems (heart disease, neurodevelopmental problems and so on) are surviving their early years. This has important implications for the design and delivery of healthcare given their extensive multidisciplinary requirements and susceptibility to poor outcomes when not optimally managed. Importantly, their medical needs must also be understood and addressed within the context of the child and family’s life circumstances. There is growing recognition that many other factors contribute to a child’s complex health needs (CHNs), for example, family problems, fragmentation of health and care provision, psychological difficulties or social issues.To facilitate proactive care for these patients, we must develop accurate ways to identify them. Whole Systems Integrated Care—an online platform that integrates routinely collected data from primary and secondary care—offers an example of how to do this. An algorithm applied to this data identifies children with CHNs from the entire patient population. When tested in a large inner-city GP practice, this analysis shows good concordance with clinical opinion and identifies complex children in the population to a much higher proportion than expected. Ongoing refinement of these data-driven processes will allow accurate quantification and identification of need in local populations, thus aiding the development of tailored services.

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How fair is our service? Evaluating access to specialist paediatric care

Cited by 4 publications

References 2 publications

Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS

Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS

What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care

Population child health: understanding and addressing complex health needs

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