The Impact of Socioeconomic Inequalities on Community Paediatrician Time Allocation

1. The Impact of Socioeconomic Inequalities on Community Paediatrician Time Allocation Christopher H. Grant University of Glasgow (John O’Dowd, Lucy Reynolds, Alan Boyd NHS Greater Glasgow & Clyde)

3. Background to Study • Scale of child poverty in Scotland • Widely accepted belief that deprivation impacts on service use • Existing knowledge from the literature: • Socioeconomic factors are powerful predictors of consultation patterns (Carr-Hill et al) • Deprivation significantly influences referral rates from primary care (Hippisley-Cox et al) • Disability more common in disadvantaged children (Hirsch et al) • Childhood consultation rates increase from SC I & II – IV & V (Saxena et al)

4. Our Study • Quantify the impact of age & socioeconomic status on community paediatrician time allocation in relation to disability • Current literature: • Primary care • Adult population • Consultation rates v. time allocation • Insufficient evidence informs RAMs • Our study uses existing appointment methods to quantify total allocated time resource

5. Methods • Data extracted from the Community Paediatric Information Glasgow (CPIG) database • Appointments made with community paediatricians for 0-19 year olds with disability or developmental concerns across the historic Greater Glasgow area • Total number of clinic appointments scheduled during 2009 regardless of attendance

6. Methods (Continued) • Mid-year population estimates derived from the Small Area Population Estimates • GRO Scotland 2008 • Age specific contact rates per head of population were calculated • Analysed by deprivation quintile according to the SIMD 2009 based on the patient’s postcodes

7. Results • Crude scheduled contact rate was 154.2 per 10,000 children per year • Highest contact rate (430.7) was children aged 0-4 in the most deprived quintile, Q1 • Lowest contact rate (9) was young people aged 15-19 in the most affluent quintile, Q5 • Age & socioeconomic status impact significantly on contact rates & resource use

8. Age Standardised Contact Rates per 10,000 by SIMD Quintile in Greater Glasgow

9. Contact Rates per 10,000 Residents by SIMD Quintile & Age in Greater Glasgow

10. Discussion • The four-five fold gradient seen across Greater Glasgow can be explained by three major contributory factors: • Prevalence of need within the community • Inequality sensitive practice • Incidence of non-attendance & cancellation within the population

11. Next Steps • Quantify how many were new vs. returns vs. DNAs vs. cancellations • Prevalence of non-attendance & cancellation in the most deprived is unknown • Possibility that cancellations were filled • Limited impact on findings

12. Conclusion • Key messages: • Socioeconomic deprivation has a profound impact on community paediatric time resource in relation to disability & developmental concerns • The variation in service time allocation should be incorporated into future models of resource allocation • We believe a similar gradient may exist across other services for children

13. Thank You