Programme no. 356-P
Health Economics
Morbidity burden among paediatric patients in Danish primary health care
Merethe Andersen*1, Ruth Kirk Ertmann2, Troels Kristensen3, Anders Halling4
1Research Unit of General Practice/Department of Public Health,Department of Public Health, SDU,Odense,Denmark, 2Research Unit of General Practice,CSS, KU,Copenhagen,Denmark, 3Research Unit of General Practice/Department of Public Health,Department of Public Health, SDU,Odense,Denmark, 4Research Unit of General Practice/Department of Public Health,Department of Public Health, SDU,Odense,Denmark
* = Presenting author
Objectives: To describe the prevalence of paediatric morbidity and to analyse the level of paediatric multimorbidity in primary care.
Background: Few studies have explored the prevalence and level of paediatric multimorbidity level among children and adolescents. In Denmark the GP is the primary doctor for all children and acts as gatekeeper. Only children with specific conditions and diseases are referred for specialist care. The GP is also responsible for a mandatory primary prevention programme for children. Through the recent development of a nationwide Danish primary care database (DAMD) it has become possible to study the prevalence of registered reasons for encounter, morbidity and the overall morbidity in a large paediatric population.
Results: Out of 69 232 children 71.2% were assigned at least one ICPC code. The most prevalent ICPC group was Respiratory R (26.5%), Skin S (26.1%) and Musculoskeletal L (14.7%). Approximately one third of the children were non-users (RUB0). The most prevalent RUB group was RUB2 (36%). About 10% of all children were categorised into RUB3-RUB5, corresponding to moderate to very high morbidity, indicating presence of one or more chronic diseases.
Material/Methods: We use a population-based approach with a comprehensive selection of diseases and International Classification of Primary Care codes (ICPC-2) to study the prevalence of morbidity and multimorbidity. A population of 69 232 children between 0-18 years, resident in Region Zealand in 2013 and affiliated with general practice clinics coding more than 70% of face-to-face encounters, were included. The prevalence of reasons for encounters was presented according to ICPC-2 groups and age groups. Multimorbidity levels were measured through Resource Utilization Bands (RUB) based on the Johns Hopkins Adjusted Clinical Groups (ACG).
Conclusion: We found that 10% of children had moderate to very high morbidity in terms of Resource Utilization Bands, indicating the presence of one or more chronic diseases. The most prevalent diagnosis concerned respiratory and skin body systems. Systematic collection and analyses of ICPC codes from primary health care provide invaluable knowledge about reasons for encounters, disease patterns and multimorbidity in primary health care.
Points for discussion: What experiences do the participants have with multimorbidity among their paediatric patients? How do we identify children with multimorbidity? What is our role, and what can we offer in general practice?