Paediatrics (RCH) - Theses
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ItemUtilisation of health services in the first twelve months of life( 2002)Introduction: Parents seek health information and care from a variety of health care providers, yet little is known regarding patterns of use. This study examined the factors that influence parents' decisions about the sources and frequency of health care and information for their child in the important first 12 months of life. Objective: To describe patterns and determinants of health service use in the first 12 months of life. Methods: In this prospective cohort study, 173 infants and their families living in 2 middle socio-economic urban areas of Melbourne, Victoria, were enrolled when presenting for their initial maternal and child health nurse (MCHN) visit (approximately 4 to 6 weeks of age), and followed for 12 months. Parents completed questionnaires at entry to the study, 6 and 12 months. Measures for the questionnaires were developed within an ecological framework and included a range of child, parent and environmental determinants. Factors such as child temperament and health, parent mental and physical health, social support, perinatal difficulties, family dynamics and a number of sociodemographic factors were all included. In addition, families kept a daily 'health diary' over the entire 12 months that recorded their use of any health service. Univariate and multivariate Poisson regression analyses, resulting in incidence rate ratios (IRR) for each determinant, were undertaken to measure the frequency, patterns and independent determinants of health service use for infants in this study. Results: There were 167 families who contributed 1,811 months of diary data (90.4% completion rate). Mean number of visits to any health service including medical, hospital, MCHN, pharmacists, allied health and naturopaths was 32.1 (95%CI 29.9-34.2) over 12 months. Of these 31 % (mean 9.79 visits) were general practitioner (GP) visits and 41.5% (mean 12.85 visits) were to the MCHN. There were 138 parents who completed all 3 questionnaires. Overall younger children visited more health services, particularly MCHN, but not GP services, and there were fewer services visited over the summer months. Determinants of health service use varied between the three provider groups explored (GP, MCHN and total services). On multivariate analysis factors such as poor maternal physical health (IRR 1.92), stress (IRR 1.20), perception of the child as vulnerable (IRR 1.44) and child sleep problems (IRR 1.52) predicted increased rates of GP use. For total use of services, factors such as maternal use of services (IRR 1.64), poor maternal mental health (IRR 1.21), parental belief in the professional for the child's health (IRR 1.30), good maternal social support (IRR 1.27) and severe infant sleep problems (IRR 1.30) were all significant predictors. There were far fewer predictors of MCHN visits. There related mainly to good maternal social support (IRR 1.39) and severe colic (IRR 1.30). Conclusions: This high rate of health service use equates to approximately one visit every 2 weeks in the first year of life, yet the majority of visits were unrelated to illness in the child. Given the varied determinants between provider groups, both curative and preventive services should engage with families about a broad range of psychosocial and preventive health issues to provide a more coordinated and consistent system of health care for young children.