Understanding the Relationship Between the Social Determinants of Health (SDH), Paediatric Emergency Department use and the Provision of Primary Care.

Author: Yvonne Karen Parry

Parry, Yvonne Karen, 2012 Understanding the Relationship Between the Social Determinants of Health (SDH), Paediatric Emergency Department use and the Provision of Primary Care., Flinders University, School of Medicine

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his resesarch aimed to explore the relationship beteween the SDH, paediatrci ED use and the provision of primary care. A mixed methodology using Hospital Admission Status data, Social Health Atlas data, measures of deprivation, levels of priamry care and parent and staff interviews found that limited service provsion for children inlfuenced ED use. Further, the qualitative findings indicate that a dearth of services, such as limited service provision (lack of GP appointments), or after hours services and a lack of broader community based primary services (for example the provision of blood tests, x-rays), and deprivation influences high Paediatric ED attendances rather than distance to ED, or cost. Furthermore, there were significant positive relationships between possible primary care attendance and discharge status, distance to ED, and attending ED using a private vehicle (rather than emergency vehicle). The epidemiological data suggests that there is a dearth of GP services in areas with higher than average levels of illness. Reasonably, this may impact on the ability of parents to access timely and appropriate health care services from primary care providers. These factors are of a structural social determinants of health (SDH) nature. The changes to universal health care provision impacting on paediatric ED use have occurred gradually over time. This is termed here as 'incremental structural inertia' and has led in recent times to a decrease in the provision of GP services that may have increased the use of ED for primary health care. The most distinctive contribution this research makes to the body of knowledge regarding health access is that despite the usefulness of the GP Plus and GP Super Clinics in addressing some of the ntermediary SDH such as social support, parenting support and preventative health interventions, the GP Plus and GP Super Clinics will not change the numbers of category 4 and 5 presentations to ED unless there is an increase in the numbers of: GPs, paediatrically trained community health care providers and after hours services.

Keywords: Social Determinants of Health,Emergency Department use,Paediatirc care,After hours care.

Subject: Primary Health Care thesis, Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2012
School: School of Medicine
Supervisor: Assoc Prof Eilleen Willis