Children’s Unscheduled Primary and Emergency Care in Ireland (CUPID)

Introduction

The question that this programme of research aims to answer is: What are the patterns, outcomes, decision making processes and parental preferences associated with paediatric healthcare utilisation in Ireland and what is the impact of the introduction of free GP care for the under 6 years old cohort? We address these questions by pairing methodological rigour with a patient-centred approach that accounts for the perspectives of parents and frontline staff. We explore temporal and spatial patterns of utilisation, patient outcomes and the decision making processes of both parents and general practitioners.

The aim of this project is to develop a thorough understanding of the current model of paediatric unscheduled healthcare provision in Ireland and the impact of recent policy interventions. The insights gained by this research can inform evidence-based health policy for the organisation of paediatric care and resource allocation. It will assess the effectiveness of the current model of healthcare delivery and identify opportunities for improvement or intervention by building on international experiences while appreciating the specific contextual differences in the Irish setting.

This project is led by Professor Eilish McAuliffe and funded by the Health Research Board.

Project Outline

CUPID is a collaborative research project with partners including the UCD School of Medicine, Maynooth University, Cork University Hospital, Limerick University Hospital CHI at Crumlin, CHI at Temple St, CHI at Tallaght and the Irish College of General Practitioners.

RESEARCH DESIGN AND METHODOLOGICAL APPROACH

The research design for this project consists of three work packages. It combines a multimethod approach including statistical and econometric analysis of temporal trends of attendance at primary and emergency care, geospatial and demographic exploration, systematic review, qualitative enquiry and discrete choice modelling. Methodological rigour will be paired with a patient and parent centred approach to answer related questions regarding various facets of paediatric healthcare utilisation and outcomes in Ireland. Each work package will further the insights gained in other streams of the project to form a context rich overall picture of this complex issue.

Work Package 1

The purpose of work package 1 is to examine temporal trends of paediatric attendance at primary care and EDs across Ireland and to determine the impact of the introduction of free GP care for children under 6 years old on attendance at General Practice (daytime and out-of-hours) and EDs.

Work Package 2

The aim of work package 2 is to analyse geospatial trends of paediatric ED attendance at ‘small-area’ level, and to identify if there are any statistically significant areas within the spatial pattern of attendance. Geospatial analysis at small-area level of ED attendance rates before and after the introduction of free GP care for the under 6 year old cohort will identify the variability in the impact of this policy.

Work Package 3

There will be evident value in understanding the choices and preferences of GPs and parents that contribute to the observed utilisation patterns identified by work packages 1 and 2. The availability of in-depth knowledge can aid policy-makers in ensuring that services are used appropriately, resources are allocated where most needed, clinicians are supported in delivering quality care and parental preferences are considered. Work package 3 will explore the decision-making processes that influence unscheduled healthcare utilisation in the Irish paediatric population by employing two DCEs.

CUPID Project Team

Accessing unscheduled healthcare, decision making and parental preferences

Delivered by Ciara Conlon, Research Assistant

Policy of Free GP Care

Delivered by Dr. Thérése McDonnell

Project Outputs

Project Protocol

McAuliffe E, Hamza M, McDonnell T, Nicholson E, DeBrún A, Barrett, M, Brunsdon C, Bury G, Collins C, Deasy C, Fitzsimons J, Galligan M, Hensey C. Children’s unscheduled primary and emergency care in Ireland: a multimethod approach to understanding decision making, trends, outcomes and parental perspectives (CUPID): project protocol. BMJ Open 2020; 10:e036729. doi: 10.1136/bmjopen-2019-036729 (opens in a new window)https://bmjopen.bmj.com/content/10/8/e036729

Parental Preferences for Unscheduled Healthcare: Systematic Review Protocol

Nicholson E, McDonnell T, Hamza M, DeBrún A, Barrett, M, Brunsdon C, Bury G, Charlton M, Collins C, Deasy C, Fitzsimons J, Galligan M, Hensey C, Kiernan F, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol [version 2; peer review: 2 approved]. HRB Open Res 2019, 2:11 (opens in a new window)https://doi.org/10.12688/hrbopenres.12897.2

Parental Preferences for Unscheduled Healthcare: Systematic Review

Nicholson E, McDonnell T, De Brún A, Barrett M, Bury G, Collins C, Hensey C, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare – systematic review. BMC Health Serv Res 20, 663 (2020). (opens in a new window)https://doi.org/10.1186/s12913-020-05527-5

GPs decisions to refer Paediatric patients to the emergency department: Systematic Review and Narrative Synthesis

Conlon C, Nicholson E, Rodríguez-Martin B, O’Donovan R, DeBrún A, McDonnell T, Bury G, McAuliffe E . Factors influencing general practitioners decisions to refer Paediatric patients to the emergency department: a systematic review and narrative synthesis. BMC Fam Pract 21, 210 (2020). (opens in a new window)https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01277-9

Impact of Free GP care for children aged under 6 on Emergency Department attendance

Policy of free GP care for children under 6 years: the impact on Emergency Department attendance. Social Science & Medicine. June 2021. Volume 279,113988, ISSN 0277-9536,

McDonnell T, Nicholson E, Barrett M, Bury G, Collins C, Cummins F, Deasy C, Denny K, De Brún A, Hensey C, McAuliffe E,

(opens in a new window)https://www.sciencedirect.com/science/article/pii/S0277953621003208?via%3Dihub

Impact of Free GP care for children aged under 6 on attendance at daytime and out-of-hours General Practice

McDonnell T, Nicholson E, Bury G, Collins C, Conlon C, Denny K, O'Callaghan M, McAuliffe E. Policy of free GP care for children under 6 years: The impact on daytime and out-of-hours general practice. Social Science & Medicine. 2022 Feb 9:114792. (opens in a new window)https://www.sciencedirect.com/science/article/pii/S0277953622000983

Assessing how the policy of free GP care for children aged under 6 has impacted unscheduled paediatric healthcare in Ireland

McDonnell T, McAuliffe E. Assessing how the policy of free GP care for children aged under 6 has impacted unscheduled paediatric healthcare in Ireland.

(opens in a new window)https://publicpolicy.ie/papers/assessing-how-the-policy-of-free-gp-care-for-children-aged-under-6-has-impacted-unscheduled-paediatric-healthcare-in-ireland/