Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network
| Autor: | Charles Godden, Simon Jones, Simon de Lusignan, Mitch Blair, Michael L. Rigby, Rachel Coyle, Uy Hoang, Harshana Liyanage |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Scarlet Fever Urban Population Cross-sectional study computerized General Practice Psychological intervention Common Cold 03 medical and health sciences 0302 clinical medicine Environmental health Streptococcal Infections Medicine Humans 030212 general & internal medicine Respiratory system Bronchitis Child medical record systems Respiratory Tract Infections Asthma Respiratory tract infections business.industry Research Respiratory infection 030208 emergency & critical care medicine Regression analysis Paediatrics Pharyngitis General Medicine Pneumonia asthma medicine.disease 3. Good health Cross-Sectional Studies England clinical practice variations Child Preschool Bronchiolitis Observational study Female business |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesRespiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations.DesignCross-sectional study.SettingWe analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England.ParticipantsChildren 5–12 years.InterventionsNone. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma.Primary and secondary outcome measuresWe describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children.Results83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5–11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children.ConclusionWe showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections. |
| Databáze: | OpenAIRE |
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