Why some children hospitalized for pneumonia do not consult with a general practitioner before the day of hospitalization

Abstract

Background: Early consultation in primary care may provide an opportunity for early intervention in children developing pneumonia, but little is known about why some children do not consult a general practitioner (GP) before hospitalization.

Objectives: To identify differences between children who consulted a GP and children who did not consult a GP before the day of hospital presentation with pneumonia or empyema.

Methods: Carers of children aged six months to 16 years presenting to hospital with pneumonia or empyema completed a questionnaire, with a subset participating in an interview to identify physical, organizational and psychological barriers to consultation. Responses from those who had consulted a GP before the day of hospital presentation were compared with those who had not on a range of medical, social and environmental variables.

Results: Fifty seven (38%) of 151 participants had not consulted a GP before the day of hospital presentation. On multivariate analysis, illness duration ≥ 3 days (odds ratio [OR] 4.36, 95% confidence interval [CI]: 1.67–11.39), prior antibiotic use (OR: 10.35, 95% CI: 2.16–49.55) and home ownership (OR: 3.17, 95% CI: 1.07–9.37) were significantly associated with early GP consultation (P < 0.05). Interviews with 28 carers whose children had not seen a GP before the day of presentation revealed that most had not considered it and/or did not think their child's initial symptoms were serious or unusual; 11 (39.3%) had considered consulting a GP but reported barriers to access.

Conclusion: Lack of early GP consultation was strongly associated with rapid evolution of pneumonia.

Keywords::

• respiratory tract infections
• pneumonia
• primary health care
• patient acceptance of health care
• child

Acknowledgements

The authors are very grateful to the following people: all carers and children who took part in the study; all clinicians who kindly recruited patients for the study; Lead Collaborators Dr Anjum Gandhi and Dr Ian Hodges (Royal Glamorgan Hospital), Dr David Deekollu (Prince Charles Hospital), Dr Kate Creese and Dr Nirupa D’Souza (Princess of Wales Hospital), Dr Marcus Pierrepoint and Dr Yvette Cloete (Nevill Hall Hospital), Dr Michelle Barber (Royal Gwent Hospital) and Dr Rachel Evans (Morriston Hospital); Ann Russell, Anwen Howells and Marie Williams at the NISCHR Clinical Research Centre for helping to collect medical data; and Hayley Prout at Cardiff University for providing an independent quality assessment of interview records.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

FINANCIAL RESOURCES

This study was supported by the Medical Research Council as part of a PhD Studentship (grant number G0600288); the British Society for Antimicrobial Chemotherapy (grant number GA854); and the South East Wales Trials Unit and Wales School for Primary Care Research, both funded by the National Institute for Social Care and Health Research (NISCHR), Welsh Government.