Use of an east end children's accident and emergency department for infants: a failure of primary health care?
OBJECTIVE
To ascertain why parents use an accident and emergency department for health care for their infants.


METHODS
Prospective one month study.


METHODS
One accident and emergency department of a children's hospital in the east end of London.


METHODS
Parents of 159 infants aged < 9 months attending as self referrals (excluding infants attending previously or inpatients within one month, parents advised by the hospital to attend if concerned about their child's health, infants born abroad and arrived in Britain within the previous month).


METHODS
Details of birth, postnatal hospital stay, contact with health professionals, perceptions of roles of community midwife and health visitor, and current attendance obtained from a semistructured questionnaire administered in the department by a research health visitor; diagnosis, discharge, and follow up.


RESULTS
152(96%) parents were interviewed, 43(28%) of whom were single parent and 68(45%) first time mothers. Presenting symptoms included diarrhoea or vomiting, or both (34, 22%), crying (21, 14%), and feeding difficulties (10, 7%). Respiratory or gastrointestinal infection was diagnosed in 70(46%) infants. Only 17(11%) infants were admitted; hospital follow up was arranged for 27(20%) infants not admitted. Most (141, 94%) parents were registered with a general practitioner; 146(27%) had contact with the community midwife and 135(89%) the health visitor.


CONCLUSIONS
Most attendances were for problems more appropriately dealt with by primary care professionals owing to patients' perceptions of hospital and primary health care services.


CONCLUSIONS
Closer cooperation within the health service is needed to provide a service responsive to the real needs of patients.
Department of Paediatric Epidemiology, Institute of Child Health, London.
H E
HE
Bedford
S M
SM
Jenkins
C
C
Shore
P A
PA
Kenny
D003159:Community-Institutional Relations; D003625:Data Collection; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000706:statistics & numerical data; D008131:London; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies