[Skin diseases as a reason for frequent preschool children, primary health care attendance].
Childhood morbidity has changed. Western children more often present with skin problems than with respiratory problems. A significant percentage of the workload of a general practitioner is dermatologic.


OBJECTIVE
To investigate the correlation of frequent preschool children primary health care attendance due to skin diseases with sociodemographic factors, most common symptoms and diagnoses.


METHODS
The study was conducted in 7 primary health care offices (six family physician practices and one pediatric practice) in the Croatian capital Zagreb. The study included 964 preschool children from one to six years of age who visited their physicians during 2004. There were 255 frequent attenders with > 75 percentile of visits, while 315 children with < 25 percentile of visits as nonfrequent attenders represented control group. Socioeconomic factors, symptoms and diagnoses were taken from standardized patient medical records. The reasons for the children's visits and diagnoses were classified according to the International Classification of Diseases, 10th Revision.


RESULTS
The visit median in frequent attenders was 10 visits per year. The five most common diagnostic groups in both frequent and nonfrequent attenders were: respiratory system diseases (J00-J99), infectious and parasitic diseases (A00-B99), middle ear diseases (H60-H95), skin and subcutaneous tissue diseases (L00-L99), and genitourinary system diseases (N00-N99). The most common symptoms presented by frequent attenders in the order of frequency were fever, cough, nasal discharge, otalgia and rash, whereas cough, fever, rash, otalgia and throat soreness were the five most common symptoms presented by nonfrequent attenders. In frequent attenders, both parents (mother and father) had higher education level (pmothers = 0.022 and fathers = 0.036), however, the proportion of parents with high education was great in the group of nonfrequent attenders. Significantly more (p < 0.001) frequent attenders were in younger age group. The highest proportion of frequent attenders (27%) were 2-3 years old while most nonfrequent attenders (27%) were aged 5-6 years. Boys attended primary health care office significantly more frequently (p = 0.041) than girls. Frequent attenders attended day care center significantly more frequently (p < 0.001). Logistic regression analysis revealed a correlation of sex, day care center attendance and certain diagnostic groups associated with frequent attendance: infectious and parasitic diseases (A00-A99), diseases of the eye and adnexa (H00-H59), middle ear diseases (H60-H95), respiratory system diseases (J00-J99), skin and subcutaneous tissue diseases (L00-L99), and genitourinary system diseases (N00-N99). Skin diseases were among the five most common diagnostic groups in both frequent and nonfrequent attenders. Rash as a dermatologic symptom ranked fifth symptom in attenders frequent and third in nonfrequent attenders symptoms.


CONCLUSIONS
Intervention activities done by planning a strategy for frequent attenders with skin diseases require additional knowledge, attitudes and skills for a new approach to patients in daily work of primary health care physicians.
Milaković
Sanja Blazeković
SB
Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet Sveucilista u Zagrebu, Zagreb, Hrvatska. sanja10@net.hr
Stojanović-Spehar
Stanislava
S
Marković
Biserka Bergman
BB
Tiljak
Hrvoje
H
D002648:Child; D002675:Child, Preschool; D017523:Croatia; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012140:Respiratory Tract Diseases / Q000628:therapy; D012871:Skin Diseases / Q000628:therapy*; D012959:Socioeconomic Factors