title: Influence of parental occupation on access to specialised treatment for paediatric chronic pain: a retrospective study.
abstract: BACKGROUND
  The purpose of this study was to determine patients' travel distances to a tertiary paediatric pain clinic and to analyse the association between travel distance and the parents' occupational skill level and the patients' pain characteristics.
  
  
  METHODS
  The retrospective study consisted of 2,248 children assessed at the first evaluation. All children (0-20 years) who visited the clinic during a 5-year period (2005-2010) were enrolled in this study.
  
  
  RESULTS
  The mean travel distance was 81 km, and the 80 % catchment area was 109 km. Children of parents with a high occupational skill level had a 1.5-fold higher probability of travelling from outside the catchment area. The 80 % catchment area increased constantly with increasing occupational skill level. Additional significant factors for greater distance travelled were high impairment, musculoskeletal pain, long pain duration and a high number of previous physician contacts.
  
  
  CONCLUSIONS
  The association between travel distance and parental occupational skill level suggests that there is social injustice due to access barriers based on socioeconomic deprivation and education. An increase in the number of health care facilities for chronic pain in children would be a first step in rectifying this injustice.
authors.affiliation: Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Dr.-Friedrich-Steiner Str. 5, 45711, Datteln, Germany. J.Wager@Kinderklinik-Datteln.de
authors.forename: J
authors.initials: J
authors.lastname: Wager
authors.forename: A
authors.initials: A
authors.lastname: Ruhe
authors.forename: G
authors.initials: G
authors.lastname: Hirschfeld
authors.forename: C
authors.initials: C
authors.lastname: Wamsler
authors.forename: M
authors.initials: M
authors.lastname: Dobe
authors.forename: T
authors.initials: T
authors.lastname: Hechler
authors.forename: B
authors.initials: B
authors.lastname: Zernikow
mesh_terms: D000293:Adolescent; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D059350:Chronic Pain / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009790:Occupations / Q000706:statistics & numerical data*; D018710:Pain Clinics / Q000600:supply & distribution; D059408:Pain Management; D011336:Probability; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000600:supply & distribution; D055815:Young Adult