Access to Hospital Outpatient Services for Children and Young People with Cerebral Palsy

Abstract

BACKGROUND: People with cerebral palsy (CP) experience increased risk of adverse health outcomes related to their disability and comorbidities. They access hospital health services more frequently than the general population. The aim of this thesis is to examine access, and equity of access, to hospital outpatient services for children with CP.

METHODS: Existing research about access to hospital health services by children with CP was synthesised in a systematic review. A series of population-based studies were conducted using the New South Wales (NSW)/Australian Capital Territory (ACT) CP Register linked to administrative health data. Ascertainment of children with CP using administrative health data was compared to the NSW/ACT CP Register. Factors associated with non-attendance and use of telemedicine in outpatient services were examined at two specialist children’s hospitals. Access to outpatient health services, continuity of care and unplanned hospital care use across NSW were investigated.

RESULTS: The review identified associations between CP severity, comorbidities and increased health service use. Hospital admission data identified many children with CP (~70%) but with more comorbidities and higher risk of death than the NSW/ACT CP Register. Non-attendance at outpatient clinics was associated with (older) age, socioeconomic disadvantage and previous non-attendance. Telemedicine use peaked during the COVID-19 pandemic and then declined. Children living in regional/remote NSW had lower rates of telemedicine than those in major cities. Access to outpatient services for Aboriginal and/or Torres Strait Islander children with CP was broadly similar to the whole population. Better continuity of outpatient care was associated with less unplanned hospital care.

CONCLUSION: Improving equity of access to outpatient services is important to improve health outcomes for children with CP. Research to identify interventions to improve equity of access should be a priority.