Inequalities in access to a tertiary children's chronic pain service: a cross-sectional study.

Poor health, including chronic pain, has been consistently shown to be associated with lower socioeconomic status (SES). To describe the SES of a clinical population of children with chronic pain referred to tertiary care in England, and to determine if access to, and utilisation of, the service is related to SES. Using a retrospective cross-sectional study design, all children referred to a tertiary chronic pain management service between 2000 and 2014 were included. SES was determined using the English Index of Multiple Deprivation for the area in which they lived. Distance from the study site, using Ordinance Survey National Grid coordinates, and service utilisation, from hospital records, were also calculated. 737 children were included. The proportion of patients referred from the most socially deprived areas was substantially lower (14%) than from the least deprived (25%). In addition, the proportion of patients from the most deprived areas fell with increasing distance from the study site. Patients from the most deprived areas were more likely not to attend hospital appointments. Contrary to expectations, there were fewer patients from the most deprived areas. The proportion of children from more deprived areas fell with increasing distance from the study site, and those children who were referred were less likely to attend scheduled appointments. Our results imply that there is a social gradient in access to tertiary services for children's chronic pain management.

Jay MA ，Howard RF 《-》

Addressing the inverse care law: the role of community paediatric services.

Rahman FR ，Maharaj V ，Yates R ，Beeley C ，Moore I ，Rose A ，Counsell A ... -  《-》

Retrospective review of consecutive cases of paediatric complex pain in a New South Wales tertiary children's hospital.

Prior to July 2013, a solo medical specialist provided a pain management service 1.5-2 days/week to children and young people aged 0-19 years, and their families at John Hunter Children's Hospital, Newcastle, NSW. A new multidisciplinary children's complex pain team now continues that service. This study aimed to identify the demographic and clinical characteristics of children, young people and their families referred to a paediatric pain specialist in the 5.5 years prior to the establishment of a multidisciplinary service and to quantify anecdotal observations, determine service priorities and identify clinical improvement opportunities. A retrospective review of the medical records of all new patients seen between January 2008 and June 2013 was conducted. Data sets for patient demographics, clinical characteristics, service outputs and disposition at discharge were determined prior to data extraction. A total of 114 children and young people aged between 7 days and 18 years (mean ± SD = 12.54 ± 3.6 years) were consecutively referred to the service. Many demographics are consistent with those previously reported; however, the number of children who identified as being of Aboriginal origin (11%), with rare diseases (28%), new diagnoses made (47%), child protection reports submitted (14%) and psychological morbidity in children (58%) and caregivers (38%) are new findings in the context of pain management and serve as indicators of the complex service needs of these patients and their families. The complexities encountered in this small cohort provide an indication of the time investment needed to understand and manage complex paediatric pain, especially in the contexts of complex families, time-poor general practitioners and under-resourced communities.

Kepreotes EA ，Lord SM 《-》

Influence of parental occupation on access to specialised treatment for paediatric chronic pain: a retrospective study.

Wager J ，Ruhe A ，Hirschfeld G ，Wamsler C ，Dobe M ，Hechler T ，Zernikow B ... -  《-》

Geographic disparities in access to the medical home among US CSHCN.

Singh GK ，Strickland BB ，Ghandour RM ，van Dyck PC ... -  《-》