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Paediatrics
Research
Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network
  1. Uy Hoang1,
  2. Harshana Liyanage1,
  3. Rachel Coyle1,
  4. Charles Godden2,
  5. Simon Jones1,3,
  6. Mitch Blair4,
  7. Michael Rigby5,
  8. Simon de Lusignan1,6
  1. 1 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
  2. 2 St Mary’s Hospital, Isle of Wight, UK
  3. 3 Division of Healthcare Delivery Science/ Center for Healthcare Innovation and Delivery Science (CHIDS), Department of Population Health, New York University, Langone Medical Centre, New York, USA
  4. 4 Department of Paediatrics and Child Health, Northwick Park Hospital, Harrow, UK
  5. 5 Section of Paediatrics, School of Medicine, Imperial College London, St. Mary’s Hospital, London, UK
  6. 6 Research and Surveillance Centre, Royal College of General Practitioners, London, UK
  1. Correspondence to Dr Uy Hoang; u.hoang{at}surrey.ac.uk

Abstract

Objectives Respiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations.

Design Cross-sectional study.

Setting We analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England.

Participants Children 5–12 years.

Interventions None. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma.

Primary and secondary outcome measures We describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children.

Results 83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5–11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children.

Conclusion We showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections.

  • asthma
  • clinical practice variations
  • general practice
  • medical record systems
  • computerized

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-024372

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    Footnotes

    • Contributors UH, SdL, MB, SJ and HL were responsible for the conception or design of the work. UH and HL were responsible for data analysis and writing the initial draft manuscript. UH, HL, RC, CG, SJ, MB, MR and SdL were responsible for interpretation of data, revising the manuscript critically for important intellectual content and final approval of the version to be published.

    • Funding This study was based on work as part of the Models of Child Health Appraised (MOCHA) project. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Grant Agreement No. 634201.

    • Disclaimer The funders did not have any role in study design, analysis or interpretation of data, in the writing of the report or in the decision to submit the article for publication.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval All data used in this study had been anonymised at the point of data extraction. No clinically identifiable information was used. The study received ethical approval from the South West Central Bristol Research Ethics Committee (REC reference number: 17/SW/0137, approval granted 16 June 2017).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional data are available by emailing Dr Uy Hoang, u.hoang@surrey.ac.uk.