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Determinants of hospital-based health service utilisation in cerebral palsy: a systematic review

  • Author Footnotes
    a Main Appointment: Senior Staff Specialist Paediatric Rehabilitation Medicine Physician
    Simon Paget
    Correspondence
    Corresponding author: Dr Simon Paget, Kids Rehab, the Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145 Australia, +61 2 98452132
    Footnotes
    a Main Appointment: Senior Staff Specialist Paediatric Rehabilitation Medicine Physician
    Affiliations
    The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia

    Kids Rehab, the Children's Hospital at Westmead, Westmead NSW Australia
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  • Author Footnotes
    b Main Appointment: Research assistant, Cerebral Palsy Alliance
    Katarina Ostojic
    Footnotes
    b Main Appointment: Research assistant, Cerebral Palsy Alliance
    Affiliations
    Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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  • Author Footnotes
    c Main Appointment: Research Fellow, Cerebral Palsy Alliance
    Shona Goldsmith
    Footnotes
    c Main Appointment: Research Fellow, Cerebral Palsy Alliance
    Affiliations
    Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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  • Author Footnotes
    d Main Appointment: Financial Markets Foundation for Children Chair in Translational Childhood Medicine
    Natasha Nassar
    Footnotes
    d Main Appointment: Financial Markets Foundation for Children Chair in Translational Childhood Medicine
    Affiliations
    Child Population and Translational Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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  • Author Footnotes
    e Main Appointment: Senior Research Fellow, Cerebral Palsy Alliance
    Sarah McIntyre
    Footnotes
    e Main Appointment: Senior Research Fellow, Cerebral Palsy Alliance
    Affiliations
    Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
    Search for articles by this author
  • Author Footnotes
    a Main Appointment: Senior Staff Specialist Paediatric Rehabilitation Medicine Physician
    b Main Appointment: Research assistant, Cerebral Palsy Alliance
    c Main Appointment: Research Fellow, Cerebral Palsy Alliance
    d Main Appointment: Financial Markets Foundation for Children Chair in Translational Childhood Medicine
    e Main Appointment: Senior Research Fellow, Cerebral Palsy Alliance
Published:December 27, 2021DOI:https://doi.org/10.1016/j.apmr.2021.12.003

      Objective

      To systematically review and synthesize evidence of determinants associated with hospital-based health service utilisation among individuals with cerebral palsy (CP).

      Data Sources

      Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020.

      Study Selection

      Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilisation (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilisation.

      Data extraction

      After initial screen, two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle Ottawa scale. Determinants of health service utilisation were identified and categorised using the Andersen Behavioural Model.

      Data synthesis

      Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across eight Andersen Model characteristics. Individual predisposing factors such as sex showed no difference in health service utilisation; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilisation was associated with “individual need” including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants.

      Conclusions

      CP health service utilisation was associated with age, severity and comorbidities. Improved understanding of determinants of health service utilisation can support health service access for people with CP.

      Keywords

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