Patterns of health service use in families where children enter public care: a nested case-control study using the general practice research database

Abstract

Aim To investigate whether mother–child pairs with children entering public care have different patterns of health service use in the previous 12 months compared to mother–child pairs where the children do not enter public care using primary care data. Methods A nested case-control study analysing data from the general practice research database (GPRD) on 147 case mother–child pairs and 538 control pairs matched by age and sex of the child and general practice. Health service use data were extracted for the 12 months before the case child entered public care. Clinical exposures of interest in the data set included mental illnesses, drug and alcohol misuse, developmental delay, referrals and admissions to hospital. Non-clinical exposures of interest included socioeconomic status, maternal age, smoking and alcohol consumption. Results 23 variables were significant on univarate conditional logistic regression analysis. A forward selection conditional logistic regression model was used to investigate the combined effect of more than one exposure of interest. Maternal mental illness (OR 2.51, 95% CI 1.55 to 4.05), maternal age at birth of the child, socioeconomic status (5th vs 1st quintile OR 7.14, 95% CI 2.92 to 17.4), maternal drug misuse (OR 28.8, 95% CI 2.29 to 363), non-attendance at appointments (OR 2.42, 95% CI 1.42 to 4.14), child mental illness (OR 2.65, 95% CI 1.42 to 4.96) and child admission to hospital (OR 3.31, 95% CI 1.21 to 9.02) were significantly associated with children entering public care. Maternal use of primary care contraception services was negatively associated with children entering public care (OR 0.52, 95% CI 0.31 to 0.87). Conclusion Different patterns of health service use are identifiable from routine primary care data in mother–child pairs where children enter public care. Mothers of these children are more likely to have mental illness, misuse drugs and to miss appointments. They are less likely to use primary care contraception services than control mothers. Children who enter public care are more likely to have mental illness and a hospital admission in the previous year than control children.