Sarah Montgomery-Taylor

Abstract
Objective To evaluate the impact of an integrated child health system.

Design Mixed methods service evaluation.

Setting and patients Children, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form ‘hubs’.

Interventions Hospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an ‘Inside-Out’ change… Show more

Abstract
Objective To evaluate the impact of an integrated child health system.

Design Mixed methods service evaluation.

Setting and patients Children, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form ‘hubs’.

Interventions Hospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an ‘Inside-Out’ change known as ‘Connecting Care For Children (CC4C)’.

Main outcome measures Cases seen in clinic or discussed at MDT meetings and their follow-up needs. Hospital Episode data: outpatient and inpatient activity and A&E attendance. Patient-reported experience measures and professionals’ feedback.

Results In one hub, 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice. In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions and a 22% decrease in A&E attenders. Smaller hubs running at lower capacity in early stages of implementation had less impact on hospital activity. Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP and all respondents said they would recommend the service to family and friends. Professionals valued the improvement in knowledge and learning and, most significantly, the development of trust and collaboration.

Conclusions Child Health GP Hubs increase the connections between secondary and primary care, reduce secondary care usage and receive high patient satisfaction ratings while providing learning for professionals. Show less

There is great awareness of the need for change in child health: for better outcomes, greater cost effectiveness, and crucially, to have children, young people and their families at the centre of everything that is done. Child health is a leading sector in understanding and developing new ways of integrating and delivering care.

Abstract
Objective
To evaluate the management and outcomes of pregnancies among women with HIV infection.

Methods
A retrospective cohort study was undertaken of pregnant women with HIV who delivered at one center in the UK in 2008–2012. Case notes were reviewed and detailed information extracted regarding obstetric and virological management.

Results
Overall, 61 pregnancies were included; 43% (26/60) were unplanned and 39% (22/57) booked late. HIV infection was… Show more

Abstract
Objective
To evaluate the management and outcomes of pregnancies among women with HIV infection.

Methods
A retrospective cohort study was undertaken of pregnant women with HIV who delivered at one center in the UK in 2008–2012. Case notes were reviewed and detailed information extracted regarding obstetric and virological management.

Results
Overall, 61 pregnancies were included; 43% (26/60) were unplanned and 39% (22/57) booked late. HIV infection was diagnosed during pregnancy for 32% (19/60); 71% (12/17) were diagnosed after the first trimester. At booking, 47% of women (28/60) were not on treatment, all but one of whom commenced treatment, either for maternal reasons (CD4 count < 350 cells per mm3; 48% [13/27]) or prevention of mother-to-child-transmission (52% [14/27]). Viral load was high (> 50 copies per mL) at delivery for 13% of women (8/61). Delivery was by cesarean for 74% [45/61]. One neonate was diagnosed with HIV infection. There were 6 (10%) preterm births, 9 (15%) cases of low birth weight, 11 (18%) small-for-gestational-age neonates, and 1 (2%) stillbirth.

Conclusion
Better pregnancy planning, earlier booking and HIV diagnosis, and optimal antiretroviral treatment should increase the proportion of women with a low viral load (< 50 copies per mL) at delivery, lead to more vaginal deliveries, and further reduce mother-to-child transmission of HIV. Show less

There is a well recognised need to shift a significant proportion of hospital-based care to the community,1 and a corresponding increase in out-of-hospital specialist presence is needed to facilitate this.2 Potentially avoidable paediatric hospital referrals indicate the need for further support for primary care health professionals,3 especially given that many have limited formal paediatric training.4

Our “Matching Michigan” program has 3 focuses for identifying and reducing nosocomial infection. First, practical training to optimize infection control; second, root cause analysis of blood-culture positives; and third, feedback and use of results to develop new guidelines. Our infection rates are comparable with adult units. Interventions have reduced coagulase-negative staphylococcal infections whereas other infection rates have reduced relative to increased activity.