Australian children’s foot, ankle, and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data

Abstract

AbstractObjectivesTo explore children’s foot, ankle and leg consultation patterns and management practices in Australian primary care.DesignCross-sectional, retrospective studySettingAustralia Bettering the Evaluation and Care of Health program dataset.ParticipantsData were extracted for GPs and patients ≤18 years from April 2000 to March 2016 inclusive.Main outcome measuresDemographic characteristics: sex, GP age groups (i.e. <45, 45-54, 55+ years), GP country of training, patient age grouping (0-4, 5-9, 10-14, 15-18 years), postcode, concession card status, Indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses, and the clinical management actioned by the GP.ResultsChildren’s foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229,137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI: 5.3-6.8) in 2005-06 to 9.0 (95% CI: 7.9-10.1) in 2015-16. Management of children’s foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15-18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100,000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping.ConclusionsChildren commonly present to GPs for foot, ankle, and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.Article SummaryStrengths and limitations of this study-This study examines the full spectrum of childhood foot, ankle, or leg presentations in primary care and how these are managed-This study also provides information about how foot, ankle and leg GP presentations and management patterns differ as children get older-This dataset provides a robust baseline on which future guidelines and implementation studies can measure the outcomes of practice change over time.-This study may be limited by how GPs coded the presentation and management data