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A Systematic Evaluation of Paediatric Allergy Pathways in the West Midlands

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A Systematic Evaluation of Paediatric Allergy Pathways in the West Midlands A SYSTEMATIC EVALUATION OF PAEDIATRIC ALLERGY PATHWAYS IN THE WEST MIDLANDS by LAVANYA DIWAKAR A thesis submitted to the University of Birmingham for the degree of DOCTOR OF PHILOSOPHY in Health Economics Health Economics Unit Institute of Applied Health Research College of Medical and Dental Sciences University of Birmingham December 2017 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT This thesis considers the design of paediatric allergy services in the West Midlands (WM) region. It is presented in 3 parts: the first discusses a systematic review of allergy service delivery pathways across the UK and the rest of the world; The second quantifies the burden of paediatric allergy across the WM and compares it with the rest of the country using data from the health information network (THIN) database for primary care and the hospital episodes statistics (HES) database for secondary care. The final part ascertains the experiences of parents in the WM region who have accessed these services through a qualitative study and elicits parental preferences for these services using a discrete choice experiment. The main argument put forth in this thesis is that services in a financially constrained environment should be planned efficiently and be responsive to the needs and preferences of the local population. A systematic way method to achieve this is presented along with recommendations for improving the efficacy and efficiency of paediatric allergy pathways in the WM region. ACKNOWLEDGEMENT I am grateful to the Wellcome Trust for funding this project. My thanks go to my supervisors Prof Tracy Roberts and Dr Carole Cummins. Their dedication to their work and the uncompromising stance on quality has been inspiring. Their guidance and friendship throughout has undoubtedly been one of the best things about my fellowship. I would also like to thank Prof Richard Lilford for his guidance during the first few months of the fellowship. Thanks also to all my colleagues in the health economics unit, especially Hareth and Louise, for all their help at various stages of the PhD. I really valued those chats over coffee. To my best friends, Urmi and Neerajana, for just being there. To my sister and brother for their love and counsel. Thanks to Diwakar for his support with all of my life projects, crazy as they sometimes seem. To my children, Aditya and Siddharth, for the joy they bring to my life. And thanks also to my parents for their unwavering love and their pride in everything I do. TABLE OF CONTENTS ABSTRACT .................................................................................................................................................. 2 ACKNOWLEDGEMENT ................................................................................................................................ 3 TABLE OF FIGURES .................................................................................................................................................. III LIST OF TABLES ...................................................................................................................................................... V APPENDIX ............................................................................................................................................................ VI 1 INTRODUCTION ..................................................................................................................................... 1 1.1 BACKGROUND ........................................................................................................................................... 2 1.2 PAEDIATRIC ALLERGY SERVICES IN THE UK ....................................................................................................... 3 1.3 AIM AND OBJECTIVES .................................................................................................................................. 4 1.4 OVERVIEW OF THE THESIS ............................................................................................................................ 4 2 A SYSTEMATIC REVIEW OF PATHWAYS FOR THE DELIVERY OF ALLERGY SERVICES ................................ 6 2.1 INTRODUCTION .......................................................................................................................................... 7 2.2 METHODS ................................................................................................................................................ 8 2.3 RESULTS ................................................................................................................................................... 9 2.4 DISCUSSION: ........................................................................................................................................... 19 2.5 CONCLUSIONS ......................................................................................................................................... 23 3 ANALYSIS OF HEALTHCARE DATABASES- THE HEALTH IMPROVEMENT NETWORK (THIN) DATABASE . 25 3.1 INTRODUCTION ........................................................................................................................................ 26 3.2 BACKGROUND ......................................................................................................................................... 26 3.3 THE HEALTH IMPROVEMENT NETWORK DATABASE (THIN) .............................................................................. 28 3.4 AIMS AND OBJECTIVES .............................................................................................................................. 32 3.5 METHODS .............................................................................................................................................. 32 3.6 ANALYSIS ................................................................................................................................................ 34 3.7 RESULTS ................................................................................................................................................. 35 3.8 ALLERGY BURDEN: UK VS WEST MIDLANDS .................................................................................................. 51 3.9 DISCUSSION ............................................................................................................................................ 54 3.10 CONCLUSIONS ......................................................................................................................................... 59 4 ANALYSIS OF HEALTHCARE DATABASES- THE HOSPITAL EPISODES STATISTICS DATABASE ................. 60 4.1 BACKGROUND ......................................................................................................................................... 61 4.2 HES ALLERGY DATA ................................................................................................................................. 63 4.3 AIM AND OBJECTIVES ................................................................................................................................ 64 4.4 METHODS .............................................................................................................................................. 65 4.5 ANALYSIS ................................................................................................................................................ 66 4.6 RESULTS ................................................................................................................................................. 67 4.7 DISCUSSION ............................................................................................................................................ 78 4.8 CONCLUSIONS ......................................................................................................................................... 82 5 A QUALITATIVE STUDY TO UNDERSTAND PARENT EXPERIENCES WITH PAEDIATRIC ALLERGY PATHWAYS IN THE WEST MIDLANDS .................................................................................................. 84 5.1 INTRODUCTION ........................................................................................................................................ 85 5.2 QUALITATIVE RESEARCH ............................................................................................................................ 86 5.3 METHODS .............................................................................................................................................. 91 5.4 RESULTS ................................................................................................................................................. 95 5.5 DISCUSSION .......................................................................................................................................... 123 5.6 CONCLUSIONS ......................................................................................................................................
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