Pathways to child hospitalization : psychological, social and medical factors associated with the admission to hospital of children with gastroenteritis : a study of mothers and doctors.
Gastroenteritis is a common self-limiting illness of childhood. Hospital treatment, except in severe cases, involves treatment which is the same as that given at home on medical advice or on parents' own knowledge. Nevertheless, in Ireland over 2,000 young children are hospitalized annually with this diagnosis. The objective of this study was to examine the reasons for the hospitalization of young children with gastroenteritis, with a view to decreasing the incidence of medically unnecessary admissions.
Doctors and mothers were interviewed. For GPs and Casualty. Doctors (the primary providers of the medical management of gastroenteritis), management decisions and the factors influencing them were systematically evaluated. Family and home circumstances of children hospitalized for gastroenteritis were compared with the circumstances of families managing gastroenteritis at home. Combining the two sources of information the major role of the individual doctor in the management of gastroenteritis emerged. The findings of the present study indicate that there is considerable scope for improvement in present. gastroenteritis management. Possible improvements have been suggested at the level of GPs' and mothers' management, and at the level of management intermediate between the GP and hospitalization. These suggestions have been made in the light of the current situation in health care in Ireland.
The report consists of four main sections. The problem of gastro- enteritis as it is relevant to this study is outlined in Section I. The background and the research work concerning doctors and their decision-making is presented in the next section (Section 2 ) . Following this is a detailed comparison of the child and family circumstances of those with gastroenteritis who have been managed at home and in hospital (Section 3). The final section (Section 4) presents information on the most fruitful alternatives to hospitalization as suggested by study findings and the current Irish situation. An executive summary of the main findings of the study is provided at the beginning of the report.