Purpose: The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. Design and methods: A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. Results: Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (beta = 0.17), shorter survival time (beta = -0.23), who had contact with the palliative care unit (beta = 0.16), and whose mothers had a higher professional occupation (beta = 0.14), had a greater use of the healthcare system. Conclusions: Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. Practical implications: Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC license (http:// creativecommons.org/licenses/by-nc/4.0/).

Background: Caregivers for children with complex chronic illnesses may experience emotional and physical strain, especially as concerns attention overload and the perceptions of their own psychosocial situation. These concerns, together with the additional financial cost and the socioeconomic inequalities that arise from caregiving responsibilities, create major challenges to the health status of this population group. Methods: A prospective analytical longitudinal study will be conducted, based on an exposed cohort of adult caregivers (parents or guardians) for children with complex chronic processes, to evaluate the impact of caregiving responsibilities on the health status of this population group. Conclusions and implications: The practical implications of this study are of great significance for clinical practice. The results of this study have the potential to inform the decision-making process in the healthcare sector and guide future research initiatives. The findings of this study will provide crucial insights into the health-related quality of life of caregivers of children with complex chronic illnesses, which will be valuable in addressing the challenges faced by this population group. This information can be used to improve the availability and accessibility of appropriate health services and to facilitate the development of more equitable health outcomes for caregivers of children with complex chronic illnesses. By highlighting the extent to which this population is affected both physically and mentally, the study can contribute to the development of clinical practices that prioritize the health and well-being of caregivers in the care of children with complex chronic illnesses.

Background/Objectives: Patients with multimorbidity frequently rely on emergency services when continuity of care is weak. Strengthening communication between emergency and primary care can prevent unnecessary hospitalizations, yet this relationship remains underexplored. The aim of this study was to analyze the relationship between primary health care utilization in patients with multimorbidity and their demand for prehospital emergency services. Methods: An observational, longitudinal, analytical, and retrospective study was conducted in Málaga (Spain) between 2013 and 2017. Adults (>18 years) with multimorbidity who requested prehospital emergency care services at home were included; those with cancer, rare diseases, severe mental disorders, or incomplete electronic records were excluded. Variables encompassed sociodemographic, clinical, and behavioral characteristics, comorbidities, functional status, polypharmacy, resource type, and outcomes (on-site resolution or hospital referral). Primary health care visits before and after prehospital emergency use were extracted from electronic records. Descriptive, bivariate, and multivariate analyses were performed. Results: Among 532 patients, prior primary health care attendance predicted subsequent utilization (β = 0.57; p < 0.001), along with caregiver availability (β = 0.12; p = 0.001) and prehospital emergency services hyper-demand (β = 0.08; p = 0.022). Super-utilizers were younger, had ≥4 comorbidities, polypharmacy, prior family medicine visits, home oxygen therapy, and lower substance or alcohol use. Conclusions: In multimorbid adults, prehospital emergencies demand is influenced by factors beyond severity, including comorbidities, polypharmacy, the use of home medical devices, caregiver availability, and primary health care utilization patterns. Strengthening coordination between prehospital emergencies and primary health care, promoting patient–caregiver education, and implementing early notification pathways may improve care continuity and reduce avoidable emergencies.