Abstract
BackgroundHaving a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes.MethodsPopulation-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations).ResultsOverall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant.ConclusionHaving a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.
Highlights
Having a primary care provider and a continuous relationship may be important for asthma outcomes
Population-based studies in Canada and the United Kingdom have demonstrated that areas with high compared to low supply of, or access to, primary care physicians reduced the risk of emergency department (ED) visits and hospitalizations for children with asthma [2, 3]
Christakis et al demonstrated that for a group of children in the United States enrolled in a large health maintenance organization and another group enrolled in Medicaid, increased continuity was associated with decreased acute health services utilization (ED visits, hospitalizations); the risk was further decreased for children with asthma [6, 7]
Summary
Having a primary care provider and a continuous relationship may be important for asthma outcomes. We sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. Population-based studies in Canada and the United Kingdom have demonstrated that areas with high compared to low supply of, or access to, primary care physicians reduced the risk of emergency department (ED) visits and hospitalizations for children with asthma [2, 3]. To provide evidence to support policies for ongoing efforts to improve access to primary care and interventions for continuity of care, we aimed to determine the association between having a UPC and continuity of care with asthma-related acute outcomes care in a population-based cohort of children with asthma living in Québec, Canada. We hypothesized that having a UPC, and high continuity of care amongst those with an assigned UPC, would be associated with fewer asthma-related ED visits and hospitalizations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
