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Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort
Katherine Yh Chen1,2,3, Renee Jones1, Shaoke Lei1
1Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.
Insights
Primary care for children with asthma is often irregular. More frequent general practitioner (GP) visits may reduce hospital readmissions and emergency department visits for childhood asthma.
Area of Science:
- Pediatric Pulmonology
- Primary Health Care Research
- Health Services Research
Background:
- Asthma is a common chronic respiratory disease in children, often requiring hospital admission.
- Primary health care plays a crucial role in managing childhood asthma and preventing exacerbations.
- Gaps in primary care access, continuity, and consistency can negatively impact asthma outcomes.
Purpose of the Study:
- To describe primary health care utilization patterns in children with asthma.
- To evaluate the impact of primary care factors (early follow-up, continuity, regularity, frequency, consultation length) on asthma hospital readmissions.
- To assess secondary outcomes including emergency department presentations and medication adherence.
Main Methods:
- A multi-site Australian cohort study involving 767 children (aged 3-18 years) admitted with asthma.
- Data collected through linked administrative datasets over a 12-month follow-up period.
- Modified Poisson regression used to estimate the effects of primary care utilization on outcomes, adjusting for confounders.
Main Results:
- Primary care for children with asthma was characterized by a median of 9 general practitioner (GP) consultations, with care often being irregular and lacking continuity.
- Increased frequency of GP visits showed an association with reduced asthma hospital readmissions (4-14 visits) and emergency department presentations (>14 visits).
- Overall, weak indications of effect were observed for most primary care exposures, except for visit frequency.
Conclusions:
- Primary health care utilization by children with asthma is frequently irregular and lacks continuity.
- Improving accessibility, consistency of care, and discharge communication from acute services is essential for better asthma management.
- Enhanced primary care engagement may contribute to reduced hospital readmissions and emergency visits for pediatric asthma.
Objectives:
To (1) describe primary health care utilization and (2) estimate the effect of primary care early follow-up, continuity, regularity, frequency, and long consultations on asthma hospital readmission, including secondary outcomes of emergency (ED) presentations, asthma preventer adherence, and use of rescue oral corticosteroids within 12 months.
Methods:
An Australian multi-site cohort study of 767 children aged 3-18 years admitted with asthma between 2017 and 2018, followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets. We estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status and self-reported GP characteristics.
Results:
The median number of general practitioner (GP) consultations, unique GPs and clinics visited was 9, 5, and 4, respectively. GP care was irregular and lacked continuity, only 152 (19.8%) children visited their usual GP on more than 60% of occasions. After adjusting for confounders, there was overall weak indication of effects due to any of the exposures. Increased frequency of GP visits was associated with reduced readmissions (4-14 visits associated with risk ratio of 0.71, 95% CI 0.50-1.00, p = 0.05) and ED presentations (>14 visits associated risk ratio 0.62, 95% CI 0.42-0.91, p = 0.02).
Conclusions:
Our study demonstrates that primary care use by children with asthma is often irregular and lacking in continuity. This highlights the importance of improving accessibility, consistency in care, and streamlining discharge communication from acute health services.
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