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Continuity of pediatric ambulatory care in a universally insured population
C A Mustard1, T Mayer, C Black
1Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Insights
Continuity of care for urban children declined significantly after 24 months, with low-income neighborhoods and certain maternal factors linked to poorer care. Even with universal insurance, barriers to consistent primary care persist.
Area of Science:
- Pediatric Health Services Research
- Health Economics
- Public Health Policy
Background:
- Continuity of care is crucial for effective pediatric health management.
- Understanding factors influencing care continuity is essential for improving child health outcomes.
- Fee-for-service reimbursement models may impact provider-patient relationships.
Purpose of the Study:
- To determine the prevalence of continuity of care in urban children over a 5-year period.
- To identify household and provider-related factors associated with continuity of care.
- To examine care continuity in a universally insured population.
Main Methods:
- A complete cohort of 12,590 urban children born between 1987-1988 was studied.
- Ambulatory physician services were tracked from birth to 60 months using administrative databases.
- Continuity of care was defined as the proportion of care from the most frequent provider.
Main Results:
- 51% of children had consistent care from one provider up to 24 months, decreasing to 28% by 60 months.
- Children in low-income areas, with young or single mothers, high residential mobility, or poor prenatal care, showed lower continuity.
- Pediatric practices were associated with better continuity than general medical practices.
Conclusions:
- Significant barriers to continuous primary care exist for urban children, even with universal medical insurance.
- Household characteristics are associated with poor continuity, highlighting socioeconomic and demographic influences.
- Organizational and delivery aspects of medical care also play a role in care continuity.
Objective:
To describe the prevalence of continuity of care over a 5-year period in a complete cohort of urban children universally insured for medical care provided under fee-for-service reimbursement.
Method:
All children enrolled in the study were born to women living in metropolitan Winnipeg between July 1, 1987 and December 31, 1988 (N = 12,590). All ambulatory physician services for this group were enumerated from computerized administrative databases for the period from birth through 60 months. Continuity of care, defined as the proportion of total care provided by the most frequently seen physician or physician practice over time, was calculated for each child. Descriptive analyses include an examination of maternal and household characteristics associated with children receiving 80% or more of total ambulatory care from a single provider source.
Results:
From birth to 24 months, 51% of children received at least 80% of ambulatory visits from a single provider practice. This proportion of the children declined to 28% at 25 through 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor continuity included young maternal age, single maternal marital status, residential mobility, and inadequate maternal use of prenatal medical care. Households affiliated with pediatric practices had better continuity profiles than households affiliated with general medical practices.
Conclusion:
Despite universal medical insurance, barriers to a longitudinally continuous relationship with a primary care provider remain in this setting. Although this study has emphasized the description of those barriers associated with household characteristics, there is evidence that factors related to the organization and delivery of medical care are also relevant.