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In Early Childhood, Continuous Care By One Doctor Improves Delivery Of Health Screenings
Children examined by
the same doctor during their first six months of life are more likely to
receive appropriate preventive health screenings -- for lead poisoning,
anemia and tuberculosis -- by age two. Pediatric researchers said being
cared for repeatedly by the same physician, often referred to as continuity
of care, was a very important factor in the children they studied.
Researchers from The Children's Hospital of Philadelphia and The
University of Pennsylvania reported on a study of 1,564 infants with
Medicare insurance in the March issue of the journal Pediatrics. All the
infants were born at three Philadelphia-area hospitals between July 1999
and March 2001 and received health care at over 120 different primary care
offices. The finding applied to all office visits, in addition to "well
child" visits, and children were followed for the first two years of life.
"Continuity of care may be of particular importance to vulnerable
pediatric patients, such as those insured through the Medicaid program,"
said Evaline Alessandrini, M.D., M.S.C.E., a pediatrician at Children's
Hospital and principal investigator of the study. "All health care visits,
not just well child visits, are important in establishing relationships
with families and meeting children's health care needs."
Children most at risk, such as those from urban, low-income families,
often don't receive proper screening for lead toxicity, anemia and
tuberculosis. Lead toxicity in early life can lead to lower intelligence
later. Iron deficiency anemia can cause problems with movement and damage
sight or hearing. Tuberculosis, while becoming less common, can have
serious complications for children.
Attempts to improve outcomes should focus not only on increasing the
number of visits to a primary care provider, but also reducing the number
of pediatricians treating the child over time. A next step is to identify
which children are most at risk of not receiving repeat care from the same
doctor.
"In 2008, there's a lot of discussion about the purpose of primary care
and the benefits children achieve by having a regular doctor," said
Alessandrini. "We don't want to forget the basics and if there are simple
ways to ensure those aspects of primary care are met, then we should find
ways to get them done."
Although they examined duration of office hours and other practice
specific information, the researchers did not determine whether a medical
office uses electronic records to alert providers when it was time for
screening, a method shown in past studies to improve vaccination rates and
other services.
Also, the authors caution that increasing continuity of care is
difficult because certain office visits require immediate medical attention
and parents may prefer their child see the first physician available rather
than wait to see their regular doctor. Future studies are needed to monitor
patients over a longer period of time and in a wider geographic region, the
authors said.
Alessandrini's co-authors are Ana Flores, B.S., from The University of
Pennsylvania School of Medicine, and Warren Bilker, Ph.D., from the Center
for Clinical Epidemiology and Biostatistics at the University of
Pennsylvania. Alessandrini's research was supported by a grant from the
National Institute of Child Health and Human Development.
About The Children's Hospital of Philadelphia: The Children's Hospital
of Philadelphia was founded in 1855 as the nation's first pediatric
hospital. Through its long-standing commitment to providing exceptional
patient care, training new generations of pediatric healthcare
professionals and pioneering major research initiatives, Children's
Hospital has fostered many discoveries that have benefited children
worldwide. Its pediatric research program is among the largest in the
country, ranking third in National Institutes of Health funding. In
addition, its unique family-centered care and public service programs have
brought the 430-bed hospital recognition as a leading advocate for children
and adolescents. For more information, visit http://www.chop.edu.
The Children's Hospital of Philadelphia
http://www.chop.edu
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