Continuity of care in the ambulatory treatment of adolescents with asthma.
OBJECTIVE
To estimate the level of continuity of care, an important component in the management of asthma, using a general index based on medical visits and a disease-specific index based on prescribed medications, and to compare how the indexes predict the use of health care services among adolescents with asthma.


METHODS
A cohort of 5586 adolescents with asthma was selected from the administrative database of the province of Québec, Canada between 1997 and 1999. Patients were followed for at least 1 year to a maximum of 3.5 years. The main exposure variables were an index of continuity of care based on the number of physicians prescribing a medication for asthma (RxICC) and an index of continuity of care based on the number of unreferred physicians (COC).


RESULTS
The average RxICC was .42 +/- .29 and the average COC was .26 +/- .22. The adjusted rate ratios for RxICC as a predictor of hospitalizations and emergency department (ED) visits for asthma were, respectively, .83 (95% confidence interval [CI] .80-.87) and .81 (95% CI .80-.83). No significant association was found between COC, hospitalizations, and ED visits for asthma.


CONCLUSIONS
Continuity of care is low among adolescents with asthma in Québec. The RxICC was, on average, higher than the COC, because patients were more likely to visit the same physician to treat their asthma than they would for other types of care. Only the RxICC was associated with the risk of hospitalization and ED visits for asthma.
Cyr
Marie-Christyne
MC
Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada.
Martens
Alexander C
AC
Berbiche
Djamal
D
Perreault
Sylvie
S
Blais
Lucie
L
D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011792:Quebec / Q000453:epidemiology; D018570:Risk Assessment; D016896:Treatment Outcome