Continuity in provider and site of care and preventive services receipt in an adult Medicaid population with physical disabilities.
BACKGROUND
This study investigated the relationship between continuity of care (having one's own doctor and a regular site of care), and receipt of preventive services in a population of adult fee-for-service Medicaid enrollees with physical disabilities.


METHODS
A random sample of 555 physically disabled Rhode Island Medicaid enrollees aged 18 to 64 years were surveyed by telephone. Respondents were asked about receipt of six preventive services in the previous year. They were also asked whether they had their own doctor and whether they had a regular site of care. Regression analyses with propensity score corrections for selection bias were used to test the associations between care continuity measures and the number of preventive services received, as well as the receipt of each individual service.


RESULTS
After adjustment for predisposing, enabling, and need factors, respondents with their own doctor received 0.73 more preventive services than peers without their own doctor, and respondents who had a usual site of care received 0.85 more services than peers who received care at the emergency department or who had no regular site. The influences of having a regular doctor and a usual site of care varied according to type of preventive service, and these influences appear to be largely complementary rather than overlapping.


CONCLUSIONS
Study findings suggest that care models for adults with physical disabilities should include mechanisms to ensure both physician and site continuity. A strong primary care component that links individual patients with a personal doctor, as well as care protocols that ensure receipt of preventive services, appear to be optimal for medically needy populations.
Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA. Susan_Allen@Brown.edu
Susan M
SM
Allen
Susan
S
Wieland
Jane
J
Griffin
Pedro
P
Gozalo
D000293:Adolescent; D000328:Adult; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D018588:Fee-for-Service Plans; D019538:Health Care Surveys; D006268:Health Facilities / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008484:Medicaid; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012044:Regression Analysis; D012237:Rhode Island; D014481:United States; D055815:Young Adult