(319) Continuity of care in primary care for young children with asthma: a population-based cohort study

Background: The existing evidence for the impacts of continuity of care (COC) in patients with asthma is low to moderate.

Objectives: This study aimed to investigate the associations between relational COC within primary care and asthma-related hospitalizations in children using a robust methodology.

Methods:

Design: Population based cohort study.
Setting: National Health Insurance Service database, South Korea
Participants: 136,296 children ( < 20 years) with asthma newly diagnosed between 2015 and 2016 were included.
Exposure: The continuity of care within primary care measured by the Continuity of Care Index (COCI)
Main outcome measures: The primary outcome was the incidence of asthma-related hospitalizations. Cox proportional hazard models were used to estimated hazard ratios and 95% confidence intervals.

Results:

Results: Out of 136,296 patients, 45,056 were continuously cared for by primary doctors (High continuity group, COCI≥0.67), 45,650 received moderate continuity of care (Medium-continuity group, 0.67>COCI≥0.4), and 45,590 did not (Low-continuity group, COCI < 0.4). During a two year follow-up period, 10,922 patients (8.01%) were hospitalized; 2,520 (5.59%) from the High-continuity group, 3,188 (6.98 %) from the Medium-continuity group, and 3,867 (8.48%) from the Low-continuity group. After adjusting for confounding covariates, patients in the Low-continuity group exhibited a significantly higher risk of hospital admission (adjusted hazard ratio (aHR) = 1.30 [95% confidence interval=1.24~1.37]) and those in the Medium-continuity group had an aHR = 1.14 [1.08~1.20], compared to those in the High-continuity group. The findings remained consistent across sensitivity and subgroup analyses.

Conclusions: In children with asthma, increased continuity of primary care was found to be associated with less hospitalization.