In Early Childhood, Continuous Care By One Doctor Best, Study Suggests

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.