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Relationship between continuity of care and emergency department utilization in children with attention deficit/hyperactivity disorder in British Columbia Mozel, Michelle R.

Abstract

Cxjntmuity of care with a primary care provider has long been thought to lead to improved health outcomes and greater patient and physician satisfaction. The benefits of continuity of care remain controversial, however, and have not been firmly established for pediatric patients. The objective of this study was to examine whether continuity of care with a primary care provider is associated with the number of emergency department (ED) visits in children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) in British Columbia We analyzed two years of physician claims records for over 4000 British Columbia children aged 4 to 16 to determine individual continuity of care (COC) scores for each study participant. Multinomial logistic regression analysis was then applied to determine if a relationship exists between COC computed during two years and number of ED visits made during the following year. Our results showed a weak association between continuity with a primary care provider and ED use. In multivariate analysis, continuity was associated with a lower likelihood of making a single ED visit (odds ratio, 0.85; 95% confidence interval, 0.70- 1.05) and is more strongly associated with a lower likelihood of making multiple E D visits (odds ratio, 0.81; 95% confidence interval, 0.62-1.05). Other variables that were associated with outcome include: age, socio-economic status, overall number of general practitioner visits, pediatrician visits, psychiatrist visits, and illness burden. This study demonstrates that high primary care provider continuity is associated with lower ED use for children aged 4 to 16 with ADHD in British Columbia. The results suggest that strategies to improve continuity of primary care provider among this population may lead to decreased ED utilization and should therefore be encouraged.

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