Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort study

Abstract

Objectives

To (1) describe primary health care utilization and (2) estimate the effect of primary care early follow-up, continuity, regularity, frequency, and long consultations on asthma hospital readmission, including secondary outcomes of emergency (ED) presentations, asthma preventer adherence, and use of rescue oral corticosteroids within 12 months.

Methods

An Australian multi-site cohort study of 767 children aged 3–18 years admitted with asthma between 2017 and 2018, followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets. We estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status and self-reported GP characteristics.

Results

The median number of general practitioner (GP) consultations, unique GPs and clinics visited was 9, 5, and 4, respectively. GP care was irregular and lacked continuity, only 152 (19.8%) children visited their usual GP on more than 60% of occasions. After adjusting for confounders, there was overall weak indication of effects due to any of the exposures. Increased frequency of GP visits was associated with reduced readmissions (4–14 visits associated with risk ratio of 0.71, 95% CI 0.50–1.00, p = 0.05) and ED presentations (>14 visits associated risk ratio 0.62, 95% CI 0.42–0.91, p = 0.02).

Conclusions

Our study demonstrates that primary care use by children with asthma is often irregular and lacking in continuity. This highlights the importance of improving accessibility, consistency in care, and streamlining discharge communication from acute health services.

Keywords:

• Asthma
• child
• readmission
• primary care
• linkage

Acknowledgements

The authors wish to thank Ms Rachel Pelly for her assistance with recruitment and data collection.

Data availability statement

The corresponding author, KC, has access to the complete study data which can be shared on request.

Additional information

Funding

All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: This study is funded by the Melbourne Academic Center for Health, Rapid Applied Research Translation 2.1 Grant. The funding body did not influence the submitted work. The authors have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.