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.
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.