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Continuity of Primary Care Clinician in Early Childhood

Moira Inkelas, PhD^*,, Mark A. Schuster, MD, PhD^*,,||, Lynn M. Olson, PhD^¶, Christina H. Park, PhD^# and Neal Halfon, MD, MPH^,,**

^* Department of Health Services, UCLA School of Public Health, Los Angeles, California
UCLA Center for Healthier Children, Families, and Communities, Los Angeles, California
Department of Pediatrics, UCLA School of Medicine, Los Angeles, California
^|| RAND, Santa Monica, California
^¶ Department of Research and Practice, American Academy of Pediatrics, Elk Grove Village, Illinois
^# Anasys, Inc, Columbia, Maryland
^** Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, California

ABSTRACT

Objectives. This study uses the first national data on well-child care for young children to 1) assess how many children have a specific clinician for well-child care; 2) identify the health insurance, health care setting, and child and family determinants of having a specific clinician; and 3) assess how parents choose pediatric clinicians.

Methods. Data from the National Survey of Early Childhood Health (NSECH), a nationally representative survey of health care quality for young children fielded by the National Center for Health Statistics in 2000, were used to describe well-child care settings for children aged 4 to 35 months. Parents reported the child’s usual setting of well-child care, whether their child has a specific clinician for well-child care, and selection method for those with a clinician. Bivariate and logistic regression analyses are used to identify determinants of having a specific clinician and of provider selection method, including health care setting, insurance, managed care, and child and family characteristics.

Results. Nearly all young children aged 4 to 35 months in the United States (98%) have a regular setting, but only 46% have a specific clinician for well-child care. The proportion of young children who have a single clinician is highest among privately insured children (51%) and lowest among publicly insured children (37%) and uninsured children (28%). In multivariate logistic regression including health care and sociodemographic factors, odds of having a specific clinician vary little by health care setting. Odds are lower for children who are publicly insured (odds ratio [OR]: 0.7; 95% confidence interval [CI]: 0.45–0.97) and for Hispanic children with less acculturated parents (OR: 0.6; 95% CI: 0.39–0.91). Odds are higher for children in a health plan with gatekeeping requirements (OR: 1.4; 95% CI: 1.02–1.88). Approximately 13% of young children with a specific clinician were assigned to that provider. Assignment rather than parent choice is more frequent for children who are publicly insured, in managed care, cared for in a community health center/public clinic, Hispanic, and of lower income and whose mother has lower education. In multivariate logistic regression, only lack of health insurance, care in a community health center, and managed care participation are associated with lack of choice.

Conclusions. Anticipatory guidance is the foundation of health supervision visits and may be most effective when there is a continuous relationship between the pediatric provider and the parent. Only half of young children in the United States are reported to have a specific clinician for well-child care. Low rates of continuity are found across health care settings. Furthermore, not all parents of children with a continuous relationship exercised choice, particularly among children in safety net health care settings. These provisional findings on a new measure of primary care continuity for children raise important questions about the prevalence and determinants of continuity.

Key Words: continuity of care • clinician • health services • child health

Abbreviations: AAP, American Academy of Pediatrics • NSECH, National Survey of Early Childhood Health • PCP, primary care provider • OR, odds ratio • CI, confidence interval

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