PEDIATRICS Vol. 98 No. 6 December 1996, pp. 1028-1034
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mustard, C. A.
Right arrow Articles by Postl, B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mustard, C. A.
Right arrow Articles by Postl, B.

Continuity of Pediatric Ambulatory Care in a Universally Insured Population

Cameron A. Mustard ScD1, Teresa Mayer 2, Charlyn Black MD, ScD3, and Brian Postl MD4

1 The Department of Community Health Sciences and the Manitoba Centre for Health Policy and Evaluation, Faculty of Medicine, University of Manitoba and the Population Health Program, Canadian Institute for Advanced Research.
2 The Department of Manitoba Centre for Health Policy and Evaluation, Faculty of Medicine, University of Manitoba
3 The Department of Community Health Sciences and the Manitoba Centre for Health Policy and Evaluation, Faculty of Medicine, University of Manitoba
4 The Department of Community Health Sciences and Pediatrics and the Manitoba Centre for Health Policy and Evaluation, Faculty of Medicine, University of Manitoba

Objective. To describe the prevalence of continuity of care over a 5-year period in a complete cohort of urban children universally insured for medical care provided under fee-for-service reimbursement.

Method. All children enrolled in the study were born to women living in metropolitan Winnipeg between July 1,1987 and December 31, 1988 (N = 12 590). All ambulatory physician services for this group were enumerated from computerized administrative databases for the period from birth through 60 months. Continuity of care, defined as the proportion of total care provided by the most frequently seen physician or physician practice over time, was calculated for each child. Descriptive analyses include an examination of maternal and household characteristics associated with children receiving 80% or more of total ambulatory care from a single provider source.

Results. From birth to 24 months, 51% of children received at least 80% of ambulatory visits from a single provider practice. This proportion of the children declined to 28% at 25 through 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor continuity included young maternal age, single maternal marital status, residential mobility, and inadequate maternal use of prenatal medical care. Households affiliated with pediatric practices had better continuity profiles than households affiliated with general medical practices.

Conclusion. Despite universal medical insurance, barriers to a longitudinally continuous relationship with a primary care provider remain in this setting. Although this study has emphasized the description of those barriers associated with household characteristics, there is evidence that factors related to the organization and delivery of medical care are also relevant.

Key Words: continuity of care • universal insurance • socioeconomic status

Submitted on October 20, 1995
Accepted on January 29, 1996




This article has been cited by other articles:


Home page
 J. Epidemiol. Community HealthHome page
T Jelleyman and N Spencer
Residential mobility in childhood and health outcomes: a systematic review
J. Epidemiol. Community Health, July 1, 2008; 62(7): 584 - 592.
[Abstract] [Full Text] [PDF]

Home page
 Med Care Res RevHome page
S. H. Jee and M. D. Cabana
Indices for continuity of care: a systematic review of the literature.
Med Care Res Rev, April 1, 2006; 63(2): 158 - 188.
[Abstract] [PDF]

Home page
 PediatricsHome page
D. G. Bundy, G. D. Randolph, M. Murray, J. Anderson, and P. A. Margolis
Open Access in Primary Care: Results of a North Carolina Pilot Project
Pediatrics, July 1, 2005; 116(1): 82 - 87.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. Hoekelman
Commentary: Pre-Primary Care Pediatrics
Pediatrics, April 1, 2005; 115(4/S1): 1148 - 1149.
[Full Text] [PDF]

Home page
 PediatricsHome page
G. D. Randolph, M. Murray, J. A. Swanson, and P. A. Margolis
Behind Schedule: Improving Access to Care for Children One Practice at a Time
Pediatrics, March 1, 2004; 113(3): e230 - 237.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
A. L. Kozyrskyj, C. A. Mustard, and F. E. R. Simons
Socioeconomic Status, Drug Insurance Benefits, and New Prescriptions for Inhaled Corticosteroids in Schoolchildren With Asthma
Arch Pediatr Adolesc Med, November 1, 2001; 155(11): 1219 - 1224.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. S. Byrd, R. A. Hoekelman, and P. Auinger
Adherence to AAP Guidelines for Well-Child Care Under Managed Care
Pediatrics, September 1, 1999; 104(3): 536 - 540.
[Abstract] [Full Text] [PDF]