March 5, 2001
Having a regular doctor protects children from a variety of ills
Children who see the same doctor repeatedly are likely to stay healthier than children who see different doctors, according to a University of Washington study. Children with a regular doctor are considerably less likely than their peers to find themselves in an emergency room or admitted to a hospital.
“Having a regular doctor is good medicine,” says Dr. Dimitri Christakis, an assistant professor of pediatrics at the UW School of Medicine and associate director of UW’s Child Health Institute in Seattle.
The results of the analysis are in the March issue of Pediatrics, a publication of the American Academy of Pediatrics. The paper is titled, “Association of Lower Continuity of Care with Greater Risk of Emergency Department Use and Hospitalization in Children.”
The finding comes at a time when the health-care system in the United States often works against parents who want to take their child to the same doctor, Christakis warns. Parents may take their children to different providers because of the policies of some managed care organizations or because of changes in insurance coverage.
“It seems clear that health-care providers and policymakers should do what they can to help children and parents maintain a consistent relationship with their doctor,” Christakis says. “This is a very simple thing that can improve childrens’ health.”
Christakis and colleagues studied the records of 47,000 children with a median age of 5 in the Seattle area. The researchers divided the children into three groups, depending on how often they saw the same physicians.
In the group with the lowest continuity of care, children were 60 percent more likely than others to have visited an emergency room, and 54 percent more likely to have been hospitalized.
In the group which had a moderate amount of continuity of care, children were 28 percent more likely than children who saw the same doctor to go on to an ER, and 22 percent more likely to require a hospital stay.
The researchers also looked at what happened to children who had a chronic disease: asthma. Children who did not see the same health-care provider regularly were almost 80 percent more likely to require hospitalization. Children who are on Medicaid who did not see a regular doctor were more than 400 percent more likely to be admitted to a hospital.
“Continuity of care is extremely important when it comes to monitoring a child who has asthma, and likely any other chronic disease,” Christakis says.
There are many possible reasons for these findings, he said:
- Parents who know a regular provider may have a better understanding of their child’s condition. Thus, they may be able to make more informed decisions about when to take the child into the emergency room.
- Previous studies have shown that people are more willing to take their medication as prescribed if they have built up a long-term relationship with their provider.
- Parents are less likely to go to an emergency room if they have a regular doctor who will see a child. Previous studies have shown that people are willing to wait 12 to 24 hours for an appointment with a known provider, rather than go to an emergency department.
- Doctors who see a patient repeatedly have a better understanding of everything about the child, from home life to health. The doctors get to know the patient better, and have a breadth of experience on which to base a treatment plan.
“Physicians who see someone regularly become more invested in that patient,” Christakis says. “And the more a doctor sees you, the more in tune he or she is with your needs and your condition.”
Other authors of the paper include Dr. Frederick Connell, associate dean for academic affairs in the UW School of Public Health and Community Medicine and professor and director of maternal and child health in the school’s Department of Health Services; Loren Mell of Group Health Cooperative, Seattle; Dr. Thomas Koepsell, professor of epidemiology in the School of Public Health; and Dr. Frederic Zimmerman, acting assistant professor of health services in the School of Public Health.
