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

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. 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. 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, <i>p</i> = 0.05) and ED presentations (&gt;14 visits associated risk ratio 0.62, 95% CI 0.42–0.91, <i>p</i> = 0.02). 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.

本研究旨在（1）描述初级医疗服务利用现状，（2）评估初级保健早期随访、诊疗连续性、就诊规律性、问诊频次以及长时问诊对哮喘患者再住院的影响，同时纳入12个月内的急诊（ED，Emergency Department）就诊、哮喘预防用药依从性以及急救性口服糖皮质激素使用作为次要结局指标。这是一项澳大利亚多中心队列研究，纳入2017至2018年间因哮喘住院的767名3~18岁儿童，通过关联行政数据集获取随访至少12个月的结局指标与初级医疗暴露数据。本研究采用改良泊松回归模型评估初级医疗利用的效应，校正变量包括儿童年龄、哮喘严重程度、社会经济地位以及自我报告的全科医生（GP，General Practitioner）特征。研究对象的全科医生问诊次数、就诊的唯一全科医生数量与诊所数量的中位数分别为9次、5名与4家。全科医疗服务普遍存在不规律且连续性不足的问题，仅152名（19.8%）儿童在超过60%的就诊中选择了其固定全科医生。校正混杂因素后，各类初级医疗暴露因素整体仅呈现微弱的效应关联。较高的全科医生问诊频次与更低的再住院风险相关（4~14次问诊对应的风险比为0.71，95%置信区间0.50~1.00，*p*=0.05）；同时，更高的问诊频次也与更少的急诊就诊相关（>14次问诊对应的风险比为0.62，95%置信区间0.42~0.91，*p*=0.02）。本研究表明，哮喘儿童的初级医疗服务利用通常缺乏规律性与连续性，这凸显了提升医疗服务可及性、保障诊疗一致性，以及优化急性医疗服务出院沟通流程的重要性。