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The Importance of Continuity of Care in Children with Asthma

Shu-Tzu Huang1, Yee-Yung Ng2 and Shiao-Chi Wu*1

1Institute of Health and Welfare Policy, School of Medicine, National Yang Ming University, Taiwan

2Taipei Veterans General Hospital, Taiwan (ROC)

*Corresponding Author:
Wu SC
Institute of Health and Welfare Policy
School of Medicine
National Yang Ming University, Taiwan
Tel: 886-2-2826-7052
Fax: 886-2-2820-4735
E-mail: [email protected]

Received date: March 12, 2016; Accepted date: May 18, 2016; Published date: May 23, 2016

Citation: Shu-Tzu Huang, Yee-Yung Ng and Shiao-Chi Wu (2016) The Importance of Continuity of Care in Children with Asthma.Gen Med (Los Angeles) 4:243. doi:10.4172/2327-5146.1000243

Copyright: © 2016 Huang ST, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Commentry

Continuity of care (COC) means the condition of “care over time by a single individual or team of health professionals,” [1] which is a cornerstone of primary care. With continuous care, patients tend to have higher quality of care, i.e., greater satisfaction, decreased emergency department (ED) visits and hospitalizations, and improved receipt of preventive services [2]. Physicians who have long-term relationships with their patients may better manage the chronic diseases because they are more familiar with their patients’ medical history and can effectively communicate with their patients. This was particularly found in patients with asthma. Love et al. [3] found a positive correlation between COC and patient perceptions of physician-patient communication.

Asthma is the most common non-communicable disease among children, whose airway inflammation is still present during clinical remission of atopic asthma [4]. The continuous treatment with inhaled corticosteroids for children with asthma leads to effective control of asthma and ensure the safety of long-term treatment for asthma [5-7]. Therefore proper disease management can avoid asthma attack or ED visit. The report “Global strategy for asthma management and prevention” from Global Initiative for Asthma emphasizes that effective asthma management requires a partnership between the patient (or the parent/carer) and the healthcare providers [8]. Physician-patient partnership can be developed through long-term relationship, in other words, COC. Numerous studies have revealed that higher COC can reduce asthma ED utilization in patients with asthma [9-11]. Our research, which was under the national health insurance system in Taiwan, supported the finding as well. The groups with medium and low COC had 21% (odds ratio [OR], 1.21; 95% CI, 1.06-1.39) and 38% (OR, 1.38; 95% CI, 1.21-1.58) higher asthmarelated ED utilization, respectively, than the group with high COC [12].

Besides, Cabana et al. [13] found that if patients with asthma who discharged from ED presented for outpatient follow-up, they had an increased likelihood for repeat ED asthma visits. For these patients, continuity of care should strongly be enhanced. Therefore, improving the COC becomes important for the patients with asthma and healthcare providers. The healthcare providers could actively make the follow-up visit appointment and remind the patient (or the parent/ carer) in advance. Government could initiate pay-for-performance program of asthma to motivate physicians and patients to improve the COC and self-care ability for reducing the ED visit and hospitalization.

Acknowledgements

The authors would like to thank the Ministry of Science and Technology (project number: 103-2410-H-010-011-MY2) in Taiwan for support.

References

  1. Donaldson MS,Yordy KD, Lohr KN, Vanselow NA (1996) Primary Care: America’s Health in a New Era. National Academy Press, Washington DC.
  2. Cabana MD, Jee SH (2004) Does continuity of care improves patient outcomes? J FamPract53:974-980.
  3. Love MM, MainousAgi, Talbert JC, Hager GL (2000) Continuity of care and the physician-patient relationship.J FamPract49:997-998.
  4. Van Den Toorn LM, Overbeek SE, De Jongste JC, Leman K, Hoogsteden HC, et al. (2001) Airway inflammation is present during clinical remission of atopic asthma.Am J RespirCrit Care Med 16:2107-2113.
  5. Anonymous(2000) Long-term effects of budesonide or nedocromil in children with asthma.N Engl J Med 343:1054-1063.
  6. Brand PL (2001) Inhaled corticosteroids reduce growth. Or do they? EurRespir J 17:287-294.
  7. Schlienger RG, Jick SS, Meier CR (2004) Inhaled corticosteroids and the risk of fractures in children and adolescents.Pediatrics114:469-473.
  8. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
  9. Cree M, Bell NR, Johnson D, Carriere KC (2006) Increased continuity of care associated with decreased hospital care and emergency department visits for patients with asthma. Dis Manag 9:63-71.
  10. Cyr MC, Martens AC, Berbiche D, Perreault S, Blais L (2006) Continuity of care in the ambulatory treatment of adolescents with asthma. J Adolesc Health 39:926.e11-926.e17.
  11. Hong JS, Kang HC, Kim J (2010) Continuity of care for elderly patients with diabetes mellitus, hypertension, asthma, and chronic obstructive pulmonary disease in Korea. J Korean Med Sci 25:1259-1271.
  12. Huang ST, Wu SC, Hung YN, Lin IP (2016) Effects of continuity of care on emergency department utilization in children with asthma.Am J Manag Care22:e31-e37.
  13. Cabana MD, Bruckman D, Bratton SL, Kemper AR, Clark NM (2003) Association between outpatient follow-up and pediatric emergency department asthma visits.J Asthma40: 741-749.
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Review summary

  1. Nastya Popov
    Posted on Oct 13 2016 at 11:38 am
    The article presents the theoretical basis of paediatric asthma care. The article is theoretical, rather a more specific and precise discussion of extant literature in this regard will benefit us. E.g. Van Den Toorn et al, AM J Resp Med 2001 showed with biopsies that the inflammation exists even when symptoms disappear. This is the cornerstone of the argument for the continuity of care.
 

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