CONTINUITY OF PEDIATRIC AMBULATORY CARE IN A UNIVERSALLY INSURED POPULATION

Objective. To describe the prevalence of continuity of care over a S-y ear 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 metro politan Winnipeg between July 1, 1987 and December 31, 1988 (N = 12 59 0). All ambulatory physician services for this group were enumerated f rom computerized administrative databases for the period from birth th rough 60 months. Continuity of care, defined as the proportion of tota l care provided by the most frequently seen physician or physician pra ctice over time, was calculated for each child. Descriptive analyses i nclude an examination of maternal and household characteristics associ ated with children receiving 80% or more of total ambulatory care from a single provider source. Results. From birth to 24 months, 51% of ch ildren received at least 80% of ambulatory visits from a single provid er practice. This proportion of the children declined to 28% at 25 thr ough 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor con tinuity included young maternal age, single maternal marital status, r esidential mobility, and inadequate maternal use of prenatal medical c are. Households affiliated with pediatric practices had better continu ity profiles than households affiliated with general medical practices . Conclusion. Despite universal medical insurance, barriers to a longi tudinally 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 ev idence that factors related to the organization and delivery of medica l care are also relevant.