Abstract
This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17, 110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiendy improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.
Similar content being viewed by others
References
National Association of Community Health Centers, Inc. Community and Migrant Health Centers: A Key Component of the U.S. Health Care System, Overview and Status Report. 1991:1–23.
National Association of Community Health Centers, Inc. Access to Community Health Care: A National and State Data Book. 1993.
Gorman SA, Nelson H. “Meeting the Data Needs of Neighborhood Health Center” (Presented at the 102nd meeting of the American Public Health Association, 1984) as quoted by the NACHC publication, “Community and Migrant Health Centers: Two Decades of Achievement”. 1987.
Okada LM, Wan TH. Impact of Community Health Centers and Medicaid on the Use of Health Services.Public Health Rep. 1980; 95: 520–534.
Hochheiser LI, Woodward K, Charney E. Effect of the Neighborhood Health Center on the Use of Pediatric Emergency Departments in Rochester, New York.N Engl J Med. 1971; July 15: 148–152.
Starfield BS, Powe NR, Weiner JR, et al. Costs vs Quality in Different Types of Primary Care Settings.JAMA. 1994; 272:1903–1908.
Goldman F, Grossman R. “The Responsiveness and Impacts of Public Health Policy: The Case of Community Health Centers”. Medical Care Section of APHA meeting, Nov 2, 1981. (As cited by Sidel VW, Sidel R. Reforming Medicine: Lessons of the Last Quarter Century. 1st ed. New York:Pantheon Books, Random House, 1984.)
Anderson RE, Morgan S. Comprehensive Health Care: A Southern View. 1973; Atlanta Southern Regional Counc.
Gold M, Rosenberg RJ. “The Emergency Room Care by the Population of a Neighborhood Health Center,”Health Services Reports. 1974.
Vaughn BJ. Maternal and Infant Care Projects: Results in Dade County, Florida.South Med J. 1968; 61:641–645.
Gordis, L. Effectiveness of Comprehensive-Care Programs in preventing rheumatic fever.N Engl J Med. 1973;289(7): 331–335.
National Association of Community Health Centers. Community and Migrant Health Centers: Two Decades of Achievement. Compiled and edited by Sara Rosenbaum. Washington, D.C., 1987.
JRB Associates. Evaluation of the cost-effectiveness of community health centers. Washington, D.C., Feb., 1981.
Fisher CR. Differences by age groups in health care spending.Health Care Financ. Rev. 1980; 1(4): 65–90.
Rosenbach ML. The impact of Medicaid on physician use by low-income children.Am J Public Health. 1989;79:1220–1226.
St.Peter RF, Newacheck PW, Halfon N. Access to Care for Poor Children: Separate and Unequal?JAMA. 1992; 267:2760–2764.
Newacheck PW. Access to Ambulatory Care for Poor Persons.Health Serv Res. 1988; 23:401–419.
Short PF, Lefkowitz DC. Encouraging Preventive Services for Low-Income Children, The Effect of Expanding Medicaid.Med Care. 1992; Vol. 30, No.9: 766–780.
Dutton DB. Explaining the low use of health services by the poor: costs, attitudes, or delivery systems?Am Sociol Rev. 1978;43:348–368.
Dutton D. Financial, organizational and professional factors affecting health care utilization.Soc Sci Med. 1986;23:721–735.
Starfield B.Primary Care: Concept, Evaluation, and Policy. 1st ed. New York: Oxford University Press, 1992.
Donaldson M, Yordy KI, Vanselow N, Editors.Defining Primary Care: An Interim Report from the Committee on the Future of Primary Care, Division of Health Care Services, Institute of Medicine, National Academy Press: Washington, D.C. 1994.
Fletcher RH, O'Malley MS, Earp JA, et al. Patients' Priorites for Medical Care.Med Care. 1983;21:234–242.
Breslau N. Continuity re-examined: differential impacts on satisfaction with medical care for disabled and normal children.Med Care. 1982; 20:347–360.
Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction.Br Med J. 1992;304:1287–1290.
Adams PF, Hardy AM. Current estimates from the National Health Interview Survey: US, 1988. Vital Health Stat 10. 1989; 173:1–11, 133–144.
National Center for Health Statistics. Public use data tape documentation: Part I. National Health Interview Survey 1988. Hyattsville, MD, November, 1988.
American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health,Guidelines for Health Supervision II. 1985–1988.
Tessler R, Mechanic D. Factors affecting children's use of physician services in a prepaid group practice.Med Care. 1978;16:33–46.
Tessler R. Birth order, family size, and children's use of physician services.Health Serv Res. 1980; 15:55–62.
Wolfe BL. Children's utilization of medical care.Med Care. 1980;18:1197–1207.
Wood DL, Hayward RA, Corey CR, et al. Access to medical care for children and adolescents in the United States.Pediatrics. 1990;86:666–673.
Newacheck PW. Characteristics of Children with High and Low Usage of Physician Services.Med Care. 1992; 30:30–42.
Eisen M, Donald C, Ware J Jr., et al.Conceptualization and Measurement of Health for Children in the Health Insurance Study. (Rand pub. no. R-2313-HEW) Santa Monica, CA, Rand Corp, 1980.
SUDAAN Survey Data Analysis Software, Release 6.30. Research Triangle Institute, 1993.
Hulka, BS, Wheat, JR. Patterns of Utilization: The Patient Perspective.Med Care. 1985; Vol. 23 No. 5: 438–460.
Newacheck PW, Halfon N. Access to ambulatory care services for economically disadvantaged children.Pediatrics. 1986; 78: 813–819.
Newacheck PW, Starfield B. Morbidity and Use of Ambulatory Care Services among Poor and Nonpoor Children.Am J Public Health. 1988; 78: 927–933.
Saver BG, Peterfreund N. Insurance, Income and Access to Ambulatory Care in King County, Washington,Am J Public Health. 1993; 83:1583–1588.
Riley, AW, Finney JW, Mellits D, et al. Determinants of Children's Health Care Use: An Investigation of Psychosocial Factors.Med Care. 1993; Vol. 31, No. 9: 767–783.
Kasper JD. The Importance of Type of Usual Source of Care for Children's Physician Access and Expenditures.Med Care. 1987; 25:386–398.
Lieu TA, Newacheck P, McManus M. Race Ethnicity and Access to Ambulatory Care among US adolescents.Am J Public Health. 1993; 83:960–965.
Freeman HE, Corey CR. Insurance Status and Access to Health Services Among Poor Persons.Health Sew Res. 1993;28 (5):531–541.
Rogers DE, Blendon RJ, Moloney TW. Who needs Medicaid?N Engl J Med. 1982; 307: 13–18.
Howell EM. Low-income persons' access to health care: NMCUES Medicaid data.Public Health Rep. 1988; 103: 507–514.
Aday L, Andersen R, Fleming G.Health Care in the U.S. Equitable for Whom? Beverly Hills: Sage Pub. 1980.
Kleinman JC, Gold M, Makuc D. Use of Ambulatory Medical Care by the Poor: Another Look at Equity.Med Care. 1981; vol XIXNo. 10: 1011–1029.
Davis K, Gold M, Makuc D. Access to health care for the poor: does the gap remain?Annu Rev Public Health. 1981;2: 159–182.
Children's Defense Fund.The nation's investment in children: an analysis of the President's FY 1993 budget. Washington, DC, 1993.
Author information
Authors and Affiliations
Additional information
This research project was supported by the following grants: NRSAS-PHS 1 732 PE 10009-02; AHCPR F32 HS00070 and AHCPR T32 HS 00029.
Rights and permissions
About this article
Cite this article
O'Malley, A.S., Forrest, C.B. Continuity of care and delivery of ambulatory services to children in Community Health Clinics. J Community Health 21, 159–173 (1996). https://doi.org/10.1007/BF01557996
Issue Date:
DOI: https://doi.org/10.1007/BF01557996