Well-Child Care Attendance and Risk of Asthma Exacerbations

Abstract

BACKGROUND: Asthma remains a leading cause of hospitalization in US children. Well-child care (WCC) visits are routinely recommended, but how WCC adherence relates to asthma outcomes is poorly described. METHODS: We conducted a retrospective longitudinal cohort study using electronic health records among 5 to 17 year old children residing in Durham County with confirmed asthma and receiving primary care within a single health system, to compare the association between asthma exacerbations and previous WCC exposure. Exacerbations included any International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, coded asthma exacerbation encounter with an accompanying systemic glucocorticoid prescription. Exacerbations were grouped by severity: ambulatory encounter only, urgent care, emergency department, hospital encounters ,24 hours, and hospital admissions $24 hours. In the primary analysis, we assessed time to asthma exacerbation based on the presence or absence of a WCC visit in the preceding year using a time-varying covariate Cox model. RESULTS: A total of 5656 children met eligibility criteria and were included in the primary analysis. Patients with the highest WCC visit attendance tended to be younger, had a higher prevalence of private insurance, had greater asthma medication usage, and were less likely to be obese. The presence of a WCC visit in the previous 12 months was associated with a reduced risk of all-cause exacerbations (hazard ratio: 0.90; 95% confidence interval: 0.83-0.98) and severe exacerbations requiring hospital admission (hazard ratio: 0.53; 95% confidence interval: 0.39-0.71). CONCLUSIONS: WCC visits were associated with a lower risk of subsequent severe exacerbations, including asthma-related emergency department visits and hospitalizations. Poor WCC visit adherence predicts pediatric asthma morbidity, especially exacerbations requiring hospitalization. WHAT'S KNOWN ON THIS SUBJECT: Well-child care visits are recommended to maintain child health. The relationship between well-child care visit adherence and subsequent asthma-related health care use in children is poorly described. WHAT THIS STUDY ADDS: In this retrospective cohort study involving 5656 children with asthma, a recent well-child visit was associated with 10% fewer any-type asthma exacerbations and 47% fewer asthma-related hospitalizations.

Reduced pediatric urgent asthma utilization and exacerbations during the COVID‐19 pandemic

“…Notably, all components require regular interactions with the health system to ensure timely evaluation and provision of prescriptions for controller and rescue medications. We and others have previously reported that children who have yearly well‐child visits have decreased risk of asthma exacerbations and related emergency department visits compared with children who do not have regular well‐child visits 11 . Similarly, continuity of care is associated with improved asthma outcomes in children and adolescents 12–16 .…”

“…We previously identified 5656 children 5 to <18 years of age who met the criteria for asthma diagnosis, had a Durham County address of residence, and were identified as receiving primary care through the DUHS. 11 Of this initial cohort, 3959 had at least one in‐person healthcare encounter in the year before the start of the COVID‐19 pandemic (Year 1) and were therefore included in the primary analysis. The demographic characteristics of this cohort are shown in Table 1 .…”

“…We and others have previously reported that children who have yearly well‐child visits have decreased risk of asthma exacerbations and related emergency department visits compared with children who do not have regular well‐child visits. 11 Similarly, continuity of care is associated with improved asthma outcomes in children and adolescents. 12 , 13 , 14 , 15 , 16 Taken together, these findings suggest that disruptions to healthcare access and utilization patterns may result in increased exacerbations and poor outcomes in children with asthma.…”

Reduced Pediatric Urgent Asthma Utilization and Exacerbations During the COVID-19 Pandemic

“…Notably, all components require regular interactions with the health system to ensure timely evaluation and provision of prescriptions for controller and rescue medications. We and others have previously reported that children who have yearly well child visits have decreased risk of asthma exacerbations and related emergency department visits compared with children who do not have regular well child visits 11 . Similarly, continuity of care is associated with improved asthma outcomes in children and adolescents [12][13][14][15][16] .…”

“…We previously identified 5,656 children 5 to <18 years of age who met the criteria for asthma diagnosis, had a Durham County address of residence, and were identified as receiving primary care through the DUHS 11 . Of this initial cohort, 3,959 had at least one in-person healthcare encounter in the year prior to the start of the COVID-19 pandemic (Year 1) and were therefore included in the primary analysis.…”