Kao Yu-Hsiang, Wu Shiao-Chi
From the Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
J Am Board Fam Med. 2017 May-Jun;30(3):384-395. doi: 10.3122/jabfm.2017.03.160285.
Continuity of care (COC) is positively associated with health care outcomes. However, the effect of COC on the reduction of asthma-related emergency department (ED) visits among older asthmatic patients is not clearly understood.
We conducted a retrospective cohort study using the Taiwan nationwide health insurance claims database between 2004 and 2013. Patients aged 65 years with asthma during 2005 to 2011 were selected. The COC index (COCI) is used to measure the number of individual physicians a patient sees in the first year and we identified asthma-related ED visit in the subsequent year. Cox model was used to examine the hazard ratio (HR) between COC and an ED visit for asthma.
Among a total of 3395 subjects, the overall mean COC was 0.73, and 48.5% of subjects had perfect COC (COCI = 1). After controlling for covariables, in the group of patients with low COC, the risk of having an asthma-related ED visit was higher compared with those with perfect COC (Adjusted HR, 2.11; 95% CI, 1.37-3.25).
Elderly asthmatic patients with lower COC had a significantly higher likelihood of having asthma-related ED visits.
连续性医疗（COC）与医疗保健结果呈正相关。然而，COC对老年哮喘患者减少哮喘相关急诊科（ED）就诊次数的影响尚不清楚。
我们使用2004年至2013年台湾全民健康保险索赔数据库进行了一项回顾性队列研究。选取了2005年至2011年期间年龄在65岁及以上的哮喘患者。COC指数（COCI）用于衡量患者在第一年就诊的个体医生数量，我们确定了随后一年中与哮喘相关的ED就诊情况。使用Cox模型检查COC与哮喘ED就诊之间的风险比（HR）。
在总共3395名受试者中，总体平均COC为0.73，48.5%的受试者具有完美的COC（COCI = 1）。在控制协变量后，在低COC组患者中，与具有完美COC的患者相比，发生哮喘相关ED就诊的风险更高（调整后的HR，2.11；95%CI，1.37 - 3.25）。
COC较低的老年哮喘患者发生哮喘相关ED就诊的可能性显著更高。
