Well-Child Visits Help Keep Kids Out of the Hospital
We have been among the voices raised against the overuse and abuse of medical resources (here and here, for example), but sometimes medical attention is wholly appropriate even without symptoms or complaints.
When it comes to kids, according to a new study in the American Journal of Managed Care, regularly scheduled doctor visits even in the absence of a problem might well be wise. Young children who missed more than half of their recommended well-child visits, the study concludes, had as much as twice the risk of hospitalization compared with children who attended theirs.
Not surprising was the fact that kids with chronic conditions such as asthma and heart disease and who missed their recommended appointments had as much as three times the risk of being hospitalized as those with chronic conditions who were seen as recommended.
The study involved more than 20,000 children enrolled in Group Health Cooperative, a large health-care system in Seattle, from 1999 to 2006. The study followed the subjects from birth to age 3 1/2 or until their first hospital stay, whichever came first.
As quoted in a story on ScienceDaily.com, lead study author Dr. Jeffrey Tom, said, "Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider. These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital."
It goes without saying (although the study made it clear) that regular, preventive care for children with special needs and chronic conditions is even more important because of possible complications.
Most children in the study—3 in 4—attended at least 3 in 4 of their recommended visits. But this could be such a high percentage because Group Health coverage required no copayment for such visits. The authors acknowledge that the lack of a financial burden, even a small one, is an important incentive to maintaining a recommended medical visit schedule.
Four in 100 children in the study, and 9 in 100 of them with a chronic condition, were hospitalized. The two most common reasons for hospitalization in both groups, according to Science Daily, were pneumonia and asthma.
Children who missed more than half of their visits had as much as twice the risk of hospitalization compared with those who attended most of theirs. Children with chronic conditions who missed more than half of their visits had nearly twice to more than three times the risk of hospitalization compared with those who attended most of their visits.
During the study period, Group Health recommended nine well-child visits between birth and 3 1/2 years of age: the first at 3 to 5 days old, then at 1, 2, 4, 6, 10 and 15 months, and at 2 and 3 ½ years.
Although the study is very clear about the value of well-baby visits, a huge consideration is that the findings might not apply to all health systems. Group Health is an integrated health-care system, or one where care is well-coordinated as a person ages or a disorder progresses. Also, most of the study’s subjects attended most of their well-child visits and belong to affluent, well-educated families. Although some research studies can adjust for certain variables within the population they study, this one couldn’t adjust for income, education, race, or ethnicity.
And of course there is no absolute cause-and-effect conclusion that missing well-child visits increases the chances of hospitalization. But it’s pretty clear that there’s an important association. In addition to well-baby visits providing the opportunity for preventive care, Science Daily notes that parents who miss well-child visits are probably less likely to manage their kids' illnesses and follow treatment regimens, which could result in higher rates of hospitalization for the children.
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