The level of care coordination provided by family physicians for children receiving care from asthma policlinic in a university hospital

Introduction and Aim: Coordination, as one of the basic functions of primary care, is gathering of all information concerning patient and utilization of that information over the course of patient care. Providing coordination is one of the primary elements of asthma management, which is a chronic disease. The aim of this study is to determine the level of coordination function performed by family physicians for health care services received by 3-18 aged group children with asthma who receive health care services from Ege University Medical Faculty Paediatric Pulmonology and Allergy Policlinic and independent variables related to this level. Besides that, determining what levels of first contact, accessibility, comprehensiveness and continuity functions of primary care are performed, defining all health care services received and development of a scale to evaluate the level of coordination function performed by family physicians were also aimed. Material and Methods: This study of cross-sectional analytical design type also has an aspect of methodological design for developing a scale. The target population of this study is children with asthma who receive health care services from Ege University Medical Faculty Paediatric Pulmonology and Allergy Polyclinic. The sample size was computed as 312 based on the target population of 650, confidence limit of 95%, sample error of 4% and 50% prevalence of performing coordination function. Following the evaluation of 334 children visited to the policlinic within five months during the process of data collection according to inclusion and exclusion criteria, remaining 320 (96%) children constituted study group. The dependent variable of the study is the level of coordination function performed by family physicians for all health services received by children with asthma. In the assessment of this level; "The Scale of The Level of Primary Care Essential Functions Performed By Family Physicians In Childhood Asthma Management" developed in four stages was used. The independent variables were grouped to four headlines; as socio-demographic and economic variables, variables aimed at asthma history, reflecting the current status of asthma and concerning family physician. The questions in the questionnaire containing variables were asked to person who knows the child's health problems and all services received for asthma, at Ege University Medical Faculty Paediatric Pulmonology and Allergy Policlinic meeting room, face to face by the researcher on the admitting day to policlinic. In the statistical analysis of collected data, a score indicating the coordination level was generated. In the determination of factors associated with coordination score; Student's T test, Mann-Whitney U test, Kruskal Wallis test, Spearman correlation analysis and logistic regression analysis was used. For the determination of the reliability of the developed scale; Cronbach's alpha coefficient was calculated, split half and item-total correlations methods were used. The principal component analysis was selected for the determination of construct validity. Results: Mean age of children was 11,84±3,82, 63,7% of their mothers and %73,2 of the fathers had a high school or higher education level. Household monthly income per person was above 500 Turkish Liras for 48,1% children. It was determined that; when symptoms started before children were diagnosed with asthma, one in every seven children had visited to a health center or family physician, one in every three children had been diagnosed with asthma at university hospital, in 69% of children with continuous service resources for asthma this facility was university hospital. It was found that; half of the children had never visited their family physician over the last year and mean number of visits to a health facility for any kind of health problem was calculated as 5,12±2,58. 16,9% of the study group stated that they did not recall the name of child's registered family physician and family physicians of one in every five children were determined not to be aware of asthma diagnosis. The developed scale was determined to include four subscales as ''accessibility, first contact and continuity functions of family physician'', ''coordination and comprehensiveness of health services'', ''preventive services'', ''services concerning paid vaccines''and 25 items, to explain %69,7 of the total variance and 0,939 of Cronbach's alpha coefficient. The scale had 2,33±0,70 of mean total score, mean scores concerning the subscales were, respectively, 3,83±1,16, 1,57±0,72, 1,54±0,78 and 1,70±0,97. The likelihood of lack of care coordination by family physician was found 2,07 times higher among children whose fathers have a high school and higher education level, 2,18 times higher among children whose mothers work regularly. Not to remember the name of child's registered family physician increased 4,11 times the likelihood of the lack of coordination. Every one unit increase in the number of visits to family physician reduced the likelihood of inadequate coordination with a ratio of 47,7%. Conclusion: In this study, it was indicated that family physicians were able to provide very limited coordination. Mother's not-working, father's education level being below high school, remembering the name of the family physician and greater number of visits to family physician were associated with increased level of coordination. In addition, the developed scale was determined to have valid and reliable results. Key Words: Primary care; Family physician; Coordination; Child; Asthma; Validity; Reliability