Preterm Infant Attendance at Health Supervision Visits

Abstract

OBJECTIVES: To assess the adherence of premature infants with the American Academy of Pediatrics health supervision visit schedule, factors affecting adherence, and the association of adherence with preventive care. METHODS: Retrospective cohort of all infants ≤35 weeks’ gestation, born 2005 to 2009, receiving care at a 30-site primary care network for at least 24 months (n = 1854). Adherence was defined as having a health supervision visit within each expected time period during the first 18 months of life. Logistic regression identified sociodemographic and medical factors associated with nonadherence and risk-adjusted association between nonadherence and outcomes. RESULTS: Only 43% received all expected health supervision visits. Those with Medicaid insurance (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI] 0.35–0.60), a visit without insurance (AOR 0.46, 95% CI 0.32–0.67), chronic illness (AOR 0.7, 95% CI 0.51–0.97), and black race (AOR 0.7, 95% CI 0.50–0.98) were less adherent, whereas provider continuity of care (AOR 2.89, 95% CI 1.92–4.37) and lower birth weight (AOR 1.67, 95% CI 1.02–2.73) increased adherence. Infants <100% adherent were less likely to be up to date with immunizations and receive recommended preventive care. In nearly half of missed visit windows, no health supervision visit was scheduled. CONCLUSIONS: Fewer than half of premature infants were fully adherent with the preventive health schedule with associated gaps in health monitoring and immunization delays. These data suggest the importance of health supervision visits and the need to explore scheduling facilitators for those at risk for nonadherence.