Importance of a Regular Source of Primary Care in Adolescents: The Case of Adolescent Idiopathic Scoliosis

AIM: Primary care practitioners should screen young adolescent patients for idiopathic scoliosis and refer those who could benefit from bracing to prevent curve progression and the need for surgery. Adolescents without a regular source of primary care may be at higher risk for not having their scoliosis diagnosed in time to benefit from bracing. We sought to determine whether adolescents with idiopathic scoliosis and a regular source of primary care are at lower risk of scoliosis surgery. METHODS: We followed a cohort of 3722 adolescents (10-18 years) whose diagnosis of adolescent idiopathic scoliosis was confirmed by an orthopedist or physiatrist, using linked administrative data of physician visits and hospital admissions, from 2001 to 2010. We used survival analysis to compare those with and without a regular source of primary care with regard to having scoliosis surgery, adjusting for covariates. RESULTS: Among the 3722 adolescents with scoliosis, 12% did not have a regular source of primary care and 158 had scoliosis surgery. Adolescents with a regular source of primary care had a lower risk of scoliosis surgery (hazard ratio 0.60, 95% confidence interval 0.40-0.89), especially those whose regular source of primary care was a pediatrician (hazard ratio 0.48, 95% confidence interval 0.30-0.76). CONCLUSION: Adolescents with scoliosis and a regular source of primary care were less likely to undergo scoliosis surgery. Policy makers need to be aware of the importance of primary health care for children and adolescents and ensure that they are not forgotten in their campaign for primary care improvement.