In their necessary preoccupation with the quality of programs and how to scale them up for community use, prevention scientists may overlook the importance of factors on the other side of the social transaction.

All very well having the means to rescue or adjust young people's lives, but not much chance of it happening, if contact with those most in need is inconsistent or intermittent.

Researchers at the Oregon Health and Science University in Portland have used information from the state's nutritional assistance (food stamp) program to examine how the stability of a “usual source of care” (USC) affects access to good treatment.

In particular, they wanted to find out how widespread USC changes were among low-income children, and how far they were associated with unmet health care need.

Jennifer E. DeVoe and her team established that low-income children who did not access health care consistently from the same place or provider were more likely to report unmet medical need, unmet prescription need, delayed care, unmet dental need, and unmet counseling need.

Their findings are considered to be particularly relevant to the US context where much of the focus has been on the importance of stable health insurance.

Devoe reported that previous studies had confirmed the opposite hypothesis: that patients who maintained a relationship with a primary care facility or provider, were more likely to use preventive health care, to experience shorter hospital stays and to rely less on emergency services.

The Oregon work went a step further by considering whether low-income children's ability to access needed services was affected by the presence or absence of a consistent source of care.

The survey asked parents whether their child had experienced an "unmet need" in the previous 12 months, defined as: a medical need; a prescription need; missed medication doses; delayed urgent care; no outpatient visits; and reports of problems obtaining necessary dental care or specialty care, and counseling.

Parents were also asked where they took their child for medical care. Children whose parents responded that their child received care at a community health center, private clinic or school-based clinic were considered to have a usual source of care.

Based on these responses, the researchers report that 79 percent of the children who lacked a usual source of health care had an unmet need compared with 45 percent who reported having a usual source of care.

"Although this study confirms the importance of a stable usual source of care, our findings do warn against any notion that having a regular source of care can be a substitute for stabilizing the US insurance system. Financial and structural reforms are needed to ensure better access to health care for low-income children," said DeVoe.

See: DeVoe J E, Saultz J W, Krois L, and Tillotson C J “A Medical Home Versus Temporary Housing: The Importance of a Stable Usual Source of Care” Pediatrics 124, 5 2009, pp. 1363-1371 (doi:10.1542/peds.2008-3141)