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Pediatric admissions by family physicians and pediatricians in a semirural environment: implications for residency
1Family Practice Residency, Latrobe, PA 15650, USA.
Insights
Family physicians and pediatricians manage similar hospitalized children, but pediatricians handle most complex newborn cases. This comparison aids understanding of pediatric care distribution in family medicine settings.
Area of Science:
- Pediatric Hospital Medicine
- Family Medicine Practice
- Comparative Healthcare Analysis
Background:
- Family practice residency programs incorporate pediatric care training.
- Understanding the scope of pediatric care by family physicians is crucial.
Purpose of the Study:
- To compare the diagnoses of hospitalized children treated by family physicians versus pediatricians.
- To analyze the utilization of pediatricians as consultants by family physicians.
Main Methods:
- Retrospective analysis of pediatric hospital discharges over three years.
- Inclusion criteria: patients under 18 discharged by family physicians or pediatricians.
- Data collected: primary diagnosis, physician type, consultations, transfer status.
Main Results:
- Family physicians managed 37% of 4169 pediatric discharges.
- Infectious diseases were common for non-newborns; top 15 diagnoses were similar for both physician types.
- Pediatricians managed 86% of complex newborns and 80% of transferred pediatric patients.
- Family physicians consulted pediatricians in 8% of inpatient cases (20% for non-neonatal issues).
Conclusions:
- Family physicians and pediatricians manage comparable pediatric patient populations in this semirural setting.
- Pediatricians manage a disproportionately higher number of critically ill newborns.
- This highlights distinct roles in managing pediatric inpatient care.
Background:
The 3-year family practice residency curriculum includes longitudinal care of children in the family health center and a 4-month experience dedicated to the care of children. This study was designed to compare the diseases of hospitalized children cared for by family physicians and pediatricians and to examine the use of pediatricians as consultants by family physicians.
Methods:
The study included all patients younger than 18 years who were discharged by a family physician or a pediatrician from this semirural hospital during a 3-year period. The primary discharge diagnosis, physician, consultations, and transfer status were recorded.
Results:
Family physicians cared for 37 percent of the 4169 pediatric patients discharged during the study. Infectious diseases and their complications were the most common conditions for patients who were discharged beyond the newborn period. The 15 most frequent discharge diagnoses were identical for family physicians and pediatricians, accounting for about 86 percent of all discharge diagnoses. Pediatricians, however, cared for 86 percent of the newborns with major complications and were responsible for 80 percent of the infants and children who were transferred. The overall inpatient consultation rate of pediatricians by family physicians was 8 percent, whereas the consultation rate for nonneonatal-related discharges was 20 percent.
Conclusion:
In this semirural environment, family physicians and pediatricians care for a very similar mix of hospitalized pediatric patients. Pediatricians, however, care for a greater proportion of newborns with major complications.