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Change in Site of Children's Primary Care: A Longitudinal Population-Based Analysis
Richard C Wasserman1, Susan E Varni2, Matthew C Hollander2
1The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont Richard.Wasserman@med.uvm.edu.
Insights
Fewer children are visiting family physician (FP) practices, a trend confirmed by population data and more pronounced in rural areas. This decline presents an ongoing challenge for pediatric care accessibility.
Area of Science:
- Pediatrics
- Family Medicine
- Health Services Research
Background:
- Anecdotal evidence suggested a decline in pediatric patients at family physician (FP) practices, but population-level data were lacking.
- Understanding trends in child attribution to FP versus pediatrician practices is crucial for healthcare planning.
Purpose of the Study:
- To examine the proportion of children seen at FP and pediatrician practices over time.
- To investigate the influence of patient demographics and rurality on pediatric attribution to FP practices.
Main Methods:
- Retrospective longitudinal analysis of Vermont all-payer claims data from 2009-2016.
- Included 184,794 children aged 0-21 years with at least two claims over eight years.
- Generalized estimating equations modeled annual child attribution to FP practices, controlling for year, age, sex, insurance, and Rural Urban Commuting Area (RUCA) category.
Main Results:
- Children were 5% less likely to be attributed to an FP practice over time (P <.001).
- Older children, females, and those with Medicaid showed increased odds of FP attribution.
- Children in rural areas (large rural cities, small rural towns, isolated/small rural towns) had significantly greater odds of FP attribution compared to urban children.
- However, stratified analysis revealed lower odds of FP attendance in both urban (3%) and isolated/small rural (8%) areas over time.
Conclusions:
- The proportion of children attending FP practices is declining, a trend confirmed by population-based analysis.
- This decline is more pronounced in rural areas, highlighting a continuing challenge in pediatric care access.
- Findings underscore the need for strategies to maintain pediatric care in FP settings, particularly in underserved rural communities.
Purpose:
Evidence that fewer children are being seen at family physician (FP) practices has not been confirmed using population-level data. This study examines the proportion of children seen at FP and pediatrician practices over time and the influence of patient demographics and rurality on this trend.
Methods:
We conducted a retrospective longitudinal analysis of Vermont all-payer claims (2009-2016) for children aged 0 to 21 years. The sample included 184,794 children with 2 or more claims over 8 years. Generalized estimating equations modeled the outcome of child attribution to a FP practice annually, with covariates for calendar year, child age, sex, insurance, and child Rural Urban Commuting Area (RUCA) category.
Results:
Over time, controlling for other covariates, children were 5% less likely to be attributed to a FP practice (P <.001). Children had greater odds of attribution to a FP practice as they aged (odds ratio (OR) = 1.11, 95% CI, 1.10-1.11), if they were female (OR = 1.05, 95% CI, 1.03-1.07) or had Medicaid (OR = 1.09, 95% CI, 1.07-1.10). Compared with urban children, those from large rural cities (OR = 1.54, 95% CI, 1.51-1.57), small rural towns (OR = 1.45, 95% CI, 1.42-1.48), or isolated/small rural towns (OR = 1.96, 95% CI, 1.93-2.00) had greater odds of FP attribution. When stratified by RUCA, however, children had 3% lower odds of attending a FP practice in urban areas and 8% lower odds in isolated/small rural towns.
Conclusions:
The declining proportion of children attending FP practices, confirmed in this population-based analysis and more pronounced in rural areas, represents a continuing challenge.