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Factors affecting pediatric preventive care utilization in a prepaid group practice
S M Horwitz1, H Morgenstern, L F Berkman
1Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn.
Insights
Pediatric preventive care use is primarily influenced by child's age and birth order, not other demographic or psychosocial factors. This suggests provider-induced demand significantly impacts well-child visit frequency.
Area of Science:
- Pediatrics
- Health Services Research
- Preventive Medicine
Background:
- Previous studies indicate sociodemographic and health beliefs influence pediatric preventive care utilization.
- Well-child services are crucial for monitoring child development and early disease detection.
Purpose of the Study:
- To investigate the simultaneous effects of sociodemographic, psychosocial, and behavioral factors on pediatric preventive care utilization.
- To identify key predictors of well-child service use in young children.
Main Methods:
- A 16-month prospective study of 532 children under five years old.
- Data collected from a university-affiliated group practice, predominantly serving white, middle-class families.
- Bivariable and model-fitting analyses were used to assess factor significance.
Main Results:
- Initially, 13 factors were found to be related to preventive care use.
- Only child's age and birth order significantly predicted preventive care visit rates.
- Younger children and first-born children showed higher utilization rates.
Conclusions:
- Child's age and birth order are the primary drivers of preventive care visits in this population.
- Observed utilization rates closely matched recommended schedules, suggesting provider-induced demand.
- Other demographic and psychosocial factors did not significantly impact preventive care use after accounting for age and birth order.
Abstract:
Previous research on the utilization of pediatric preventive care has shown that certain sociodemographic factors, such as age, birth order, family size and race, as well as health attitudes and beliefs are related to the use of well-child services. To examine the simultaneous effects of sociodemographic, psychosocial and behavioral factors, we conducted a 16-month prospective investigation of 532 children belonging to a university-affiliated prepaired group practice. The children were under 5 years of age upon enrollment and came predominantly from white, middle-class families with well-educated parents. Our bivariable results showed that 13 factors were related to preventive care utilization (p less than 0.05) and, in effect, confirmed findings from previous investigations. However, using model-fitting procedures, we found that only two variables, child's age and birth order, significantly predicted the rate of preventive care visits; a high utilization rate was observed for younger children and for first-born children. Since the observed age-specific rates of preventive care utilization were nearly identical to the schedule recommended by the pediatricians in this practice, we believe that most of the variability in well-child care in our population was due to provider-induced demand. Furthermore, none of the other demographic or psychosocial factors that significantly predicted acute care utilization in this population had any effect on preventive care once age and birth order were accounted for.