Change in Site of Children’s Primary Care: A Longitudinal Population-Based Analysis

Abstract

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 allpayer 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.

The Pediatric Workforce: Recent Data Trends, Questions, and Challenges for the Future

“…38 Equally concerning is a recent analysis of all-payer claims data from Vermont that found that an increasing rural location of a child was associated with decreasing odds of receiving care in a family medicine practice. 40 Any hope that pediatric advanced practice providers will augment the pediatric and family medicine workforce is challenged by an impending critical shortage of the pediatric nurse practitioners. Of the more than 270,000 licensed nurse practitioners only 5% are certified in pediatrics.…”

Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use

“…VCHIP collected data on practice characteristics (Table 1) from state administrative data and national registries and compiled these data annually as part of VCHIP's attribution process. 23…”

“…We describe the full details of our attribution of children to practices using Vermont's all-payer claims database in a previous publication. 23 27 including the one used in this study.…”

Proportion of Family Physicians Caring for Children is Declining

“…Family physicians (FPs) are trained to provide comprehensive care to their patients-including children of all ages-and are key to ensuring accessible care for all children. 1 However, previous studies have documented the decline in the percentage of office visits for children to FPs, 2 the proportion of children seeing FPs for their primary care, 3 and the proportion of FPs providing care to children of any age. 4,5 Our objective was to track FP care of children over the past 5 years to assess whether the decline in pediatric care by FPs has continued since the previous study using similar data tracked pediatric care by FPs between 2000 and 2009.…”