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

Autor: Wasserman RC; The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont Richard.Wasserman@med.uvm.edu., Varni SE; The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont., Hollander MC; The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont., Harder VS; The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont.
Jazyk: angličtina
Zdroj: Annals of family medicine [Ann Fam Med] 2019 Sep; Vol. 17 (5), pp. 390-395.
DOI: 10.1370/afm.2416
Abstrakt: 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.
(© 2019 Annals of Family Medicine, Inc.)
Databáze: MEDLINE
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