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

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Evidence that fewer children are being seen at family physician practices has not been confirmed using population-level data. This study examines the proportion of children seen at family physician and pediatrician practices over time and the influence of patient demographics and rurality on this trend.

We conducted a retrospective longitudinal analysis of Vermont all-payer claims (2009-2016) for children aged 0 to 21 years. The sample included more than 185,000 children with 2 or more claims over 8 years. Generalized estimating equations modeled the outcome of child attribution to a family physician practice annually, with covariates for calendar year, child age, sex, insurance, and child Rural Urban Commuting Area (RUCA) category.

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 family physician 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 family physician attribution. When stratified by RUCA, however, children had 3% lower odds of attending a family physician practice in urban areas and 8% lower odds in isolated/small rural towns.

The declining proportion of children attending family physician practices, confirmed in this population-based analysis and more pronounced in rural areas, represents a continuing challenge. Our analysis confirmed the temporal trend from family physician to pediatrician practices noted in survey studies, and suggested a new finding related to an enhanced trend toward pediatrician practices among children living in rural areas. This will need to be confirmed by research in other settings.

Wasserman RC, Varni SE, Hollander MC, Harder VS. Change in Site of Children's Primary Care: A Longitudinal Population-Based Analysis. Ann Fam Med. 2019;17(5):390-395. doi:10.1370/afm.2416