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Research ArticleOriginal Research

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

Richard C. Wasserman, Susan E. Varni, Matthew C. Hollander and Valerie S. Harder
The Annals of Family Medicine September 2019, 17 (5) 390-395; DOI: https://doi.org/10.1370/afm.2416
Richard C. Wasserman
The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
MD, MPH
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  • For correspondence: Richard.Wasserman@med.uvm.edu
Susan E. Varni
The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
PhD
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Matthew C. Hollander
The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
MD, MHA
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Valerie S. Harder
The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
PhD, MHS
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Article Figures & Data

Tables

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    Table 1

    Characteristics of Children Having at Least 2 Years With a Medical Claim Attributed to a Family Physician Practice

    CharacteristicsYear, No. (%)a
    20092010201120122013201420152016
    36,660 (36)36,977 (36)37,045 (36)36,776 (35)34,372 (34)33,444 (34)31,041 (32)25,407 (32)
    Age
     0-11 m2,554 (26)2,577 (27)2,511 (26)2,396 (24)2,171 (23)2,224 (23)1,979 (21)796 (19)
     1-4 y5,426 (27)5,426 (26)5,441 (26)5,357 (26)4,786 (25)4,604 (24)4,078 (22)3,470 (21)
     5-10 y8,315 (30)8,388 (30)8,270 (29)8,254 (29)7,591 (27)7,505 (27)6,967 (25)5,914 (25)
     11-21 y20,365 (47)20,586 (47)20,823 (47)20,769 (47)19,824 (46)19,111 (45)18,017 (43)15,227 (43)
    Sex
     Male17,923 (35)18,088 (35)18,289 (35)17,957 (34)16,739 (33)16,244 (33)15,184 (31)12,251 (30)
     Female18,737 (37)18,889 (37)18,756 (37)18,819 (37)17,632 (36)17,200 (35)15,857 (33)13,156 (33)
    Home location
     Urban10,510 (24)10,620 (24)10,610 (24)10,901 (24)10,512 (24)10,436 (24)10,432 (24)8,483 (25)
     Large town7,528 (41)7,627 (41)7,565 (41)7,261 (39)6,758 (36)6,549 (35)6,258 (34)5,174 (34)
     Small town5,853 (38)5,815 (38)5,879 (37)5,825 (37)5,111 (37)4,927 (36)4,157 (31)3,273 (29)
     Isolated rural12,769 (53)12,915 (53)12,991 (53)12,789 (52)11,991 (52)11,532 (50)10,194 (44)8,477 (43)
    Insurance
     Non-Medicaid16,135 (33)15,598 (32)15,611 (33)15,391 (33)14,610 (32)13,818 (31)12,606 (30)8,570 (30)
     Medicaid20,525 (39)21,379 (39)21,434 (39)21,385 (38)19,762 (37)19,626 (36)18,435 (33)16,837 (32)
    • ↵a Percentages are in relation to 100% of children with claims attributed to either a family physician or a pediatrics primary care practice.

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    Table 2

    Regression Results for Children Having at Least 2 Years With a Medical Claim

    CharacteristicUrban
    (n = 81,141)
    Large Town
    (n = 37,031)
    Small Town
    (n = 31,383)
    Isolated Rural
    (n = 49,188)
    ORP
    Value
    95% CIORP
    Value
    95% CIORP
    Value
    95% CIORP
    Value
    95% CI
    Age (0-21 yr)1.11<.0011.11-1.121.13<.0011.12-1.131.09<.0011.09-1.101.09<.0011.09-1.10
    Sex (Reference = males)1.13<.0011.10-1.161.030.150.99-1.071.030.250.98-1.070.980.190.94-1.01
    Year0.97<.0010.97-0.970.940.160.94-0.940.93<.0010.93-0.930.92<.0010.92-0.92
    Medicaid insurance (Reference = non-Medicaid)1.20<.0011.18-1.220.94<.0010.91-0.971.09<.0011.05-1.121.04.0011.02-1.07
    • OR = odds ratio

Additional Files

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    Supplemental Appendixes

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    • Supplemental data: Appendixes - PDF file
  • The Article in Brief

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

    Richard C. Wasserman , and colleagues

    Background 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.

    What This Study Found A Vermont study suggests that a declining proportion of children receive care in family medicine practices. These same children, particularly those in isolated rural areas, are more likely to visit pediatric practices. Using statewide all-payer claims data from 2009-2016, the study looked at 184,794 children with at least two claims in that period. The data revealed that a child�s odds of attending a family practice vs. a pediatric practice declined by an average of 5% each year during the study period. Reasons for this trend may include the national decline in family physicians providing prenatal care and lack of capacity for new patients in family medicine practices. The study also showed that the likelihood of attending a family medicine practice went up with increased child age, if the patient was female, or if the patient was enrolled in Medicaid.

    Implications

    • The declining proportion of children attending FP practices, especially in very rural areas, represents a continuing challenge for the specialty of family medicine.
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The Annals of Family Medicine: 17 (5)
The Annals of Family Medicine: 17 (5)
Vol. 17, Issue 5
September/October 2019
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Change in Site of Children’s Primary Care: A Longitudinal Population-Based Analysis
Richard C. Wasserman, Susan E. Varni, Matthew C. Hollander, Valerie S. Harder
The Annals of Family Medicine Sep 2019, 17 (5) 390-395; DOI: 10.1370/afm.2416

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Change in Site of Children’s Primary Care: A Longitudinal Population-Based Analysis
Richard C. Wasserman, Susan E. Varni, Matthew C. Hollander, Valerie S. Harder
The Annals of Family Medicine Sep 2019, 17 (5) 390-395; DOI: 10.1370/afm.2416
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