Article Figures & Data
Tables
- Table 1
Characteristics of Children Having at Least 2 Years With a Medical Claim Attributed to a Family Physician Practice
Characteristics Year, No. (%)a 2009 2010 2011 2012 2013 2014 2015 2016 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 m 2,554 (26) 2,577 (27) 2,511 (26) 2,396 (24) 2,171 (23) 2,224 (23) 1,979 (21) 796 (19) 1-4 y 5,426 (27) 5,426 (26) 5,441 (26) 5,357 (26) 4,786 (25) 4,604 (24) 4,078 (22) 3,470 (21) 5-10 y 8,315 (30) 8,388 (30) 8,270 (29) 8,254 (29) 7,591 (27) 7,505 (27) 6,967 (25) 5,914 (25) 11-21 y 20,365 (47) 20,586 (47) 20,823 (47) 20,769 (47) 19,824 (46) 19,111 (45) 18,017 (43) 15,227 (43) Sex Male 17,923 (35) 18,088 (35) 18,289 (35) 17,957 (34) 16,739 (33) 16,244 (33) 15,184 (31) 12,251 (30) Female 18,737 (37) 18,889 (37) 18,756 (37) 18,819 (37) 17,632 (36) 17,200 (35) 15,857 (33) 13,156 (33) Home location Urban 10,510 (24) 10,620 (24) 10,610 (24) 10,901 (24) 10,512 (24) 10,436 (24) 10,432 (24) 8,483 (25) Large town 7,528 (41) 7,627 (41) 7,565 (41) 7,261 (39) 6,758 (36) 6,549 (35) 6,258 (34) 5,174 (34) Small town 5,853 (38) 5,815 (38) 5,879 (37) 5,825 (37) 5,111 (37) 4,927 (36) 4,157 (31) 3,273 (29) Isolated rural 12,769 (53) 12,915 (53) 12,991 (53) 12,789 (52) 11,991 (52) 11,532 (50) 10,194 (44) 8,477 (43) Insurance Non-Medicaid 16,135 (33) 15,598 (32) 15,611 (33) 15,391 (33) 14,610 (32) 13,818 (31) 12,606 (30) 8,570 (30) Medicaid 20,525 (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.
Characteristic Urban
(n = 81,141)Large Town
(n = 37,031)Small Town
(n = 31,383)Isolated Rural
(n = 49,188)OR P
Value95% CI OR P
Value95% CI OR P
Value95% CI OR P
Value95% CI Age (0-21 yr) 1.11 <.001 1.11-1.12 1.13 <.001 1.12-1.13 1.09 <.001 1.09-1.10 1.09 <.001 1.09-1.10 Sex (Reference = males) 1.13 <.001 1.10-1.16 1.03 0.15 0.99-1.07 1.03 0.25 0.98-1.07 0.98 0.19 0.94-1.01 Year 0.97 <.001 0.97-0.97 0.94 0.16 0.94-0.94 0.93 <.001 0.93-0.93 0.92 <.001 0.92-0.92 Medicaid insurance (Reference = non-Medicaid) 1.20 <.001 1.18-1.22 0.94 <.001 0.91-0.97 1.09 <.001 1.05-1.12 1.04 .001 1.02-1.07 OR = odds ratio
Additional Files
Supplemental Appendixes
Supplemental Appendixes
Files in this Data Supplement:
- 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.