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.
Richard C. Wasserman, Susan E. Varni, Matthew C. Hollander, and Valerie S. Harder
Analysis of Family Medicine