The typical day in Pediatrics is a busy one and Contemporary Pediatrics’ recent annual survey1 is proof that the need to see as many patients as possible is a pressure felt by many. However, a new study published in JAMA Pediatrics indicates that more and more children aren’t being seen by a pediatrician, but retail clinics and urgent care or specialists.2
The researchers used claims data for children aged 17 years and younger from 2008 to 2016 who were insured by a large national commercial health plan.
Over the course of the 8 years, the data included 71 million primary care visits over 29 million pediatric child-years, with male children making up a slight majority of the visits. When unadjusted, the rate of primary care visits per 100 child-years dropped from 259.6 in 2008 to 227.2 in 2016, an estimated change of -14.4% (95% confidence interval [CI], -15.0% to -13.9%; absolute change, -32.4 visits per 100 child-years). Following adjustment for changes in demographics, the decrease became -12.8% (95% CI, -13.3% to -12.2%).
Visits for problems spur care outside the office
Breaking down the type of visits to preventive care visits and visits as a result of an issue, the investigators found that preventive care visits per 100 child-years increased from 74.9 in 2008 to 83.2 visits in 2016 (9.9% change in visit rate; 95% CI, 9.0%-10.9%; absolute change, 8.3 visits per 100 child-years). However, visits due to a problem decreased from 184.7 in 2008 to 144.1 in 2016 (-24.1%; 95% CI, -24.6% to -23.5%; absolute change, -40.6 visits per 100 child-years). With the exception of the behavioral and psychiatric diagnostic group, the rate of visits decreased across diagnoses.
The researchers looked at potential answers for where children are turning to care, which includes going to acute care venues, which increased from 21.3 to 27.6 (30.3%; 95% CI, 28.5% to 32.1%; absolute change, 6.3 visits per 100 child-years). Children are also increasingly visiting specialists for care, going from 45.2 visits to 53.5 (16.4%; 95% CI, 14.8% to 18.0%; absolute change, 8.3 visits per 100 child-years).
Another reason that parents may be turning to other sources of care is likely the increase of out-of-pocket costs for issue-based primary care visits, which rose by 42% in the study period.
1. Radwan CM. What's ruining medicine for pediatricians? Contemp Pediatr. 2020;37(1):28-29.
2. Ray KN, Shi Z, Ganguli I, Rao A, Orav EJ, Mehrotra A. Trends in pediatric primary care visits among commercially insured US children, 2008-2016. JAMA Pediatr. January 21, 2020. Epub ahead of print.