Researchers examined data on more than 71 million pediatric primary
care visits from 2008 to 2016 for children with private health
insurance. During the study period, overall visits decreased 14.4%,
driven by a decline in sick visits, researchers report in JAMA
Pediatrics.
"We found that overall, commercially insured children are visiting
primary care offices less often than in the past," said lead study
author Dr. Kristin Ray of the University of Pittsburgh and UPMC
Children's Hospital of Pittsburgh.
"There was a small increase in visit rates for well-child visits,
and so the decrease was due to decreased visits for specific
concerns like cold symptoms, rashes and gastrointestinal symptoms,"
Ray said by email.
Over the course of the study period, preventive checkup visit rates
climbed from 74.9 to 83.4 each year for every 100 children.
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Sick visit rates declined over the same time frame, from 184.7 to
144.1 each year per 100 children.
Primary care visits rates decreased for every type of diagnosis
except mental health issues, the study found.
All of the kids in the study had private insurance, and it's
possible that costs or access might be different for children
without health benefits or with coverage through Medicaid, the U.S.
health program for the poor.
While the study wasn't designed to prove whether or how any specific
factors might have changed how often children see doctors, several
factors may be in play, Ray said.
It's possible that more preventive checkups are getting more kids
routine care and vaccines they need to stay healthy, reducing
illnesses that might send kids to the doctor, Ray said.
Several new or improved vaccines were introduced during the study
period that may have helped reduce sick visits and hospitalizations
for conditions like pneumococcal infections, some strains of
seasonal flu and rotavirus, the study team notes.
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Ear infections, another common cause of childhood sick visits, have
also become less-common causes of sick visits in part because of the
pneumococcal vaccine and more stringent diagnostic criteria, the
researchers point out.
Increasing out-of-pocket costs like co-payments or co-insurance are
making some parents less likely to take children to the doctor when
they're sick, Ray added.
Out-of-pocket costs for sick visits climbed 42% during the study
period, the study found.
Better communication between doctors and parents online or by phone
might also be decreasing the need for children to see the
pediatrician when they're sick, said Dr. James Perrin of MassGeneral
Hospital for Children and Harvard Medical School in Boston.
More parents might also be realizing they don't need to take kids to
the doctor for a common cold, or they're taking kids to urgent care
clinics instead of their regular primary care providers, Perrin, who
wasn't involved in the study, said by email.
"In many communities, the growth of retail clinics, especially in
suburbs, has provided a convenient alternative for parents to seeing
their primary care doctor for illness care," Perrin said. "There is
some possibility that the ACA support for preventive care could have
led to relabeling (renaming) some acute care visits as preventive."
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SOURCE: https://bit.ly/2G9aIje and https://bit.ly/2tuZu68 JAMA
Pediatrics, online January 21, 2020.
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