1
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Wang J, Bird JA, Cleary K, Doucette J, du Toit G, Groetch M, Gupta R, Hathaway KH, Klein S, Lack G, Leeds S, Leon T, Lewis MO, Lieberman J, Nowak-Wegrzyn A, Scribner P, Vickery BP, Warren CM. Awareness and Application of United States Food Allergy Prevention Guidelines Among Pediatricians and Other Clinicians. J Pediatr 2024; 275:114218. [PMID: 39074733 DOI: 10.1016/j.jpeds.2024.114218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/27/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE To characterize the awareness of, adherence to, and barriers to the 2017 National Institute of Allergy and Infectious Diseases (NIAID) peanut allergy prevention guidelines among the pediatrics health care workforce. STUDY DESIGN Pediatricians, family physicians, advanced practice providers (APPs), and dermatologists who provide care for infants were solicited for a population-based online survey, administered from June 6, 2022, through July 3, 2022. The survey collected information about NIAID guideline awareness, implementation, and barriers as well as concerns related to the guidelines. RESULTS A total of 250 pediatricians, 250 family physicians, 504 APPs, and 253 dermatologists met inclusion criteria. Self-reported guideline awareness was significantly higher for pediatricians (76%) compared with dermatologists (58%), family physicians (52%), and APPs (45%) (P < .05). Among participants who were aware of the guidelines, most reported using part or all of the guidelines in their clinical practices. Reported practice patterns for peanut introduction in 6-month-old infants were variable and did not always align with guidelines, particularly for infants with mild-to-moderate atopic dermatitis. CONCLUSIONS Although pediatricians have the highest self-reported level of NIAID guideline awareness, awareness was suboptimal irrespective of provider type. Education for all pediatric clinicians is urgently needed to promote evidence-based peanut allergy prevention practices.
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Affiliation(s)
- Julie Wang
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, UT Southwestern Medical Center, Dallas, TX
| | - Kelly Cleary
- Food Allergy Research & Education (FARE), McLean, VA
| | - Julianne Doucette
- Primary Care Pediatric Nurse Practitioner DNP Program, Rush University, Chicago, IL
| | | | - Marion Groetch
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Sara Klein
- Food Allergy Research & Education (FARE), McLean, VA
| | - Gideon Lack
- Pediatric Allergy, King's College London, London, UK
| | - Stephanie Leeds
- Division of Pediatric Allergy and Immunology, Yale School of Medicine, New Haven, CT
| | - Tiffany Leon
- Food Allergy Research & Education (FARE), McLean, VA
| | - Megan O Lewis
- Food Allergy Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jay Lieberman
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Paul Scribner
- Food Allergy Research & Education (FARE), McLean, VA
| | - Brian P Vickery
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Christopher M Warren
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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2
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Soares N, VanDerKolk K, Hasan MS, Burge SK, Graves L. Family Medicine Residency Program Directors' Perception of Curricular Elements Related to Autism: A CERA Study. Fam Med 2024; 56:94-101. [PMID: 38055853 DOI: 10.22454/fammed.2023.160547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The family medicine (FM) approach to health care across the life span is well-suited to providing care for persons living with autism spectrum disorder (ASD). Little is known about ASD curricula in FM residency training and the characteristics of FM residency programs that prepare their residents to care for persons with this disorder. METHODS Our study questions were part of a larger omnibus survey by the Council of Academic Family Medicine Educational Research Alliance (CERA) with data collection from November 16 to December 18, 2022, from FM residency program directors (PDs). ASD curricula were investigated using 10 questions, with descriptive analyses and nonparametric comparisons between program variables and ASD curriculum. RESULTS The response rate was 42.18%, with FM PDs reporting that their programs were preparing residents in the care of youth (71.53%) and adults (68.33%) with ASD, but to a lesser extent (58.89%) in facilitating transitions of care. Programs with faculty champions, access to published curricula, sufficient patients with ASD, and engagement of interprofessional faculty reported a higher proportion of resident preparedness. PDs of community-based programs were most confident in their ability to teach ASD care and transitions of care. CONCLUSIONS Most FM PDs modestly agreed that they are preparing residents to provide care to patients with ASD and their families. PDs of programs with greater access to resources (ie, published curriculum, faculty champions, sufficient patients with ASD, interprofessional faculty experts) believed that their residents were more prepared. Community-based FM educators may help lead the way in providing models for care and education in this regard.
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Affiliation(s)
- Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | - Kristi VanDerKolk
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | | | | | - Lisa Graves
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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3
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Russ CM, Gao Y, Karpowicz K, Lee S, Stephens TN, Trimm F, Yu H, Jiang F, Palfrey J. The Pediatrician Workforce in the United States and China. Pediatrics 2023:191246. [PMID: 37158018 DOI: 10.1542/peds.2022-059143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.
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Affiliation(s)
- Christiana M Russ
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | - Shoo Lee
- Mount Sinai Hospital, New York City, New York
- University of Toronto, Toronto, Canada
| | - Timothy Noel Stephens
- Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, China
| | - Franklin Trimm
- University of South Alabama College of Medicine, Mobile, Alabama; and
| | - Hao Yu
- Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Judith Palfrey
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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4
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Krugman SD, Hodo LN, Morgan ZJ, Eden AR. Challenges Meeting Training Requirements in the Care of Children in Family Medicine Residency Programs: A CERA Study. Fam Med 2023; 55:238-244. [PMID: 37043184 PMCID: PMC10622019 DOI: 10.22454/fammed.2023.761754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVE In 2014, the Accreditation Council for Graduate Medical Education (ACGME) implemented numeric requirements for family medicine (FM) pediatric patient encounters. Impact on residency programs is unclear. We aimed to identify any difficulties faced by FM program directors (PDs) meeting these numeric requirements. METHODS Questions about pediatric training in family medicine residencies were included in a survey of PDs conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA). We performed univariate analysis of the demographic and program characteristics. We then used χ2 tests of independence to test for bivariate associations between these characteristics and our primary outcome: the most difficult ACGME pediatric care requirement to meet. RESULTS Most programs reported the hospital as the primary location of training (n=131, 46%) and their family medicine practice (FMP) patient population consisted of over 20% pediatric patients (n=153, 56%). Over 80% of program directors reported challenges meeting FM requirements for the care of children. Challenges meeting pediatric requirements were associated with fewer than 20% FMP patients under 19 years of age (P<.0001), fewer than 50% of core FM faculty caring for sick children (P=.0128), and primary location of pediatric training in a family health center (P=.0006). CONCLUSION Difficulty meeting ACGME requirements for the care of children in FM residency programs is common, especially for programs with fewer than 20% FMP patients under 19 years of age. Further research is needed to determine how best to assure FM resident competencies in the care of children and adolescents.
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Affiliation(s)
- Scott D. Krugman
- Herman and Walter Samuelson Children's Hospital at SinaiBaltimore, MD
| | - Laura Nell Hodo
- Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount SinaiNew York, NY
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5
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Poole NM, Frost H. Targets and Methods to Improve Outpatient Antibiotic Prescribing for Pediatric Patients. Infect Dis Clin North Am 2022; 36:187-202. [DOI: 10.1016/j.idc.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Vinci RJ. The Pediatric Workforce: Recent Data Trends, Questions, and Challenges for the Future. Pediatrics 2021; 147:peds.2020-013292. [PMID: 33692163 DOI: 10.1542/peds.2020-013292] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
The future of the pediatric workforce has been the subject of significant dialogue in the pediatric community and generated much discussion in the academic literature. There are significant concerns regarding the ability of pediatricians to meet the growing demands of our pediatric population. Over the past 5 years, there has been a decline in the percentage of doctor of osteopathic medicine students who pursue a career in pediatrics but an equally important increase in the number of pediatric positions that are filled by doctor of osteopathic medicine students and international medical graduates. Although there has been an increase in the number of pediatric positions offered in the National Resident Matching Program, the last 4 years have seen a significant increase in the number of unfilled pediatric positions. A number of pediatric subspecialties struggle to fill their training positions, and those with low match rates may have 20% to 40% fewer applicants than positions. The pediatric vision for the future must include a commitment to a comprehensive strategic planning process with the many organizations involved across the multiple stages of the educational continuum. It is time to elucidate and address the questions raised by the workforce data. Developing solutions to these questions will require a careful planning process and a thoughtful analysis of the pediatric workforce data. Establishing this as an important priority will require a major collaborative effort between pediatric academic and professional organizations, but the future benefit to the nation's children will be significant.
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Affiliation(s)
- Robert J Vinci
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
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7
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Jeong D, Verma S, Weeraratne A, Atalla M, Hassan-Ali M, Kam AJ. Pediatric emergency preparedness in Canadian family physician offices: A national survey. World J Emerg Med 2021; 12:225-227. [PMID: 34141039 DOI: 10.5847/wjem.j.1920-8642.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Dayae Jeong
- Department of Pediatrics, University of Toronto, Toronto M5S 1A1, Canada
| | - Subhrata Verma
- Department of Pediatrics, University of Western, London N6A 3K7, Canada
| | | | - Marina Atalla
- Department of Health Sciences, McMaster University, Hamilton L8S 4K1, Canada
| | | | - April J Kam
- Department of Pediatrics, McMaster University, Hamilton L8S 4K1, Canada.,Division of Pediatric Emergency Medicine, McMaster University, Hamilton L8S 4K1, Canada
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8
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Nasim U, Morgan ZJ, Peterson LE. The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas. J Rural Health 2020; 37:734-744. [PMID: 33244807 DOI: 10.1111/jrh.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Scope of practice of family physicians (FPs) has been decreasing overall. Our objective was to determine if the distribution of declining scope occurs across urban and rural settings. METHODS We used secondary data from practicing FPs collected on the American Board of Family Medicine examination registration demographic questionnaire from 2014 to 2016 on scope of practice merged with county-level data from the Area Health Resources File. Rurality was assigned using 4 population-based groupings from the Rural Urban Continuum Codes. Outcome measures were scope of practice score (0-30, higher score reflecting broader scope) and provision of specific types of care/procedures. Bivariate statistics assessed changes in scope of practice over time. Adjusted regression models tested associations between time, physician, practice, and county characteristics with scope of practice score. FINDINGS Our sample was 27,343 practicing FPs. Overall, the scope score decreased from 15.5 to 15.0 (P value < .05) but was significant only for urban settings. Regression analysis found that scope decreased each year (β = -0.15), broader scope for rural FPs, and no interaction between year and rural. CONCLUSIONS The decrease in FP scope of practice is largely an urban phenomenon. FPs in rural areas have a broad scope of practice, which may ensure access to care in rural areas that rely on FPs to provide a large portion of health care services. However, county characteristics like persistent poverty and the presence of nurse practitioners, physician assistants, and other physicians were associated with changes in scope that may modify the gains associated with rurality.
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Affiliation(s)
- Urooj Nasim
- Department of Political Science, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky.,Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
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9
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Barrera SC, Cancino RS, Barreto TW. The impact of continuity of care on antibiotic prescribing in acute otitis media. Int J Pediatr Otorhinolaryngol 2019; 126:109616. [PMID: 31376791 DOI: 10.1016/j.ijporl.2019.109616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND The rate of antibiotic prescribing for acute otitis media (AOM) remains high despite efforts to decrease inappropriate use. Studies have aimed to understand the prescribing patterns of providers to increase antibiotic stewardship. Watch and wait (WAW) prescriptions are effective at decreasing the number of antibiotic prescriptions being filled by patients. Additionally, poor continuity of care has been associated with higher cost and lower quality health care. OBJECTIVE To understand the antibiotic prescribing habits for AOM in a largely Hispanic population. METHODS A retrospective review was performed from 2016 to 2018 of all patients under 25 years old with a diagnosis of AOM seen at multiple outpatient primary care clinics of a single institution. Charts were reviewed for factors including race, ethnicity, gender, insurance status, presence of fever, primary care physician visit, and treatment choice. Data were collected and analyzed using STATA software with t-tests, ANOVA, and Pearson chi squared analysis. RESULTS Antibiotics were prescribed 95.6% of the time with 3.8% being WAW prescriptions. There was no significant difference in antibiotic prescribing by race (p = 0.66), ethnicity (p = 0.38), gender (p = 0.34) or insurance status (p = 0.24). There was a difference between physicians, nurse practitioners, and physician's assistants and antibiotic prescribing rate (p < 0.01). Additionally, seen by their primary care provider were less likely to be prescribed antibiotics (85.8% vs 94.4%, p = 0.01). CONCLUSION While a patient's race, ethnicity, gender, and insurance status did not influence the prescribing rate of physicians, continuity of care may play an important role in decreasing inappropriate antibiotic prescribing.
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Affiliation(s)
- Shelby C Barrera
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Ramon S Cancino
- UT Health San Antonio Long School of Medicine, Department of Family and Community Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Tyler W Barreto
- SeaMar Community Health Centers, 1920 100th St SE, Suite B, Everett, WA, 98208, USA
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10
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Wasserman RC, Varni SE, Hollander MC, Harder VS. Change in Site of Children's Primary Care: A Longitudinal Population-Based Analysis. Ann Fam Med 2019; 17:390-395. [PMID: 31501199 PMCID: PMC7032921 DOI: 10.1370/afm.2416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/01/2019] [Accepted: 03/26/2019] [Indexed: 11/09/2022] Open
Abstract
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 all-payer 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.
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Affiliation(s)
- Richard C Wasserman
- The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
| | - Susan E Varni
- The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
| | - Matthew C Hollander
- The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
| | - Valerie S Harder
- The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont
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11
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Shen AK, Warnock R, Selna W, MaCurdy TE, Chu S, Kelman JA. Vaccination among Medicare-fee-for service beneficiaries: Characteristics and predictors of vaccine receipt, 2014–2017. Vaccine 2019; 37:1194-1201. [DOI: 10.1016/j.vaccine.2019.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/29/2018] [Accepted: 01/02/2019] [Indexed: 01/03/2023]
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12
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Trope LA, Congdon JL, Brown L, Zuckerman B. Family Planning in Pediatrics: An Appeal for Enhanced Training. J Pediatr 2018; 200:4-5. [PMID: 30144929 DOI: 10.1016/j.jpeds.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Lee A Trope
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
| | | | - Lauren Brown
- Boston Children's Hospital and Boston Medical Center, Boston, MA
| | - Barry Zuckerman
- Boston Children's Hospital and Boston Medical Center, Boston, MA
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13
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Strengthening the Effectiveness of National, State, and Local Efforts to Improve HPV Vaccination Coverage in the United States: Recommendations From the National Vaccine Advisory Committee. Public Health Rep 2018; 133:543-550. [PMID: 30091942 DOI: 10.1177/0033354918793629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In February 2018, recognizing the suboptimal rates of human papillomavirus (HPV) vaccination in the United States, the assistant secretary for health of the US Department of Health and Human Services charged the National Vaccine Advisory Committee (NVAC) with providing recommendations on how to strengthen the effectiveness of national, state, and local efforts to improve HPV vaccination coverage rates. In the same month, the NVAC established the HPV Vaccination Implementation Working Group and assigned it to develop these recommendations. The working group sought advice from federal and nonfederal partners. This NVAC report recommends ways to improve HPV vaccination coverage rates by focusing on 4 areas of activity: (1) identifying additional national partners, (2) guiding coalition building for states, (3) engaging integrated health care delivery networks, and (4) addressing provider needs in rural areas.
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14
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Tarini BA, Gornick MC, Zikmund-Fisher BJ, Saal HM, Edmondson L, Uhlmann WR. Family History Collection Practices: National Survey of Pediatric Primary Care Providers. Clin Pediatr (Phila) 2018; 57:537-546. [PMID: 29034736 DOI: 10.1177/0009922817733693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While family history (FH) collection is a core responsibility of pediatric primary care providers (PCPs), few details about this practice are known. We surveyed a random national sample of 1200 pediatricians and family medicine physicians about FH collection practices. A total of 86% of respondents (n = 289 pediatricians; n = 152 family medicine physicians) indicated that they collect a FH "always" or "most of the time" with 77% reporting collection at the first visit, regardless of whether it is a health maintenance or problem-focused visit. Less than half ask about relatives other than parents, siblings, or grandparents (36.3%). Among respondents, 42% routinely update the FH at every health maintenance visit while 6% updated FH at every visit. Pediatric PCPs use a variety of methods to collect a FH that is limited in scope and variably updated. Our results suggest that interventions are needed to help pediatric PCPs collect a systematic, efficient, and updated FH.
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Affiliation(s)
| | | | | | - Howard M Saal
- 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Rebelo S, Velho Rua S, d’Orey Leça J, Couto A, Teixeira R, Firmino-Machado J. Is healthy children surveillance being duplicated by family physicians and paediatricians? A cross-sectional study in Portugal. BMJ Open 2018; 8:e015902. [PMID: 29496894 PMCID: PMC5855303 DOI: 10.1136/bmjopen-2017-015902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine if children attend the family physician (FP) or the FP/paediatrician for their surveillance medical appointments, as well as analyse the variables associated with the parents' choice between the two physicians. DESIGN Cross-sectional study. SETTING Public, semiprivate and private kindergartens in the city of Vila Nova de Famalicão (Portugal). PARTICIPANTS Parents of children aged 6 years or less without chronic diseases, enrolled in the selected kindergartens. MAIN OUTCOME MEASURES Proportion of children attending the FP or FP/paediatrician for their surveillance appointments; association between the chosen physician and sociodemographic and household variables (parents' age, educational level, professional situation and marital status; household net income; number of children; the child's age; presence of private health insurance), assessment of the parents' perception of clinical knowledge and accessibility regarding the FP and the paediatrician. RESULTS A total of 697 children were included in the analysis: 30.6% attended only the FP and 69.4% attended both the FP and the paediatrician. Using a Poisson regression, the mother's age (PR=1.02, 95% CI 1.00 to 1.03), higher educational level (prevalence ratio (PR=1.15, 95% CI 1.00 to 1.33), private health insurance (PR=1.30, 95% CI 1.15 to 1.46), number of children (PR=0.86, 95% CI 0.78 to 0.94) and the child's age (PR=0.95, 95% CI 0.91 to 0.98) were statistically associated with attending both the FP and the paediatrician; parents of children who attended only FP rated the FP with a higher accessibility and knowledge mean score than those who consulted both physicians (2.91vs2.38, P<0.001, and 4.11vs3.85, P<0.001). CONCLUSIONS Our data show that 70% of our sample simultaneously attended an FP and a paediatrician. FPs are equally qualified to provide medical care to healthy children but this information is not properly transmitted to the general population.
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Affiliation(s)
- Susana Rebelo
- Family Health Unit Ribeirão, Northern Regional Health Administration, Vila Nova de Famalicão, Portugal
| | - Sofia Velho Rua
- Family Health Unit Ribeirão, Northern Regional Health Administration, Vila Nova de Famalicão, Portugal
| | - Joana d’Orey Leça
- Family Health Unit Terras do Ave, Northern Regional Health Administration, Vila Nova de Famalicão, Portugal
| | - Ana Couto
- Personalized Health Care Unit Chaves A, Northern Regional Health Administration, Chaves, Portugal
| | - Rute Teixeira
- Family Health Unit Serzedelo, Family Health Unit Ribeirão, Guimarães, Portugal
| | - João Firmino-Machado
- Western Oporto Public Health Unit, Northern Regional Health Administration, Porto, Portugal
- EPIUnit -The Epidemiology Research Unit, University of Porto, Porto, Portugal
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16
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Xierali IM, Nivet MA. The Racial and Ethnic Composition and Distribution of Primary Care Physicians. J Health Care Poor Underserved 2018; 29:556-570. [PMID: 29503317 PMCID: PMC5871929 DOI: 10.1353/hpu.2018.0036] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Racial and ethnic minority physicians are more likely to practice primary care and serve in underserved communities. However, there are micro-practice patterns within primary care specialties that are not well understood. To examine the differences among primary care physician practice locations by specialty and race/ethnicity, a retrospective study was conducted on U.S. medical graduates who were direct patient care physicians in 2012. The group-specific contributions to primary care accessibility were decomposed by individual group of minorities underrepresented in medicine (URM). Results confirm significant differences not only in their distribution across underserved areas but also in their racial/ethnic composition by primary care specialties, with internist most diverse and family physicians least diverse. However, stratified analysis shows that within each primary care subspecialty, URM physicians were more likely to practice in underserved areas than their White peers regardless of specific specialties.
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Walker TY, Elam-Evans LD, Singleton JA, Yankey D, Markowitz LE, Fredua B, Williams CL, Meyer SA, Stokley S. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years - United States, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:874-882. [PMID: 28837546 PMCID: PMC5687818 DOI: 10.15585/mmwr.mm6633a2] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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18
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Liu HY, Liu CC, Shen TH, Wang YJ, Liu JY, Chen TJ, Chou LF, Hwang SJ. Pattern of Visits to Older Family Physicians in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E499. [PMID: 28481318 PMCID: PMC5451950 DOI: 10.3390/ijerph14050499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
Many family physicians still practice at an old age. Nevertheless, their practice patterns have scarcely been studied. To address this lack of research, the current study analyzed claims data for a total of 2,018,440 visits to 171 family physicians in 2011 sourced from Taiwan's National Health Insurance Research Database. Family physicians aged 65 years and over had fewer patients (mean: 2330, standard deviation (SD): 2019) and visits (mean: 9220, SD: 8600) than younger physicians had. Furthermore, the average age of the patients who visited physicians aged 65 years and over was 51.9 (SD: 21.5) years, significantly higher than that of patients who visited younger physicians. However, the proportions of visits for upper respiratory tract infections, hypertension, diabetes mellitus, and dyslipidemia did not differ significantly among different age groups of physicians. In the future, the manpower planning of physicians should take into consideration the age structure and work profile of physicians.
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Affiliation(s)
- Hao-Yen Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Cheng-Chieh Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Tzu-Hsiang Shen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Yi-Jen Wang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Jui-Yao Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, No. 64, Sec. 2, Zhi-Nan Road, Taipei 116, Taiwan.
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
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Correll CK, Spector LG, Zhang L, Binstadt BA, Vehe RK. Use of Rheumatology Laboratory Studies Among Primary Pediatricians. Clin Pediatr (Phila) 2016; 55:1279-1288. [PMID: 26755273 PMCID: PMC5233599 DOI: 10.1177/0009922815624902] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Rheumatology laboratory tests are often inappropriately ordered in situations for which they are of low diagnostic utility. We surveyed pediatricians to investigate reasons for ordering these tests. The response rate was 15.3% (93/609). The most commonly ordered tests were antinuclear antibody (ANA), anti-double-stranded DNA (dsDNA) antibody, and rheumatoid factor (RF). Of the 89% (83/93) who ordered an ANA, 86% ordered it for correct/possibly correct reasons; of the 73% (68/93) who ordered RF, 80% did so for correct/possibly correct reasons; and among the 59% (54/92) who had ordered anti-dsDNA antibody, 34% ordered it for correct reasons. A positive relationship was seen between years since residency completion and correct use of ANA. However, positive associations were not seen between measures of pediatric rheumatology experience and correct use of other tests. Interventions are needed to improve pediatricians' utilization of rheumatology tests.
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Affiliation(s)
- Colleen K. Correll
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA,University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Lei Zhang
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, USA
| | - Bryce A. Binstadt
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Richard K. Vehe
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Villanti AC, Bover Manderski MT, Gundersen DA, Steinberg MB, Delnevo CD. Reasons to quit and barriers to quitting smoking in US young adults. Fam Pract 2016; 33:133-9. [PMID: 26733658 PMCID: PMC5006105 DOI: 10.1093/fampra/cmv103] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young adulthood provides an enormous opportunity to alter trajectories of smoking behaviour for a large public health impact. OBJECTIVE The purpose of this study was to examine correlates of perceived barriers to quitting smoking and reasons to quit in a sample of young adult current and former smokers. METHODS This study used data from the 2011 National Young Adult Health Survey, a random-digit-dial cellphone survey. Participants were US young adult current smokers aged 18-34 (n = 699) and young adults who were either current smokers who had made a quit attempt in the past-year (n = 402) or former smokers (n = 289). Correlates of barriers to quitting smoking and reasons for quitting smoking were assessed using bivariate and multivariable analyses. RESULTS More than half of current smokers identified 'loss of a way to handle stress' (59%) and 'cravings or withdrawal' (52%) as barriers to quitting. Female gender, daily smoking and intention to quit remained significantly associated with endorsing 'loss of a way to handle stress' as a barrier to quitting in multivariable analyses. The two most popular reasons for quitting smoking were physical fitness (64%) and the cost of tobacco (64%). CONCLUSION These findings highlight barriers to cessation and the reasons that young smokers give for quitting. This information may be helpful to physicians as they counsel their young adult patients to quit smoking.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Daniel A Gundersen
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and
| | - Michael B Steinberg
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and
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Correll CK, Spector LG, Zhang L, Binstadt BA, Vehe RK. Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States. Pediatr Rheumatol Online J 2015; 13:32. [PMID: 26215389 PMCID: PMC4517495 DOI: 10.1186/s12969-015-0028-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Access to pediatric rheumatology (PR) care is limited, however the impact that limited access to PR has on pediatricians has not been examined. The goal of this study was to investigate barriers to PR referrals and resulting alternative referral patterns among primary pediatricians. METHODS A web-based survey was emailed to primary pediatricians practicing in Minnesota, North Dakota, and South Dakota in order to investigate access to PR care issues. Basic descriptive analysis was performed. RESULTS The response rate was 15 % (93/609). Twenty-nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9 % (8/92) were more than six hours away. Ninety-two percent (85/92) had referred a patient to PR at least once, but 89 % (83/93) had experienced a situation in which they considered a referral to PR but ultimately did not. Many had referred to other subspecialists instead: 29 % (24/83) to pediatric infectious disease, 20 % to adult rheumatology, and 12 % to pediatric orthopedics, while 34 % managed the patient themselves. Thirty-five percent (32/60) had referred to an adult rheumatologist, commonly due to decreased travel (44 %), while physician preference was never selected as a reason. CONCLUSION Pediatricians often refer children with possible rheumatic disease to specialists other than PR mainly due to long travel distances. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to PR care.
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Affiliation(s)
- Colleen K. Correll
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN USA
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA ,University of Minnesota Masonic Cancer Center, Minneapolis, MN USA
| | - Lei Zhang
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Bryce A. Binstadt
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN USA
| | - Richard K. Vehe
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN USA
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Stange KC. In this issue: raise the gaze. Ann Fam Med 2014; 12:398-9. [PMID: 25354413 PMCID: PMC4157973 DOI: 10.1370/afm.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Rayburn WF, Petterson SM, Phillips RL. Trends in family physicians performing deliveries, 2003-2010. Birth 2014; 41:26-32. [PMID: 24654634 DOI: 10.1111/birt.12086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This observational study examined the proportion of family physicians continuing to perform deliveries from 2003-2010. METHODS Data were collected annually from the same census questionnaire completed by family physicians who passed their recertification examination. Aggregated responses began in 2003 when data first became available electronically and ended in 2009 before recertification changes. Using cross-sectional design and logistic regression analysis, we examined associations between physician demographic or geographic factors and performance of deliveries. RESULTS The sample consisted of 49,267 family physicians between 2003 and 2009, including 7,456 in 2009. The proportion performing any deliveries declined by 40.6 percent, from 17.0 percent in 2003 to 10.1 percent in 2009. Most recently, 5.5 percent of all family physicians delivered 1-25 babies per year, whereas 2.8 percent delivered 26-50, and 1.9 percent delivered ≥ 51. Those who performed deliveries were most likely to be junior members of a partnership or group practice, and provided prenatal and newborn care. Deliveries were more common in nonmetropolitan areas, where other obstetric practitioners were unavailable. CONCLUSIONS The proportion of family physicians performing deliveries continues to decline with most delivering 25 or fewer babies per year. This change will require more effort by obstetrician-gynecologists and midwives in being primary birth attendants.
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Affiliation(s)
- William F Rayburn
- Director at the Robert Graham Center for Policy Studies in Family Practice and Primary Care, Washington, DC, USA
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