Primary care of mothers and infants by the same or different physicians: a population-based cohort study

Maternal Disability and Early Child Preventive Care

OBJECTIVES

Preventive health care for children comprises routine well-child visits and immunizations. Women with physical, sensory, or intellectual or developmental disabilities tend to experience more barriers to preventive health care; yet it is unknown whether such barriers are observed among their young children.

METHODS

This population-based study in Ontario, Canada included children born between 2012 and 2019 whose mothers had a physical (n = 74 084), sensory (n = 26 532), or intellectual or developmental (n = 1391) disability, multiple disabilities (n = 5774), or no disability (n = 723 442). Primary outcomes were receipt of the recommended number of well-child visits and routine immunizations in the first 2 years. Secondary outcomes included receipt of the enhanced 18-month developmental assessment and any developmental screen. Relative risks (aRR) were generated using modified Poisson regression and adjusted for maternal sociodemographics and mental health and child sex.

RESULTS

Compared with children of mothers without disabilities, those whose mothers had intellectual or developmental disabilities were less likely to receive the recommended number of well-child visits (56.3% vs 63.2%; aRR 0.92, 95% confidence interval [CI] 0.88-0.97), routine immunizations (43.8% vs 53.7%; aRR 0.88, 95% CI 0.83-0.94), enhanced 18-month developmental assessment (52.3% vs 60.8%; aRR 0.92, 95% CI 0.88-0.97), or any developmental screen (54.9% vs 62.5%; aRR 0.94, 95% CI 0.90-0.99). Other disability groups did not experience such disparities.

CONCLUSIONS

There is a need to develop resources to improve access to preventive health care for young children of women with intellectual or developmental disabilities.

Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians

BACKGROUND

Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups.

METHODS

Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points.

RESULTS

Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking.

CONCLUSION

Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.

Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

OBJECTIVE

To test the association of material deprivation and the utilization of vision care services for young children.

STUDY DESIGN

We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician.

RESULTS

Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas.

CONCLUSIONS

Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.

Primary Care Provider and Child Characteristics Associated with Age of Diagnosis of Autism Spectrum Disorder: A Population-Based Cohort Study

In a cohort of kindergarten children in Ontario, Canada with Autism Spectrum Disorder (ASD) (n = 1522), we tested the association of age at ASD diagnosis and characteristics of (1) the child's primary care provider and, (2) the child using health administrative databases. We tested the association of primary care practice model and time from developmental delay identification to age at ASD diagnosis. Older age of diagnosis was associated with provider foreign training (vs. domestic) (adjusted Hazard Ratio [aHR] 1.17, 95% CI 1.03, 1.33) but not sex, care model, and years of practice. After developmental delay identification, children with paediatricians had longer time to diagnosis than children with providers in care models (aHR 0.68, 95% CI 0.54, 0.86). Findings can be used to inform primary care provider ASD training.