Primary care physician supply and children's health care use, access, and outcomes: findings from Canada.

Abstract:

OBJECTIVES:To describe the relationship of primary care physician (PCP) supply for children and measures of health care access, use, and outcomes. METHODS:We conducted a population-based, cross-sectional study of all Ontario children from 2003 to 2005. We used health administrative data to calculate county-level supply (full-time equivalents [FTEs]) of PCPs. We modeled the relationship of supply to (1) recommended primary care visits, (2) emergency department (ED) use, and (3) ambulatory care-sensitive condition admissions and adjusted for neighborhood income. We used population-based surveys to describe access. RESULTS:The county-level PCP supply ranged from 1720 to 4720 children per FTE. Of the children, 45.4% live in the highest-supply areas (<2000 children per FTE) and 8% in the lowest-supply areas (>3000 children per FTE). Compared with high-supply counties, the lowest had significantly lower rates of primary care visits (2716 vs 7490 per 1000) and higher proportions of newborns without early follow-care (58.2% vs 14.5%). Low-supply areas had higher rates of ED visits (440 vs 179 per 1000) and admissions. A stepwise gradient existed for every decrease in supply for most measures. Self-reported access barriers were most evident in areas with >3500 children per FTE (32.8% without a physician). CONCLUSIONS:Under universal insurance there are differences in access to, and outcomes of, primary care related to local physician supply after controlling for neighborhood income. The most pronounced effect is on primary and ED care use, but there are implications for acute and chronic disease control. Physician distribution is a critical issue to address in policies to improve access to care.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Guttmann A,Shipman SA,Lam K,Goodman DC,Stukel TA

doi

10.1542/peds.2009-2821

subject

Has Abstract

pub_date

2010-06-01 00:00:00

pages

1119-26

issue

6

eissn

0031-4005

issn

1098-4275

pii

peds.2009-2821

journal_volume

125

pub_type

杂志文章
  • Relationship between bed sharing and breastfeeding: longitudinal, population-based analysis.

    abstract:OBJECTIVES:This is an investigation into the longitudinal patterns of bed sharing, the characteristics associated with those patterns, and the relationship with breastfeeding. METHODS:The study used prospective, population-based data from the United Kingdom to investigate nocturnal bed sharing at 5 time points from bi...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2010-1277

    authors: Blair PS,Heron J,Fleming PJ

    更新日期:2010-11-01 00:00:00

  • Munchausen's syndrome by proxy (child abuse) presenting as apparent autoerythrocyte sensitization syndrome: an unusual presentation of Polle syndrome.

    abstract::Munchausen's syndrome was initially described in 1951. It has become increasingly recognized since that time. Recently, Munchausen's syndrome by proxy or Polle syndrome has been described. In this disease entity, a parent causes a factitious disease in a child. The disease may require extensive medical testing and the...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Clark GD,Key JD,Rutherford P,Bithoney WG

    更新日期:1984-12-01 00:00:00

  • Improving Anaphylaxis Care: The Impact of a Clinical Pathway.

    abstract:BACKGROUND:Recommended durations of observation after anaphylaxis have been widely variable, with many ranging from 4 to 24 hours. Prolonged durations often prompt admission for ongoing observation. METHODS:In a multidisciplinary quality improvement initiative, we revised our emergency department (ED) anaphylaxis clin...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2017-1616

    authors: Lee J,Rodio B,Lavelle J,Lewis MO,English R,Hadley S,Molnar J,Jacobstein C,Cianferoni A,Spergel J,Zielinski L,Tsarouhas N,Brown-Whitehorn T

    更新日期:2018-05-01 00:00:00

  • Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease.

    abstract:OBJECTIVES:Unintended variation in the care of patients with Crohn disease (CD) and ulcerative colitis (UC) may prevent achievement of optimal outcomes. We sought to improve chronic care delivery and outcomes for children with inflammatory bowel disease by using network-based quality improvement methods. METHODS:By us...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2011-1700

    authors: Crandall WV,Margolis PA,Kappelman MD,King EC,Pratt JM,Boyle BM,Duffy LF,Grunow JE,Kim SC,Leibowitz I,Schoen BT,Colletti RB,ImproveCareNow Collaborative.

    更新日期:2012-04-01 00:00:00

  • Long-term follow-up study of serum immunoglobulin G and immunoglobulin A antibodies after Helicobacter pylori eradication.

    abstract:OBJECTIVE:There have been few studies concerning serum titers of anti-Helicobacter pylori immunoglobulin G (IgG) antibody >12 months after eradication of the original infection. Moreover, clinical usefulness of immunoglobulin A (IgA) antibody levels remains to be established. The purpose of this study was to investigat...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.104.2.e22

    authors: Kato S,Furuyama N,Ozawa K,Ohnuma K,Iinuma K

    更新日期:1999-08-01 00:00:00

  • Special requirements of electronic health record systems in pediatrics.

    abstract::Some functions of an electronic health record system are much more important in providing pediatric care than in adult care. Pediatricians commonly complain about the absence of these "pediatric functions" when they are not available in electronic health record systems. To stimulate electronic health record system ven...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-3527

    authors: Spooner SA,Council on Clinical Information Technology, American Academy of Pediatrics.

    更新日期:2007-03-01 00:00:00

  • Treatment of apnea of prematurity with aminophylline.

    abstract::The effectiveness of aminophylline in the treatment of apnea of prematurity was evaluated in 13 premature infants (mean birthweight, 1.13 kg; mean gestational age, 29 weeks). Apnea was recorded by direct observation in combination with impedance monitoring. Rectal suppositories of aminophylline (5 mg) were given at si...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Bednarek FJ,Roloff DW

    更新日期:1976-09-01 00:00:00

  • Varicella zoster virus meningitis in a previously immunized child.

    abstract::We are reporting a previously well 5-year-old child with varicella-zoster meningitis who had a history of a previous immunization against varicella. This child also developed a transient sensorineural hearing loss. The child was treated with acyclovir and made a full recovery. ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.114.2.e273

    authors: Schwab J,Ryan M

    更新日期:2004-08-01 00:00:00

  • Influenza burden for children with asthma.

    abstract:OBJECTIVE:The goal was to estimate the influenza disease burden among children with asthma and among healthy children by using active, laboratory-confirmed, population-based surveillance. METHODS:Children 6 to 59 months of age residing in 3 US counties who were hospitalized with acute respiratory illnesses or fever we...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2007-1053

    authors: Miller EK,Griffin MR,Edwards KM,Weinberg GA,Szilagyi PG,Staat MA,Iwane MK,Zhu Y,Hall CB,Fairbrother G,Seither R,Erdman D,Lu P,Poehling KA,New Vaccine Surveillance Network.

    更新日期:2008-01-01 00:00:00

  • Milk intolerance in children with persistent sleeplessness: a prospective double-blind crossover evaluation.

    abstract::From July 1986 to July 1988, 146 children less than 5 years of age were referred by their physicians to our university sleep clinic for continual waking and crying during sleep hours. For 85 children (58.2%), the sleeplessness was attributed to inappropriate sleep habits. For 17 children (11.6%), no explanation was fo...

    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Kahn A,Mozin MJ,Rebuffat E,Sottiaux M,Muller MF

    更新日期:1989-10-01 00:00:00

  • Ethnic differences in the link between insulin resistance and elevated ALT.

    abstract:BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) exhibits tight links with insulin resistance (IR) and the metabolic syndrome (MetS), a cluster of cardiovascular risk factors. Compared with non-Hispanic whites, non-Hispanic black adolescents have more IR but a lower prevalence of NAFLD and MetS. Our hypothesis was t...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2012-3584

    authors: Deboer MD,Wiener RC,Barnes BH,Gurka MJ

    更新日期:2013-09-01 00:00:00

  • Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.

    abstract:CONTEXT:Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. OBJECTIVES:There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 yea...

    journal_title:Pediatrics

    pub_type: 杂志文章,随机对照试验

    doi:10.1542/peds.2005-2318

    authors: Black MM,Bentley ME,Papas MA,Oberlander S,Teti LO,McNary S,Le K,O'Connell M

    更新日期:2006-10-01 00:00:00

  • Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial.

    abstract:BACKGROUND:Growth-restricted preterm infants are at increased risk of developing necrotizing enterocolitis (NEC) and initiation of enteral feeding is frequently delayed. There is no evidence that this delay is beneficial and it might further compromise nutrition and growth. METHODS:Infants with gestation below 35 week...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1542/peds.2011-2379

    authors: Leaf A,Dorling J,Kempley S,McCormick K,Mannix P,Linsell L,Juszczak E,Brocklehurst P,Abnormal Doppler Enteral Prescription Trial Collaborative Group.

    更新日期:2012-05-01 00:00:00

  • Exemplar pediatric collaborative improvement networks: achieving results.

    abstract::A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children's Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving "...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2012-3786F

    authors: Billett AL,Colletti RB,Mandel KE,Miller M,Muething SE,Sharek PJ,Lannon CM

    更新日期:2013-06-01 00:00:00

  • Are we overprescribing antireflux medications for infants with regurgitation?

    abstract:OBJECTIVE:Our goal was to evaluate the diagnosis and treatment of infants with persistent regurgitation who were referred to a pediatric gastroenterology service. METHODS:The records of 64 infants with persistent regurgitation and without any neurodevelopmental abnormalities, underlying illness, or cigarette smoke exp...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2007-1146

    authors: Khoshoo V,Edell D,Thompson A,Rubin M

    更新日期:2007-11-01 00:00:00

  • Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment.

    abstract:OBJECTIVES:Acquisition and maintenance of the skills necessary for successful resuscitation of the neonate are typically accomplished by a combination of completion of standardized training courses using textbooks, videotape, and manikins together with active participation in the resuscitation of human neonates in the ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.106.4.e45

    authors: Halamek LP,Kaegi DM,Gaba DM,Sowb YA,Smith BC,Smith BE,Howard SK

    更新日期:2000-10-01 00:00:00

  • Does early treatment of urinary tract infection prevent renal damage?

    abstract:OBJECTIVE:Therapeutic delay has been suggested as the most important factor that is likely to have an effect on the development of scarring after acute pyelonephritis. However, this opinion has not been supported by prospective studies, so we tested it. METHODS:In a prospective clinical study, we evaluated whether the...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-2417

    authors: Doganis D,Siafas K,Mavrikou M,Issaris G,Martirosova A,Perperidis G,Konstantopoulos A,Sinaniotis K

    更新日期:2007-10-01 00:00:00

  • Racial (black-white) differences in insulin secretion and clearance in adolescents: the Bogalusa heart study.

    abstract:OBJECTIVE:Earlier we found black-white contrast in insulin levels in adolescents. The purpose of this study is to assess whether this difference is attributable to alterations in insulin secretion and/or clearance. METHODS:Fasting circulating insulin and C-peptide concentrations were examined in 1157 adolescents aged ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Jiang X,Srinivasan SR,Radhakrishnamurthy B,Dalferes ER,Berenson GS

    更新日期:1996-03-01 00:00:00

  • Validity of mass blood pressure screening in children.

    abstract::The validity of a mass blood pressure screening program carried out on Dallas high school students who were followed for at least 3 years is reported. Blood pressure results on initial screening in the tenth grade were related to outcome blood pressure status. The frequency of initial blood pressure elevation (systoli...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Fixler DE,Laird WP

    更新日期:1983-10-01 00:00:00

  • Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.

    abstract::Young patients and their parents often are unsure about what represents normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual cycle length and amount and duration of flow through adolescence. It is important to be able to educate young patients and their parents regarding what ...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2006-2481

    authors: American Academy of Pediatrics Committee on Adolescence.,American College of Obstetricians and Gynecologists Committee on Adolescent Health Care.,Diaz A,Laufer MR,Breech LL

    更新日期:2006-11-01 00:00:00

  • Early Intervention, Parent Talk, and Pragmatic Language in Children With Hearing Loss.

    abstract:BACKGROUND AND OBJECTIVES:Pragmatic language skills form the foundation for conversational competence, whereas deficits in this area are associated with behavioral problems and low literacy skills. Children who are deaf or hard of hearing demonstrate significant delays in this critical area of language. Our purpose wit...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2020-0242F

    authors: Yoshinaga-Itano C,Sedey AL,Mason CA,Wiggin M,Chung W

    更新日期:2020-11-01 00:00:00

  • Is a "wage-payment" model for research participation appropriate for children?

    abstract:OBJECTIVE:Our goal was to evaluate the applicability of a "wage-payment" model to inducements for children to participate in research. SUBJECTS AND METHODS:We interviewed 42 children and adolescents between the ages of 4 and 16 years who had diabetes, asthma, seizures, or no chronic medical condition. The interview ex...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-1813

    authors: Bagley SJ,Reynolds WW,Nelson RM

    更新日期:2007-01-01 00:00:00

  • Hospitalizations of newborns with folate-sensitive birth defects before and after fortification of foods with folic acid.

    abstract:CONTEXT:The prevalence of neural tube defects is reduced in populations of women who receive folic acid supplementation. Since 1998, grain products in the United States have been fortified with folic acid. Fortification may have additional benefits by reducing the national prevalence of newborn hospitalizations for oth...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2005-2784

    authors: Robbins JM,Tilford JM,Bird TM,Cleves MA,Reading JA,Hobbs CA

    更新日期:2006-09-01 00:00:00

  • Emergency Department and Hospital Use Among Adolescents With Justice System Involvement.

    abstract:OBJECTIVES:Adolescents with justice system involvement have high rates of physical and behavioral health disorders and are potentially high users of costly health care services. We examined emergency department (ED) and hospital use among a national sample of adolescents with various levels of justice involvement. MET...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2017-1144

    authors: Winkelman TNA,Genao I,Wildeman C,Wang EA

    更新日期:2017-11-01 00:00:00

  • Electrocardiograph monitor artifacts in a neonatal intensive care unit.

    abstract::A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tr...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Stanger P,Lister G,Silverman NH,Hoffman JI

    更新日期:1977-11-01 00:00:00

  • Prenatal detection of neuroblastoma: a ten-year experience from the Dana-Farber Cancer Institute and Children's Hospital.

    abstract:OBJECTIVES:To assess the relative frequency of, the clinical and pathological correlates in, and the prognosis of the subset of infants with neuroblastoma who were identified initially by prenatal ultrasonography. DESIGN:Retrospective review of all patients with neuroblastoma evaluated between 1982 and 1992. SETTING:...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Ho PT,Estroff JA,Kozakewich H,Shamberger RC,Lillehei CW,Grier HE,Diller L

    更新日期:1993-09-01 00:00:00

  • Fluoride ingestion in children: a review of 87 cases.

    abstract::All cases of fluoride ingestion in children younger than 12 years old reported to the Rocky Mountain Poison Center between January 1 and December 31, 1986, were retrospectively reviewed. Eighty-seven cases were identified. Eighty-four cases involved accidental ingestion of dental fluoride products in the home (tablets...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Augenstein WL,Spoerke DG,Kulig KW,Hall AH,Hall PK,Riggs BS,el Saadi M,Rumack BH

    更新日期:1991-11-01 00:00:00

  • Attitudes toward neonatal intensive care treatment of preterm infants with a high risk of developing long-term disabilities.

    abstract:OBJECTIVES:To assess (1) the differences in attitudes toward disabilities of 3 groups of subjects involved in neonatal care decision-making: health care workers, mothers of term infants, and parents of preterm infants, and (2) the impact of subject characteristics on these attitudes including parental education level, ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-2061

    authors: Lam HS,Wong SP,Liu FY,Wong HL,Fok TF,Ng PC

    更新日期:2009-06-01 00:00:00

  • Intentional poisoning of children--an overlooked category of child abuse: report of seven cases and review of the literature.

    abstract::Seven instances of child abuse due to poisoning are reported; two of the children died. Forty-one cases of this form of poisoning are found in the literature. Of the total of 48 children, eight (17%) died as a result of the incident; and one was mentally retarded. The seven different agents described here are alcohol,...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Dine MS,McGovern ME

    更新日期:1982-07-01 00:00:00

  • Update of newborn screening and therapy for congenital hypothyroidism.

    abstract::Unrecognized congenital hypothyroidism leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. The primary thyroid-stimulating hormone screening has become standard in many parts of the world. However, newborn thyroid screening is not yet un...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2006-0915

    authors: American Academy of Pediatrics.,Rose SR,Section on Endocrinology and Committee on Genetics, American Thyroid Association.,Brown RS,Public Health Committee, Lawson Wilkins Pediatric Endocrine Society.,Foley T,Kaplowitz PB,Kaye CI,Sundarar

    更新日期:2006-06-01 00:00:00