Pediatricians' involvement in community child health activities has declined even though community engagement is an important professional duty, according to an analysis of 2 national mailed surveys of pediatricians (with 881 participants in 2004 and 820 in 2010).
Cynthia S. Minkovitz, MD, MPP, a professor in the Department of Population, Family, and Reproductive Health at Johns Hopkins Bloomberg School of Public Health and in the Department of Pediatrics at Johns Hopkins School of Medicine, and the director of the Women's and Children's Health Policy Center in Baltimore, Maryland, and colleagues present their findings in an article published online November 18 in Pediatrics.
"This study reveals a continued decline in pediatricians' involvement in community child health activities and is the first national study to identify a link between formal training and pediatricians' community involvement," the authors write.
The researchers analyzed 2 national mailed surveys of pediatricians from 2004 and 2010. The surveys included questions about personal characteristics (age, sex, marital status, child 5 years old or younger, underrepresented in medicine), practice characteristics (type, setting, full-time status, time spent in general pediatrics), formal community pediatrics training, and community pediatrics involvement and related perspectives.
The researchers used chi-square statistics to determine associations of personal and practice characteristics, previous training, and perspectives with involvement during the previous 12 months. They used logistic regression to assess independent contributions.
Fewer pediatricians reported involvement in community health in 2010 (45.1% in 2004 vs 39.9% in 2010), with a higher percentage reporting volunteer work (79.5% vs 85.8%; both P = .03). In 2010, fewer pediatricians reported any formal training (56.1% vs 42.9%), but more pediatricians reported special training during residency (22.0% vs 28.4%; both P < .05).
Factors linked with participation in 2010 included older age of the pediatrician, not having children aged 5 years or younger, practicing in rural settings, practice type, training, and feeling they were moderately or very responsible for child health.
Older age, practice setting and type, feeling responsible for children's health, and training were associated with involvement (P < .05) after adjusting for potential confounders including age, sex, community setting, employment status, percentage of time in general pediatrics, and training.
In an accompanying editorial, Judith S. Palfrey, MD, from Boston Children's Hospital in Massachusetts, explains, "The big issue is not whether pediatricians have the motivation. Nor is the question whether educational tools are available to boost community health and advocacy know-how. The big issue is whether the pediatric field has a strategy to integrate our child health activities into the changing health care system."
"These challenges [for pediatricians] include fee for service, high throughput care, lack of integration of services (particularly physical and mental health services), poor articulation of pediatrics and public health care, high debt load on young physicians, and inadequate support for underrepresented minority physicians. The failing economy and increased fiscal pressures on physicians has intensified these problems since the early 1990s," Dr. Palfrey explains.
The Affordable Care Act (ACA) may be able to change some of these pressures, Dr. Palfrey notes. "The ACA offers funding support for academic health centers to become involved in training in 'new competences,' community health and community health worker training, public health epidemiology, home visiting for early childhood development, among other initiatives," Dr. Palfrey concludes.
This study was funded by the American Academy of Pediatrics' National Center for Medical Home Implementation Medical Home Capacity Building for Children with Special Health Care Needs Cooperative Agreement through the Health Resources and Services Administration, Maternal and Child Health Bureau. The authors and Dr. Palfrey have disclosed no relevant financial relationships.
Pediatrics. Published online November 18, 2013. Abstract
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