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Variation in the Treatment of Children by Primary Care Physician Specialty
Ann K. Boulis, PhD;
Judith Long, MD
Arch Pediatr Adolesc Med. 2002;156:1210-1215.
Objective To investigate specialty differences in the treatment of a diverse array of routine childhood problems.
Study Design Analysis of the first round of the Community Tracking Study Physician Survey, a survey designed to assess the effect of corporatization of medicine on physician practice patterns.
Participants A cohort of 1735 pediatricians and 1267 family practitioners interviewed between 1996 and 1997 for round 1 of the Community Tracking Study. Physicians practicing more than 20 hours per week in the United States, whose primary specialty is either general pediatrics or family practice were included.
Main Outcome Measure Physicians' responses to 6 vignettes describing model patients with clinical presentations contrived to have multiple appropriate treatment plans.
Results Relative to general pediatricians, family practitioners are more likely to: (1) recommend desmopressin acetate for primary enuresis (58.9% vs 37.4%); (2) request an office visit for a child with nasal stuffiness, fever, and no other symptoms (69.8% vs 63.3%); (3) recommend a chest x-ray for a child with productive cough, tachypnea, and rales at the right base (51.3% vs 47.7%); (4) refer a 4-year-old child with eczema and seasonal asthma to an allergist (64.3% vs 59.2%); and (5) refer a child with recurring suppurative otitis media to an otolaryngologist (49.7% vs 33.9%). However, family practitioners are significantly less likely than pediatricians to order a sepsis workup on a 6-week-old infant with a temperature of 38.3°C (66.4% vs 81.1%). Physician attributes, practice characteristics, referral patterns, and geographical traits explain little of these differences in practice style.
Conclusions On average, there are significant differences between the approaches of pediatricians and family practitioners to the treatment of children, which may relate to the relative experience that each profession has in treating children.
From the Veterans Affairs Medical Center, Philadelphia, Pa, and the University of Pennsylvania, Philadelphia.
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