The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice

Article Abstract:

Independent practice associations (IPAs) are the fastest-growing type of health care in the United States. Under such a plan, a patient pays a small out-of-pocket fee for each visit to the doctor, and the doctor is paid by the IPA organization, which withholds between 15 and 20 percent of the fee, to be returned to the physician at the end of the year if the IPA remains economically healthy. Few studies have addressed the consequences of the choice of a health care plan on pediatric ambulatory health care. To learn more about this issue, a suburban pediatric group practice in Rochester, New York, was studied. The group consisted of five pediatricians who had practiced from 17 to 47 years, and each pediatrician had a similar number of IPA patients. A group of 640 patients who changed from Blue Cross coverage to an IPA was compared with a similar group of 640 children who remained on Blue Cross. Reviews of medical charts were conducted for the baseline year, the year prior to the patients' change to IPA status, and for the year after the switch to IPA status. The results revealed no differences in socioeconomic status and several other background variables among children enrolled in the two payment plans. However, during the baseline year, the patients who would later be enrolled in the IPA had 19 percent more acute-illness visits, 35 percent more weekend visits, and 15 percent more total visits. During the first year of IPA enrollment these patients had 42 percent more acute-illness visits, 22 percent more well-child visits, 93 percent more chronic-illness visits, and 39 percent more total visits. The IPA patients also had 27 percent more after-hours visits, 53 percent more weekend visits, 185 percent more laboratory tests, and 70 percent more referrals to specialists. When data were evaluated according to specific diagnoses, such as acute middle-ear infection, IPA patients also tended toward higher numbers of visits during both years. Although IPA patients had greater utilization of outpatient care than Blue Cross subscribers, their rate of hospitalization was not reduced. It is possible that the families who chose an IPA plan did so partly because they already had a high rate of ambulatory care use and related expense; as such, they constitute a different sample than those who continued on Blue Cross. In addition, the findings indicate that removing financial barriers for ambulatory pediatric care stimulates more visits to pediatricians. On the whole, the development of more IPA plans is likely to increase the use of all pediatric ambulatory services and lead to busier pediatric practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Usage, Case studies, Practice, Surveys, Pediatrics, Health insurance, Health maintenance organizations, Physician services utilization, Ambulatory medical care for children, Ambulatory pediatrics

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Measles immunization: recommendations, challenges, and more information

Article Abstract:

Current recommendations on measles vaccination suggest that minor illnesses with or without accompanying fever are not a good reason to avoid giving the vaccine. Because some vaccinations have been deferred due to minor illness, unvaccinated children have gone on to develop measles. Not all cases of measles are due to lack of vaccination. Some children experience primary vaccine failure, where the vaccine does not induce the immune response necessary to protect against the illness. Some of these vaccine failures are due to residual antibodies the infant's mother passes on which are interfering with the vaccine. Other failures may be attributed to inappropriate handling of the vaccine. A new study suggests that some children with minor upper respiratory infections with or without fever appear to experience primary measles vaccine failure. The authors of a study reported in the April 24, 1991 issue of The Journal of the American Medical Association suggested that perhaps the children's illnesses caused them to produce quantities of the protein interferon, which inhibited the vaccine's ability to produce immunity. However, measles vaccine is generally given in conjunction with mumps and rubella (German measles) vaccines, and these are generally effective, even when the children have respiratory infections. Since interferon has a broad spectrum of activity, it would be expected that the children who did not respond to measles vaccine should not respond to mumps or rubella, if interferon was the cause of the vaccine failure. Given that 79 percent of the children with upper respiratory illnesses did develop immunity to measles with vaccination, the vaccine should continue to be given to children on schedule, with a second dose given at a later date to ensure protection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Vaccination of children, Vaccination, Cold (Disease), Common cold, Measles vaccine, Measles vaccines, editorial

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Effect of Patient Reminder/Recall Interventions on Immunization Rates: A Review

Article Abstract:

Patient reminder systems are effective in raising immunization rates, according to a review of 41 studies. Primary care physicians should use these systems whenever possible.

United States, Immunization of children, Immunization

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