The changing pattern of primary pediatric care: update for one community.
The changing pattern of primary pediatric care: update for one community.
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初级儿科护理模式的变化：一个社区的最新情况。
作者：
K. Roghmann;R. Hoekelman;T. McInerny
本文描述了20世纪60年代末至70年代末纽约罗切斯特社区儿科医疗实践模式的变化，并对下一个十年进行了一些推断。儿童人口从1970年的24.3万减少到1980年的19.2万，预计到1990年将进一步减少到16万，到2000年可能稳定在14万。儿科病床数量以及病床使用率均下降，但全职等效执业儿科医生数量略有增加。其中三分之一的医生现在在社区卫生中心或健康维护组织执业。长期以来，内城居民人力短缺和就医不便的问题已经消失。一旦儿童进入医疗保健系统，不同种族和社会经济区域的儿童利用率相似。然而，对于“健康儿童”保健，黑人的利用率可能仍然较低，尤其是年龄较大的儿童。儿科医生对儿童保健服务的“市场渗透率”较高，而且在所有就诊中健康儿童就诊比例较高（40%），这对于整个国家来说可能不具代表性，但可能预示着其他地方未来的儿科医疗情况。儿童数量减少以及每个儿童的急性病治疗需求减少，将使儿科医生能够越来越多地关注预防、发育和社会心理方面的需求。
The changing pattern of pediatric practice in the Rochester, New York, community between the late 1960s and the late 1970s is described, and some extrapolations for the next decade are discussed. The child population shrunk from 243,000 in 1970 to 192,000 in 1980 and is expected to decrease further to 160,000 in 1990, possibly stabilizing at 140,000 by 2000. The number of pediatric beds as well as occupancy rates declined, but the number of full-time equivalent practicing pediatricians increased slightly. One third of them are now practicing out of neighborhood health centers or health maintenance organizations. Problems of manpower shortage and inadequate access to care for the inner city residents have long since disappeared. Utilization rates by race and socioeconomic area are similar once the children enter the care system. For "well child" care, however, there may still be lower utilization for blacks, especially for older children. The high "market penetration" for child health services by pediatricians, and the high proportion of well child visits (40%) among all visits, may be atypical for the nation as a whole, but is probably indicative of what pediatric care elsewhere will be in the future. Fewer children, and less acute care per child, will allow pediatricians to focus increasingly on preventive, developmental, and psychosocial needs.