Objectives: To compare the medical management of children by private pediatricians or by general practitioners.
Population and methods: A retrospective cohort study analyzed information from the automated database of the Regional Health Insurance Fund for salaried workers in Franche-Comté from January 2001 through December 2002 and compared the mean rates of prescriptions in the populations seen only by general practitioners or mainly by pediatricians.
Results: Analysis concerned 1 535 208 visits (office and home). Management by pediatricians was associated with 25% fewer consultations and 6% fewer hospitalizations. Pediatricians also wrote 25% fewer prescriptions for drugs, 17% fewer for laboratory tests, and 42% fewer for speech and language therapy. Children seen by pediatricians took antibiotics much less often (penicillin: -24%; cephalosporins: -74%; macrolides: -53%) as well as half as many corticoids and NSAIDs. Their vaccination coverage was more complete (31% more hepatitis B vaccines, 7% more MMR), as was prevention against rickets and cavities (twice the rate of vitamin D and fluoride prescriptions). The population followed mainly by pediatricians included 25% more children with a chronic disease.
Conclusion: General practitioners and pediatricians appear to differ significantly in their management of children. Other studies that can take into account such confounding factors as health status are needed to confirm these results.