Access to primary care may reduce surgeries among children

Insertion of tubes in the ears of children with chronic infections and tonsillectomy and/or adenoidectomy are among the most common surgeries in pediatric patients. Recent studies have shown that tubes are overused.

Researchers, led by Lawrence C. Kleinman, MD, MPH, hypothesized that pediatricians may refer children to surgeons when they do not have enough time to manage chronic complaints. Using 2006 population data from New York State, they sought to describe regional variations in ear-nose-throat surgeries and their relationship to the number of primary care physicians and surgical specialists.

Results showed that the use of tonsillectomies and ear tube surgery varied a great deal by region of the state.

"We were not surprised that regions that had more surgical specialists had higher rates of these surgeries, which often are discretionary," said Dr. Kleinman, vice chair for research and education in the Department of Health Policy and associate professor of health policy and pediatrics at Mount Sinai School of Medicine. "In contrast, we were surprised that the presence of more primary care doctors in a region was associated with fewer surgeries."

Researchers could not determine from the data whether primary care physicians' opinions on how they would treat a patient differed from surgeons.

"These results extend a classic finding that adequacy of primary care in a community may reduce the number of hospitalizations for children and suggest a new outcome for future studies looking at the benefits of primary care," Dr. Kleinman said. "While these data indicate that we still have much to learn about the benefits of primary care, they also point out how critical it is to support training in primary care and to provide for adequate reimbursement for primary care providers."