39 - Past, Present, Future: Trends in Pediatric Primary Care Visit Rates Pre- and Post-Pandemic for Commercially Insured Patients in an Independent Practice Association

Publication Number: 3036.39

Michelle L. Lock, Pediatric Physicians' Organization at Children's, Wellesley Hills, MA, United States; Emily T. Correa, Boston Children's Hospital, Wellesley, MA, United States; Jonathan Hatoun, Pediatric Physicians' Organization at Children's, Boston, MA, United States; Louis Vernacchio, Pediatric Physicians' Organization at Boston Children's, Wellesley, MA, United States

Background: In a shifting pediatric primary care landscape, understanding long-term trends in visit type and care setting is essential to preserve patient access, train clinicians, maintain practice viability, and strengthen public policy.

Objective: To evaluate changes in the rates of visits for pediatric patients in primary- and acute-care settings before and after the COVID-19 pandemic.

Design/Methods: Using claims data from a large commercial insurer for children whose primary care provider belonged to a statewide pediatric primary care network, we performed an interrupted time series (ITS) analysis on the rate of visits in pediatric primary care, emergency department (ED), and urgent care (UC) from Jan 2007-Mar 2025. The pandemic period was defined as Mar 2020-May 2023. The ITS compared monthly visits per 1000 patient-years before and after the pandemic with autoregression to account for seasonality. Visits for well child care (WCC), mental health (MH), and acute respiratory tract illness (ARTI) were identified by primary diagnosis using ICD codes.

Results: Before the pandemic, the total primary care visit rate (Table; Figure 1) fell slightly (-3.0 visits per 1000 patients/year). During that time, the ED visit rate also fell (-5.7). UC visit rates, first noted in 2015, grew steadily (+39.8) and surpassed ED visit rates by late 2018. Post-pandemic, the primary care visit rate rose in level (P=0.01) with no change in slope. The level of ED visits fell (P=0.003) and the UC visit level increased (P=0.0002) with no change in the slope for either. Within primary care (Figure 2), the WCC visit rate grew pre-pandemic (+8.1) and ARTI visit rates fell slightly (-1.7) with no significant change for either post-pandemic. The rate of MH visits, already rising pre-pandemic (+8.3), saw a significant increase in both the level (P=0.003) and slope (P=0.02) of visits post-pandemic.

Conclusion(s): Over the study period, net pediatric primary care visit volumes declined slightly while ED visits fell and UC visits rose steadily. Importantly, the types of visits occurring in primary care shifted. Despite a brief rebound post-pandemic, visits for ARTI are declining, likely due to changes in prevention (pneumococcal and RSV vaccines), electronic access (portal messaging, internet), and cost-sharing. Visit volumes for MH roughly tripled over the study period and are now nearly one-third as frequent as those for ARTI. These trends have major implications for practice viability, particularly the need for better training and financial incentives from value-based care to support integrated MH in pediatric primary care.

Table
Utilization Trends

Figure 1
Monthly Visit Rates in Pediatric Primary Care, Emergency Department, and Urgent Care

Figure 2
Monthly Pediatric Primary Care Visit Rates for Well Child Care, Mental Health, and Acute Respiratory Tract Illness