Pediatric primary health care (PPHC) is of principal importance to the health and development of all children, helping them reach their true potential. Pediatricians, as the clinicians most intensively trained and experienced in child health, are the natural leaders of PPHC within the context of the medical home. Given the rapidly evolving models of pediatric health care delivery, including the explosion of telehealth in the wake of the COVID-19 pandemic, pediatricians, together with their representative national organizations such as the American Academy of Pediatrics (AAP), are the most capable clinicians to guide policy innovations on both the local and national stage.
What Is Pediatric Primary Health Care?
Pediatric primary health care (PPHC) always aspires to be continuous, comprehensive, and coordinated care that is accessible and affordable to meet the health needs of the infant, child, adolescent, and young adult by providing family-centered care. PPHC encompasses comprehensive care across the life cycle, from infancy to young adulthood. PPHC includes health supervision, with a focus on prevention of physical and mental health conditions; anticipatory guidance and promotion of wellness including mental health and monitoring physical, cognitive, and social growth and development; and age-appropriate screening for health promotion and disease prevention.1 Although 1 in 5 children have an identified special health care need or chronic illness, these illnesses are diverse with a relatively low but increasing prevalence. Board-certified and board-eligible pediatricians have the ongoing challenge of identifying and addressing significant clinical concerns in a typically healthy population.2 Therefore, PPHC also encompasses diagnosis and treatment of acute and chronic health disorders; management of serious and life-threatening illnesses; and when appropriate, referral of patients with more complex conditions for medical subspecialty or surgical specialty care. To achieve optimal health outcomes, PPHC also involves coordinated management of health problems that require multiple professional services and well-planned transitioning of all children, especially those with chronic illness, to adult care. Finally, PPHC ideally strives to be both patient- and family-centered and to incorporate community resources and strengths, risk and protective factors, and sociocultural effectiveness into strategies for care delivery and clinical practice.1
What Is the Unique Role of the Pediatrician in Pediatric Primary Care?
Pediatricians have received comprehensive education and training devoted to all aspects of pediatric health care.3 This education and training is coupled with a demonstrated interest in and total professional commitment to the health care of infants, children, adolescents, and young adults. Because of these unique qualifications, the pediatrician is a highly skilled and qualified supervisor of PPHC delivery, often partnering with other professionals to support team-based care. Within all of medicine, pediatrics is the only specialty for which training focuses exclusively on the care and unique health needs of infants, children, adolescents, and young adults. Given the continuity that pediatricians typically establish with their patients, often spanning their entire childhood and adolescence, pediatricians are uniquely able to monitor normal growth and development and flag concerns when their patients deviate from their expected developmental path. In this way, pediatricians have a singular role in maintaining their patients’ physical and mental health, with benefits that extend well into their adulthood.
PPHC is best delivered within the context of a patient- and family-centered medical home that provides comprehensive, continuous, coordinated, compassionate, and culturally effective care that is accessible, affordable, and delivered or directed by board-certified or board-eligible pediatricians.4 Advanced practice providers (ie, nurse practitioners, physician assistants, and other trained pediatric professionals) best support the medical home when they work in collaboration with pediatricians.5,6
Team-based care, with physician supervision, limits the occurrence of fragmented care, such as that received from freestanding or retail-based clinics outside the medical neighborhood.7 Indeed, the medical home best serves as the “hub” of the entire medical neighborhood, placing the pediatrician at the hub’s center.8 In some instances, the pediatric medical subspecialist or pediatric surgical specialist will be the leader of the child’s health care team while managing complex conditions and will coordinate the delivery of care among the entire health care team.9 Collaboration among all providers of PPHC, guided by the pediatrician, is critical to the maximal efficiency, accuracy, and effectiveness of the care of the patient, the family, the community, and the population.
Evolving Health Care Delivery Models
Because of their training and holistic outlook, pediatricians are uniquely prepared to move PPHC into integrated health systems that “allow children to develop and realize their potential.”10 Of all health professionals who care primarily for children, pediatricians have a unique mandate to maintain awareness of the larger health policy landscape to ensure it addresses the unique needs of children’s health.11 Pediatricians are also frequently leaders of larger health organizations such as accountable care organizations (ACOs), which have been shown to improve health care quality while also containing costs.12 With the increased use of telehealth platforms as a result of the COVID-19 pandemic, pediatricians’ experience and training will be vital to appropriately integrating this new care pathway into established medical homes. Pediatricians are also best positioned to keep abreast of issues beyond the medical home that can affect the care of children. By participating in the larger health care and policy arena—with state legislators, agency administrators, and other advocacy groups—pediatricians can enhance their patients’ health as well as the soundness of public policy regarding children.
Recommendations for Policymakers*:
Recognize that the pediatrician is the best expert to navigate the myriad children’s health issues that come before health systems, legislatures, executive agencies, and courts. Although other health care professionals should lend their expertise, pediatricians’ training and experience are vital to informing policy and understanding how best to promote the health of children.
Include the American Academy of Pediatrics (AAP) and its relevant state chapters in policy decision-making. As the nation’s flagship pediatric organization, the AAP has access to pediatricians, pediatric medical subspecialists and pediatric surgical specialists, policy experts, and decades of experience regarding pediatric health care.
Always consider the impact of any policy change on children’s health and well-being. As our nation’s most vulnerable population, children, especially those experiencing health inequity, are unable to advocate for themselves—their well-being depends on astute policy-makers who not only understand their needs but can take them into account as they consider a given policy.
Alexy Boudreau, MD, FAAP
Alex Hamling, MD, FAAP
Edward Pont, MD, FAAP
Thomas W. Pendergrass, MD, MSPH, FAAP
Julia Richerson, MD, FAAP
Committee on Pediatric Workforce, 2020–2021
Harold K. Simon, MD, MBA, FAAP, Chairperson
Julie S. Byerley, MD, MPH, FAAP
Nancy A. Dodson, MD, FAAP
Eric N. Horowitz, MD, FAAP
Thomas W. Pendergrass, MD, MSPH, FAAP
Edward A. Pont, MD, FAAP
Kristin N. Ray, MD, FAAP
Laurel K. Leslie, MD, MPH, FAAP – American Board of Pediatrics
Lauren F. Barone, MPH
Committee on Practice and Ambulatory Medicine, 2020–2021
Jesse M. Hackell, MD, FAAP, Chairperson
Joseph J. Abularrage, MD, MPH, MPhil, FAAP
Yvette M. Almendarez, MD, FAAP
Alexy D. Arauz Boudreau, MD, MPH, FAAP
Abeba M. Berhane, MD, FAAP
Patricia E. Cantrell, MD, FAAP
Lisa M. Kafer, MD, FAAP
Katherine S. Schafer, DO, FAAP
Robin Warner, MD, FAAP
FORMER COMMITTEE MEMBERS
Alex Hamling, MD, FAAP
Julia Richerson, MD, FAAP
Policymakers refers to federal and state executive branches, Congress and state legislatures, health insurers and health systems, courts, and other entities that influence pediatric health policy.
FUNDING: No external funding.
Drs Boudreau, Hamling, Pont, Pendergrass, and Richerson were each responsible for all aspects of writing and editing the document and reviewing and responding to questions and comments from reviewers and the board of directors; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.
Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.
The recommendations in this report do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.
FINANCIAL DISCLOSURE: The authors have indicated they do not have a financial relationship relevant to this article to disclose.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.