Reinvigorating pediatric care in an academic family medicine practice.

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Background and objectives

Primary care access is critical for all populations, and family physicians remain a vital link to pediatric care, especially for rural/underserved areas and adolescents. Pediatric visits to family physicians have declined nationally, a trend also noted at the University of North Carolina (UNC) Family Medicine Center (FMC). Academic FMCs are challenged with maintaining their pediatric population in a competitive environment and providing excellent pediatric training to prepare residents to care for children. We investigated potential factors impacting pediatric visits with a goal of reversing this trend. We developed a 360-degree approach to examine and reinvigorate pediatric care and training in our practice.


To determine which aspects of our practice made pediatric care challenging, we conducted focus groups with parents of former and current FMC pediatric practices. We used billing data to assess pediatric patient volume and performed chart audits to examine preventive health visits, immunizations, and developmental screening. We anonymously contacted local family medicine and pediatric practices to compare services offered in their practice versus ours. Resident in-training exam scores and graduate surveys were reviewed to assess our pediatric training.


Based on our evaluation, we identified and implemented improvements in the areas of clinical quality interventions, provider/education competency, and community marketing/relationships.


A longitudinal evaluation and quality improvement initiative positively impacted our pediatric practice and training. The 360-degree approach of quality improvement may be useful for other academic family practices that are challenged with pediatric volume.







Martha Carlough

Visiting Professor in the Divinity School

Martha Carlough, MD MPH is family physician and Ignatian trained spiritual director and is the Director of Spiritual Formation for the Theology, Medicine and Culture Initiative. Dr. Carlough is also affiliate faculty in the Duke Global Health Initiative (DGHI) and has more than 30 years of experience in clinical and public aspects of maternal and child health, including a decade of work in Nepal. She is Professor Emeritus at UNC-Chapel Hill where she was on clinical faculty for many years and founded and directed the Office of Global Health Education. Dr. Carlough continues to care for patients and work in community health through Samaritan Health Center in Durham.

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