Generalist-subspecialist communication about children with chronic conditions: an analysis of physician focus groups
Stille, Christopher J. ; Korobov, Neill ; Primack, William A.
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Keywords
Child Health Services
Chronic Disease
Communication Barriers
Disabled Children
Family Practice
Feedback
Focus Groups
Humans
Information Dissemination
*Interdisciplinary Communication
Massachusetts
Nurse Practitioners
Pediatric Nursing
Pediatrics
Primary Health Care
Health Services Research
Primary Care
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Abstract
OBJECTIVE: To describe barriers and facilitators to effective generalist-subspecialist communication in the care of children with chronic conditions.
METHODS: We conducted 5 focus groups with 14 general pediatricians and 10 pediatric specialty providers to discuss factors that facilitate or obstruct effective communication. The specialty groups included 2 nurse practitioners; the rest were pediatricians from an academic medical center and the surrounding community. We performed a content analysis to generate groups of themes and classify them as barriers or facilitators, and we returned to the participants to solicit their feedback.
RESULTS: We identified 201 themes in 6 domains: the method, content, and timing of communication; system factors; provider education; and interpersonal issues. Barriers to communication mostly involved the method of communication and system factors. Most facilitating themes promoted timely communication, understanding of the reasons for referral and the nature of the child's condition, or appropriate definition of generalist and specialist roles. Participants described numerous examples where communication had direct effects on patient outcomes. Generalists and specialists agreed on many issues, although specialists discussed the pros and cons of curbside consults at length whereas generalists emphasized the importance of their own education in the referral-consultation process.
CONCLUSIONS: Efforts to improve communication between pediatric generalists and specialists in the care of children with chronic conditions should emphasize the importance of timely information transfer. The content of messages is important, but lack of receipt when needed is more of a problem. Improving generalist-subspecialist communication has great potential to improve the quality of care.
Source
Ambul Pediatr. 2003 May-Jun;3(3):147-53.