Determinants and impact of generalist-specialist communication about pediatric outpatient referrals
Authors
Stille, Christopher J.McLaughlin, Thomas J.
Primack, William A.
Mazor, Kathleen M.
Wasserman, Richard C.
UMass Chan Affiliations
Department of PsychiatryMeyers Primary Care Institute
Department of Pediatrics
Document Type
Journal ArticlePublication Date
2006-10-04Keywords
Ambulatory CareChild
*Communication
Health Care Surveys
Humans
Interprofessional Relations
Outpatients
Pediatrics
Physician's Practice Patterns
Primary Health Care
Prospective Studies
*Referral and Consultation
Regression Analysis
Specialties, Medical
Health Services Research
Life Sciences
Medicine and Health Sciences
Pediatrics
Primary Care
Metadata
Show full item recordAbstract
OBJECTIVE: Effective communication between primary care and specialty physicians is essential for comanagement when children are referred to specialty care. We sought to determine rates of physician-reported communication between primary care physicians and specialists, the clinical impact of communication or its absence, and patient- and practice system-level determinants of communication for a cohort of children referred to specialty care. METHODS: We enrolled 179 patients newly referred from general pediatricians in 30 community practices to 15 pediatric medical specialists in 5 specialties. Primary care physicians and specialists completed questionnaires at the first specialty visit and 6 months later. Questions covered communication received by primary care physicians and specialists, its impact on care provision, system characteristics of practices, and roles of physicians in treatment. We used multivariate logistic regression to determine associations between practice system and patient characteristics and the dependent variable of reported primary care physician-specialist communication. RESULTS: Specialists reported communication from referring primary care physicians for only 50% of initial referrals, whereas primary care physicians reported communication from specialists after 84% of initial consultations. Communication was strongly associated with physicians' reported ability to provide optimal care. System characteristics associated with reported primary care physician-specialist communication were computer access to chart notes and lack of delays in receipt of information. Associated patient characteristics included non-Medicaid insurance, no additional specialists seen, and specialty to which referred. Physicians favored comanagement of referred patients in more than two thirds of the cases. CONCLUSIONS: Although a prerequisite for optimal care, communication from primary care physicians to specialists is frequently absent. Interventions should promote widely accessible clinical information systems and target children with complex needs and public insurance.Source
Pediatrics. 2006 Oct;118(4):1341-9. Link to article on publisher's siteDOI
10.1542/peds.2005-3010Permanent Link to this Item
http://hdl.handle.net/20.500.14038/38888PubMed ID
17015522Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1542/peds.2005-3010