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How do primary care physicians manage children with possible developmental delays? A national survey with an
Laura Sices1, Chris Feudtner, John McLaughlin
1Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio 44106-6038, USA. Laura.Sices@uhhs.com
Insights
Physician referral practices for children with developmental delays are influenced by patient gender and behavior type. Female children with language delays and those exhibiting avoidant behaviors are more likely to be referred for early detection and treatment.
Area of Science:
- Pediatric healthcare
- Developmental pediatrics
- Primary care medicine
Background:
- Early detection and intervention are crucial for improving outcomes in children with developmental delays.
- Factors influencing primary care physicians' management of young children with probable developmental delays are not well understood.
Purpose of the Study:
- To describe physician referral practices for young children with developmental delays.
- To investigate whether parental concern, child's gender (specifically language delay), behavioral presentation (disruptive vs. avoidant), and physician characteristics influence referral likelihood.
Main Methods:
- A cross-sectional survey with a randomized block design was administered to a national sample of pediatricians and family practice physicians.
- Physicians responded to clinical vignettes using a 5-point Likert scale regarding referral likelihood.
- Multivariable logistic regression was used to test hypotheses.
Main Results:
- Female children with language delays were 60% more likely to be referred than males (OR: 1.6).
- Female physicians and pediatricians were more likely to refer patients.
- Parental concern did not significantly increase referral probability; avoidant behaviors were associated with higher referral rates compared to disruptive behaviors.
Conclusions:
- Patient gender and behavioral presentation significantly influence referral decisions for young children with suspected developmental delays.
- Findings can inform targeted educational initiatives to enhance early detection and referral rates.
Objective:
Although early detection and treatment of developmental delays can improve outcome, little is known about factors that influence how primary care physicians manage young children with probable developmental delays. The objective of this study was to describe physician referral practices for children with developmental delays and to test whether the probability of referral is increased by 1) the expression of parental concern; 2) female gender in a child with language delay; 3) disruptive, as opposed to avoidant behaviors; and 4) physician characteristics, including female gender or being a pediatrician.
Methods:
A cross-sectional survey was mailed to a national random sample of 800 pediatricians and 800 family practice physicians in primary care practice, using an experimental randomized block design. Recipients randomly received alternative variants of clinical vignettes, which differed only in regard to the variable specific to each of the first 3 hypotheses. Physicians answered questions about the likelihood of referral on a 5-point scale for listed referral options. Hypotheses were tested using multivariable logistic regression modeling. A total of 55% of pediatricians and 43% of family practice physicians returned the survey, for an overall response rate of 49%.
Results:
A girl with language delay was 60% more likely to be referred to audiology than a boy (odds ratio: 1.6; 95% confidence interval: 1.1-2.3), and respondents who were female or pediatricians were more likely to refer patients. The expression of parental concern did not increase the probability of referral to diagnostic and treatment services, and avoidant rather than disruptive patient behaviors were associated with an increased probability of referral.
Conclusions:
Patient gender and type of behavioral presentation seem to influence referrals to diagnostic and treatment services for young children with probable developmental delays described in clinical vignettes. These findings can guide targeted educational interventions to increase rates of detection and referral for young children with developmental delays.
