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Determinants and impact of generalist-specialist communication about pediatric outpatient referrals
Christopher J Stille1, Thomas J McLaughlin, William A Primack
1Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. stillec@ummhc.org
Insights
Primary care physicians often fail to communicate with specialists for referred children, impacting care. Improving information systems and targeting vulnerable patients are key to enhancing physician communication and comanagement.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Physician Communication
Background:
- Effective communication between primary care physicians and specialists is crucial for optimal comanagement of pediatric patients.
- Referrals to specialty care highlight potential gaps in information exchange between physicians.
Purpose of the Study:
- To assess physician-reported communication rates between primary care and specialists for referred children.
- To examine the clinical impact of this communication (or lack thereof).
- To identify patient and practice system factors influencing communication.
Main Methods:
- A cohort of 179 children referred to specialists was studied.
- Primary care physicians and specialists completed questionnaires regarding communication, care impact, and system characteristics.
- Multivariate logistic regression analyzed associations between patient/system factors and communication.
Main Results:
- Specialists received primary care physician communication for only 50% of referrals; primary care physicians received specialist communication for 84%.
- Communication strongly correlated with physicians' ability to provide optimal care.
- Computerized access to notes, timely information, non-Medicaid insurance, and fewer concurrent specialists were linked to better communication.
Conclusions:
- Communication from primary care physicians to specialists is frequently lacking, despite its necessity for optimal care.
- Interventions should focus on accessible clinical information systems.
- Targeting children with complex needs and public insurance may improve communication outcomes.
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.
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