Related Experiment Videos
Pediatric endocrinologic recommendations, pediatric practice, and current pediatric training regarding care of
M P Golden1, R A Hibbard, G M Ingersoll
1Department of Pediatrics, Indiana University Medical Center, Indianapolis.
Insights
Pediatric endocrinologists recommend more subspecialty care and psychosocial support for pediatric diabetes patients than general pediatricians practice or are trained for. This highlights a gap in training and care coordination for children with diabetes.
Area of Science:
- Pediatric Endocrinology
- General Pediatrics
- Medical Education
Background:
- Most pediatric diabetes patients receive care from community-based pediatricians.
- Optimal diabetes care requires integrating endocrinologist recommendations with general pediatrician practices.
- Current training and practices in pediatric diabetes care need evaluation.
Purpose of the Study:
- To assess the alignment between pediatric endocrinologists' recommendations and general pediatricians' practices in diabetes care.
- To evaluate the current state of pediatric diabetes care training in residency programs.
- To identify discrepancies in recommended versus practiced care, particularly in psychosocial support.
Main Methods:
- Survey of pediatric endocrinologists, general pediatricians, and pediatric residency coordinators.
- Assessment of current recommendations, practices, and training in pediatric diabetes care.
- Comparison of reported practices against expert recommendations.
Main Results:
- Pediatric endocrinologists recommended more subspecialty care than pediatricians reported providing.
- A significant gap exists in psychosocial support, with 85% of endocrinologists advocating for mental health team members versus 37% of pediatricians reporting their use.
- Pediatricians' practices (e.g., glycosylated hemoglobin, lipid measurements, urinary glucose) deviate from endocrinologist recommendations.
- Residency programs often lack essential multidisciplinary team members (social workers, psychologists) and sufficient exposure to diabetic patients in continuity clinics.
Conclusions:
- There is a notable discordance between recommended and practiced pediatric diabetes care, especially concerning psychosocial support.
- Pediatric residency training programs require enhancement to adequately prepare pediatricians for comprehensive diabetes care.
- Improved integration and training are crucial for optimizing diabetes management in pediatric populations.
Abstract:
Many pediatric diabetes patients are cared for by community-based pediatricians. Training for pediatricians in optimal diabetes care should be based on both the recommendations of pediatric endocrinologists regarding optimal care and the practices of general pediatricians. Pediatric endocrinologists, general pediatricians, and pediatric residency coordinators were surveyed to assess the consonance of current recommendations, practices, and training in pediatric diabetes care. Not surprisingly, pediatric endocrinologists recommended more subspecialty care than pediatricians reported practicing. A major difference between endocrinologists and pediatricians emerged in the area of psychosocial support. A total of 85% of endocrinologists answered that there should be a mental health diabetes team member, but only 37% of pediatricians reported often or sometimes working with one to develop care plans. Pediatricians who provide complete diabetes care for most of their patients measure frequent glycosylated hemoglobin levels, obtain yearly lipid measurements marginally less often, and use urinary glucose measurements more often than recommended by pediatric endocrinologists. According to the descriptions of most pediatric residency training programs, multidisciplinary teams include a pediatrician, an endocrinologist, and a dietician. However, 25% do not include a social worker or nurse and 70% do not include a psychologist. Although most training programs operate on the assumption that their trainees will ultimately share responsibility with a subspecialist for diabetes care, in 26% of programs residents saw no diabetics in their continuity clinics. Most residents do not participate in providing diabetes education.(ABSTRACT TRUNCATED AT 250 WORDS)