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PEDIATRICS Vol. 106 No. 2 August 2000, pp. 264-269

Parental Preferences for Primary and Specialty Care Collaboration in the Management of Teenagers With Congenital Heart Disease

Received Aug 30, 1999; accepted Dec 10, 1999.

Marlene R. Miller*, Dagger , Christopher B. Forrest§, and Jean S. Kan*

From the * Division of Pediatric Cardiology, Johns Hopkins University School of Medicine; Dagger  Graduate Training Program in Clinical Investigation; and the § Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland.

Objectives.  We examined parental preferences for locus of service delivery for their teenager's congenital heart disease (CHD) and the influence of disease severity, sociodemographic factors, and insurance on these preferences.

Methods.  A consecutive sample of parents of teenagers followed in a pediatric cardiology clinic completed a mailed questionnaire. Disease severity was classified as low (<= 1 cardiovascular procedure), moderate (>1 cardiovascular procedure), and high (cyanosis or single ventricle physiology).

Results.  Eighty-six of 148 parents responded (58%): 40, low severity; 36, moderate severity; and 10, high severity of illness. Parents preferred using primary care providers (PCPs) as a point of first contact for all 11 of 11 general health concerns and 5 of 7 potential cardiovascular-related concerns: chest pain (52%), syncope (73%), seeming seriously ill (79%), sports physical examination (79%), and endocarditis prophylactic antibiotics (94%). Increasing disease severity was significantly associated with preferring cardiologists for 6 of 7 cardiovascular-related concerns. Overall, 58% of parents viewed their care as a PCP-cardiologist comanagement model versus a cardiologist-dominated model. Lower family income (odds ratio [OR]: 1.5; confidence interval [CI]: 1.0-2.2) and severity of illness (OR: 2.1; CI: 1.0-4.4) were associated with a comanagement model of health care versus a cardiologist-dominated model.

Conclusions.  This study suggests that the majority of parents of teenagers with CHD prefer to use their teenager's PCP for all routine health care needs and many cardiovascular health needs. Severity of illness and family income are positively associated with greater preference for cardiologist care.  Key words:  primary health care, chronic disease, specialist, congenital heart defects, patient care management.




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