Published online October 2, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. 1341-1349 (doi:10.1542/peds.2005-3010)
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ARTICLE

Determinants and Impact of Generalist–Specialist Communication About Pediatric Outpatient Referrals

Christopher J. Stille, MD, MPHa,b, Thomas J. McLaughlin, ScDa,c, William A. Primack, MDd, Kathleen M. Mazor, EdDb,e and Richard C. Wasserman, MD, MPHf

a Departments of Pediatrics
c Psychiatry
e Medicine
b Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
d Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, North Carolina
f Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont

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.

Key Words: ambulatory care • specialty care • communication • referral/consultation • medical home

Abbreviations: PCP—primary care physician • UMMHC—University of Massachusetts Memorial Health Care • EHR—electronic health record

Accepted May 23, 2006.




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