Community Physician's Role in Case Management of Children With Chronic Illnesses
1 The Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
There is general agreement that case management should be provided to children with chronic illnesses, yet it is not clear who should provide this service. A survey of physicians and parents of children with chronic illnesses was conducted to evaluate the practice and views of pediatricians and compare their assessments with those of parents. Surveys were mailed to 360 physicians and 519 families with response rates of 39% and 63%, respectively. The majority of physicians (74%) thought that the primary care physician should provide case management. When compared with parents, physicians underestimated the parental need for information about the child's diagnosis (8% vs 52%, P < .001), treatments (3% vs 54%, P < .01), and prognosis (30% vs 78%, P < .01). They also overestimated parental needs for information regarding financial aid (70% vs 58%, P < .01), vocations (78% vs 54%, P < .01), and insurance (62% vs 51%, P < .05). Four services ranked by need by parents in the top 10 were not ranked in the top 10 by physicians. Rural physicians noted that services were more difficult to obtain than did those in nonrural areas. The physicians surveyed made several recommendations for steps that could be implemented to facilitate their role as case manageers. If primary care physicians are to be effective case managers, alterations in the current system of care will be required including continuing education related to chronic illness, information about community resources, reimbursement for the time required to perform case management, and better communication between physician and parents.
Key Words: case management • chronic illness • physician attitude • pediatric practice
Submitted on June 13, 1988
Accepted on September 27, 1988
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