PEDIATRICS Vol. 90 No. 1 July 1992, pp. 71-74
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Referral Patterns for Children with Chronic Diseases

Ingeborg R. Blancquaert MD1, Inta Zvagulis 1, Katherine Gray-Donald PhD1, and I. Barry Pless MD, FRCP(C)1

1 From the Department of Epidemiology and Biostatistics, McGill University, and the Department of Pediatrics, Community Pediatric Research, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada

A sample of 1377 physicians were surveyed by mailed questionnaire to study to what extent primary care physicians are involved in the long-term care of children with chronic disorders. The sample included all pediatricians practicing in the province of Quebec and a stratified random sample of general practitioners (10% sample in urban areas and 25% sample in rural areas). A response rate of 81% was achieved. Referral patterns were studied for asthma, congenital heart disease, and diabetes. Although pediatricians referred their patients less frequently than general practitioners, referral patterns depended mainly on the clinical condition. "No routine referral" was the most popular management strategy for asthma, whereas for congenital heart disease and diabetes more than 20% of physicians referred their patients for all aspects of care. Rural physicians tended to assume patient care to a greater extent than did urban physicians. Most pediatricians referred patients directly to subspecialists practicing in tertiary care centers, whereas general practitioners often sent patients to pediatricians practicing elsewhere, or to other specialists. These data suggest that the availability of medical resources in the community and accessibility to tertiary care centers also influence physicians' involvement in the long-term care of these children.

Key Words: chronic childhood illnesses • referral patterns • physicians' practice patterns

Submitted on November 4, 1991
Accepted on February 7, 1992




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