How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design
How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design
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DOI：
10.1542/peds.113.2.274
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发表时间：
2004-02-01
期刊：
影响因子：
8
通讯作者：
Williams, M
中科院分区：
文献类型：
--
作者：
Sices, L;Feudtner, C;Williams, M
Objective.虽然早期发现和治疗发育迟缓可以改善结果，但对影响初级保健医生如何管理可能存在发育迟缓的幼儿的因素知之甚少。本研究的目的是描述发育迟缓儿童的医生转诊实践，并测试转诊的可能性是否会增加1）父母的关注表达; 2）女性在语言发育迟缓的儿童中; 3）破坏性行为，而不是回避行为;和4）医生特征，包括女性性别或儿科医生。采用随机区组设计，对全国800名儿科医生和800名家庭医生进行了一项横断面调查。接受者随机接受临床小插曲的替代变体，其仅在前3个假设中的每一个的特定变量方面不同。医生回答了关于列出的转诊选项的5分制转诊可能性的问题。使用多变量逻辑回归模型对假设进行检验。共有55%的儿科医生和43%的家庭医生返回了调查，总体应答率为49%。有语言延迟的女孩比男孩更容易被转介到听力学中心（比值比：1.6; 95%置信区间：1.1 - 2.3），女性或儿科医生更容易被转介到患者。父母关心的表达并没有增加转诊到诊断和治疗服务的可能性，并且回避而不是破坏性的患者行为与复发的可能性增加相关。患者的性别和行为表现类型似乎会影响临床小插曲中描述的可能存在发育迟缓的幼儿的诊断和治疗服务。这些发现可以指导有针对性的教育干预措施，以提高发育迟缓幼儿的发现率和转诊率。
Objective. Although early detection and treatment of developmental delays can improve outcome, little is known about factors that influence how primary care physicians manage young children with probable developmental delays. The objective of this study was to describe physician referral practices for children with developmental delays and to test whether the probability of referral is increased by 1) the expression of parental concern; 2) female gender in a child with language delay; 3) disruptive, as opposed to avoidant behaviors; and 4) physician characteristics, including female gender or being a pediatrician.Methods. A cross-sectional survey was mailed to a national random sample of 800 pediatricians and 800 family practice physicians in primary care practice, using an experimental randomized block design. Recipients randomly received alternative variants of clinical vignettes, which differed only in regard to the variable specific to each of the first 3 hypotheses. Physicians answered questions about the likelihood of referral on a 5-point scale for listed referral options. Hypotheses were tested using multivariable logistic regression modeling. A total of 55% of pediatricians and 43% of family practice physicians returned the survey, for an overall response rate of 49%.Results. A girl with language delay was 60% more likely to be referred to audiology than a boy ( odds ratio: 1.6; 95% confidence interval: 1.1 - 2.3), and respondents who were female or pediatricians were more likely to refer patients. The expression of parental concern did not increase the probability of referral to diagnostic and treatment services, and avoidant rather than disruptive patient behaviors were associated with an increased probability of referral.Conclusions. Patient gender and type of behavioral presentation seem to influence referrals to diagnostic and treatment services for young children with probable developmental delays described in clinical vignettes. These findings can guide targeted educational interventions to increase rates of detection and referral for young children with developmental delays.