Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States
Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States
复制标题
DOI：
10.1186/s12969-015-0028-6
复制
发表时间：
2015-07-29
影响因子：
2.5
通讯作者：
Vehe, Richard K.
中科院分区：
文献类型：
--
作者：
Correll, Colleen K.;Spector, Logan G.;Vehe, Richard K.
背景资料：获得儿科风湿病（PR）护理是有限的，然而，有限的获得PR对儿科医生的影响还没有得到检查。本研究的目的是调查PR转介的障碍，并由此产生的替代转介模式之间的初级pediatricians.Methods：一个基于网络的调查通过电子邮件发送给初级儿科医生执业在明尼苏达州，北达科他州，和南达科他州，以调查访问PR护理问题。结果：有效率为15%（93/609）. 29%（27/92）的受访者的诊所距离儿科风湿病专家至少两个小时的车程，9%（8/92）的受访者的诊所距离超过六个小时。92%（85/92）的患者至少转诊一次PR，但89%（83/93）的患者曾考虑转诊PR，但最终没有。许多人转介给其他专科医生：29%（24/83）的儿科感染性疾病，20%的成人风湿病学，12%的儿科骨科，而34%的人自己管理病人。百分之三十五（32/60）提到了一个成人风湿病学家，通常是由于减少旅行（44%），而医生的偏好从来没有被选为一个reason.Conclusion：儿科医生往往是指儿童可能患有风湿性疾病的专家以外的PR主要是由于长途旅行距离。成人风湿病医生的转诊发生，但不是基于儿科医生的偏好。这些调查结果表明，公共关系的劳动力是不够的，以满足需求，至少在上中西部。需要采取干预措施来改善PR护理的可及性。
Background: Access to pediatric rheumatology (PR) care is limited, however the impact that limited access to PR has on pediatricians has not been examined. The goal of this study was to investigate barriers to PR referrals and resulting alternative referral patterns among primary pediatricians.Methods: A web-based survey was emailed to primary pediatricians practicing in Minnesota, North Dakota, and South Dakota in order to investigate access to PR care issues. Basic descriptive analysis was performed.Results: The response rate was 15 % (93/609). Twenty nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9 % (8/92) were more than six hours away. Ninety-two percent (85/92) had referred a patient to PR at least once, but 89 % (83/93) had experienced a situation in which they considered a referral to PR but ultimately did not. Many had referred to other subspecialists instead: 29 % (24/83) to pediatric infectious disease, 20 % to adult rheumatology, and 12 % to pediatric orthopedics, while 34 % managed the patient themselves. Thirty-five percent (32/60) had referred to an adult rheumatologist, commonly due to decreased travel (44 %), while physician preference was never selected as a reason.Conclusion: Pediatricians often refer children with possible rheumatic disease to specialists other than PR mainly due to long travel distances. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to PR care.