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Primary Care

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Pediatricians often make referrals to specialists during telephone conversations with parents

Pediatricians use the telephone more than other primary care providers, typically spending 13 percent of their workday on the phone. According to a recent study, supported in part by the Agency for Healthcare Research and Quality (HS08430), referrals to specialists during telephone conversations with parents are a regular occurrence in pediatric practice. Pediatricians made one telephone referral every five practice days, which constituted 27.5 percent of all referrals they made during office hours. In other words, for every three referrals made during office visits, pediatricians made one referral during a telephone conversation. Pediatricians who saw more patients per day, saw more patients in gatekeeping health plans, and referred more during office visits made more telephone referrals than other pediatricians.

Changes in the health system that create greater demands on primary care physician productivity (seeing more patients per day) or put more patients in gatekeeping health plans will likely increase the number of pediatric referrals made during telephone conversations with parents, according to lead author Gordon B. Glade, M.D., of the Center for Child Health Research, American Academy of Pediatrics, and the University of Utah School of Medicine. The researchers prospectively studied a sample of 1,856 referrals made from the offices of 142 pediatricians in a national practice-based research network over 20 consecutive practice days, including pediatricians' assessments of referral outcomes 3 months later.

Telephone specialty referrals were more often made at the request of parents or because of insurance administrative guidelines than those made during office visits. Telephone referrals also were more likely to be for ongoing health problems rather than a new complaint and for a return visit to a specialist previously consulted by the patient. Referrals for advice on diagnosis and surgical procedures were more frequently made during office visits. Pediatricians were equally satisfied with the specialty care their patients received for telephone and office visit referrals.

See "Specialty referrals made during telephone conversations with parents: A study from the Pediatric Research in Office Settings Network," by Dr. Glade, Christopher B. Forrest, M.D., Ph.D., Barbara Starfield, M.D., and others, in the March 2002 Ambulatory Pediatrics 2(2), pp. 93-98.

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