Generalist-Subspecialist Communication for Children with Chronic Conditions

A Regional Physician Survey

The study objective was to identify target areas for interventions to improve communication between pediatric generalists (PCPs) and pediatric subspecialists (SPs) in the outpatient care of children with chronic conditions. The authors constructed a four-page mailed questionnaire probing communication practices, opinions about the role of communication in care and perceived barriers and facilitators to PCP-SP communication in the care of children with chronic conditions. In spring 2001, they surveyed all 495 New England SPs who were members of the American Academy of Pediatrics and/or SP societies and a random sample of 495 generalist AAP members in New England. Physicians actively providing outpatient care were eligible to participate. Almost all respondents agreed that communication was important for good care, but reported practices reflected large gaps in this area. Frequent receipt of communication about an initial referral was reported by only 28 percent of SPs. Barriers reported as most important involved inefficiencies in telephone contact, transcription delay and failure to keep all providers informed when more than one specialist is involved. Important facilitators included letters or phone calls at or before the time of consultation, and clear and specific referral questions from PCPs. PCPs saw communication as more of a problem than did SPs, and reported several barriers as more important. The survey response rate (48 percent) limits the generalizability of these findings. PCPs and SPs sharing care for children with chronic conditions are troubled by their frequent failure or inability to contact colleagues by phone and letter. PCPs communicate less frequently than SPs yet perceive more problems with communication. Interventions to promote efficient contact between providers at or before the time of subspecialty visits can lead to improved care coordination, which may better meet the family needs. Toll-free access made available with permission.