Determinants and Impact of Generalist-Specialist Communication About Pediatric Outpatient Referrals

When primary care physicians refer children to specialty physicians, it is important that the physicians communicate effectively with each other in order to provide patients with optimal care. Though pediatricians have identified lack of communication at the time of referral as a problem, no literature describes communication patterns in the care of children. This study seeks to determine rates of communication between primary care physicians and specialists, to identify which practice system and patient characteristics might be associated with increased communication and to assess the impact of communication on patient care.

The authors enrolled 179 patients from 62 general pediatricians in 30 practices. These patients were seen by 15 medical specialists in five specialties. Primary care physicians and specialists completed questionnaires at the beginning of the study and then six months later.

Key Findings:

  • Primary care physicians communicated with specialists at the point of initial referral 50 percent of the time.
  • Specialists communicated with primary care physicians after initial consultation 84 percent of the time.
  • Communication was strongly associated with physicians' reported ability to provide optimal care.
  • Communication was more likely when there were system supports to increase the access physicians had to medical information.
  • Communication was less common for children who saw multiple specialists and for those with Medicaid insurance.

Limitations include the physicians were from one region and were self-reporting about patient outcomes. The study could not detect a relationship between physician communication and adverse patient outcomes.

The authors conclude that communication from referring primary care physicians to specialists is often absent. Interventions should promote accessible medical information systems and focus on those children who visit multiple specialists and those with Medicaid insurance.