Use Of Adult-trained Medical Subspecialists By Children Seeking Medical Subspecialty Care.

Title

Use Of Adult-trained Medical Subspecialists By Children Seeking Medical Subspecialty Care.

Creator

Ray KN; Kahn JM; Miller E; Mehrotra A

Identifier

DOI: 10.1016/j.jpeds.2016.05.073

Publisher

Journal Of Pediatrics

Date

2016

Subject

Barriers To care; Consultation; Geographic Access; Pediatrics; Referral; Specialty; Subspecialty; Travel Time

Description

OBJECTIVES:
To quantify the use of adult-trained medical subspecialists by children and to determine the association between geographic access to pediatric subspecialty care and the use of adult-trained subspecialists. Children with limited access to pediatric subspecialty care may seek care from adult-trained subspecialists, but data on this practice are limited.
STUDY DESIGN:
We identified children aged <16 years in 2007-2012 Pennsylvania Medicaid claims. We categorized outpatient visits to 9 selected medical subspecialties as either pediatric or adult-trained subspecialty visits. We used multinomial logistic regression to examine the adjusted association between travel times to pediatric referral centers and use of pediatric vs adult-trained medical subspecialists for children with and without complex chronic conditions (CCCs).
RESULTS:
Among 1.1 million children, 8% visited the examined medical subspecialists, with 10% of these children using adult-trained medical subspecialists. Compared with children with a ≤30-minute travel time to a pediatric referral center, children with a >90-minute travel time were more likely to use adult-trained subspecialists (without CCCs: relative risk ratio [RRR], 1.94, 95% CI, 1.79-2.11; with CCCs: RRR, 2.33; 95% CI, 2.10-2.59) and less likely to use pediatric subspecialists (without CCCs: RRR, 0.66; 95% CI, 0.63-0.68; with CCCs: RRR, 0.76, 95% CI, 0.73-0.79).
CONCLUSION:
Among medical subspecialty fields with pediatric and adult-trained subspecialists, adult-trained subspecialists provided 10% of care to children overall and 18% of care to children living >90 minutes from pediatric referral centers. Future studies should examine consequences of adult-trained medical subspecialist use on pediatric health outcomes and identify strategies to increase access to pediatric subspecialists.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

September 2016 List

Citation

Ray KN; Kahn JM; Miller E; Mehrotra A, “Use Of Adult-trained Medical Subspecialists By Children Seeking Medical Subspecialty Care.,” Pediatric Palliative Care Library, accessed October 28, 2021, https://pedpalascnetlibrary.omeka.net/items/show/10692.

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