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Comfort of General Internists and General Pediatricians in Providing Care for Young Adults with Chronic Illnesses of Childhood

  • Megumi J. OkumuraEmail author
  • Michele Heisler
  • Matthew M. Davis
  • Michael D. Cabana
  • Sonya Demonner
  • Eve A. Kerr
Original Article

Abstract

Background

As an increasing number of patients with chronic conditions of childhood survive to adulthood, experts recommend that young adults with chronic conditions transfer from child-focused to adult-focused primary care. Little, however, is known about how comfortable physicians are caring for this population.

Objectives

To assess the comfort of general internists and general pediatricians in treating young adult patients with chronic illnesses originating in childhood as well as the factors associated with comfort.

Participants

In a random sample, 1288 of 2434 eligible US general internists and pediatricians completed a mailed survey (response rate = 53%).

Methods

We measured respondents’ comfort level in providing primary care for a patient with sickle cell disease (SCD) or cystic fibrosis (CF). We also measured levels of disease familiarity, training and subspecialty support, as well as individual physician characteristics.

Results

Fifteen percent of general internists reported being comfortable as the primary care provider for adults with CF and 32% reported being comfortable providing primary care for adults with SCD, compared with 38% of pediatricians for CF (p < .001) and 35% for SCD (p > 0.05). Less than half of general internists felt that their specialty should take primary care responsibility for adult patients with CF and SCD.

Conclusions

A majority of general internists and pediatricians are not comfortable providing primary care for young adults with chronic illnesses of childhood origin, such as CF and SCD. Efforts to increase treatment comfort among providers may help with the transition to adult-focused care for the growing numbers of young adults with complex chronic conditions.

KEY WORDS

transitional care cystic fibrosis sickle cell disease young adults adolescents children with special health care needs primary care childhood diseases health care transitions 

Abbreviations

CF

cystic fibrosis

PCP

primary care physician

SCD

sickle cell disease

Notes

Acknowledgements

We wish to thank Dylan Smith and Norbert Schwarz for psychometric input on the survey; Samya Nasr and Andrew Campbell for disease specific input to the clinical vignette; Paula Lantz for her generous insight regarding the survey items; Camilla Payne for editing. We also received biostatistical assistance from the BREAD of the UCSF CTSI (Grant #UL1 RR024131).

Conflicts of Interest

None disclosed.

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Megumi J. Okumura
    • 1
    • 7
    Email author
  • Michele Heisler
    • 2
    • 4
  • Matthew M. Davis
    • 2
    • 3
    • 5
  • Michael D. Cabana
    • 1
    • 6
    • 7
  • Sonya Demonner
    • 4
  • Eve A. Kerr
    • 2
    • 4
  1. 1.Division of General PediatricsUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of General MedicineUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Child Health Evaluation and Research Unit, Division of General PediatricsUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborUSA
  5. 5.Gerald R. Ford School of Public PolicyUniversity of MichiganAnn ArborUSA
  6. 6.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA

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