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.
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Abbreviations
- CF:
-
cystic fibrosis
- PCP:
-
primary care physician
- SCD:
-
sickle cell disease
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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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Additional information
This work was funded by the Robert Wood Johnson Clinical Scholars Program and the UCSF Division of Pediatrics. Dr. Heisler is a VA Health Services Research and Development Career Development Awardee.
Appendix
Appendix
Physicians were randomized to receive a CF or SCD clinical vignette to anchor their answers to the question who would be the best primary care provider to a patient.
Cystic fibrosis clinical vignette:
An 18-year-old woman with cystic fibrosis comes to your office to establish care. Her medical history is significant for multiple pulmonary infections and pancreatic insufficiency. Today she would like to discuss with you her chronic cough, increased sputum production, chronic back pain, dysmenorrhea and cystic fibrosis management.
Sickle cell disease clinical vignette
An 18-year-old woman with sickle cell disease comes to your office to establish care. Her medical history is significant for multiple pain crises, complicated by acute chest syndrome and an intracranial hemorrhage in the past. Today she would like to discuss with you her chronic back pain, dysmenorrhea and sickle cell management.
We then asked the following question:
Who do you feel would be best to provide for the primary care needs for young adults (17–25 years old) with sickle cell disease/cystic fibrosis?
Response choices included pediatric generalist, pediatric pulmonologist or hematologist, adult generalist, adult pulmonologist or hematologist or other depending on vignette.
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Okumura, M.J., Heisler, M., Davis, M.M. et al. Comfort of General Internists and General Pediatricians in Providing Care for Young Adults with Chronic Illnesses of Childhood. J GEN INTERN MED 23, 1621–1627 (2008). https://doi.org/10.1007/s11606-008-0716-8
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DOI: https://doi.org/10.1007/s11606-008-0716-8