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

BackgroundAs 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.ObjectivesTo 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%).MethodsWe 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.ResultsFifteen 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.ConclusionsA 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.

[1]  N. Onetto,et al.  Adolescents with chronic disease. Are they receiving comprehensive health care? , 1983, Journal of adolescent health care : official publication of the Society for Adolescent Medicine.

[2]  R. Blum.  Physicians' assessment of deficiencies and desire for training in adolescent care. , 1987, Journal of medical education.

[3]  D. Schidlow,et al.  Life beyond pediatrics. Transition of chronically ill adolescents from pediatric to adult health care systems. , 1990, The Medical clinics of North America.

[4]  J. Britton,et al.  Cystic fibrosis: current survival and population estimates to the year 2000. , 1991, Thorax.

[5]  D. Addy.  Cystic fibrosis: current survival and population estimates to the year 2000. , 1992, Thorax.

[6]  D P Orr,et al.  Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. , 1993, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[7]  O. Platt,et al.  Mortality in sickle cell disease. Life expectancy and risk factors for early death. , 1994, The New England journal of medicine.

[8]  M. Donohoe,et al.  Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. , 1998, Archives of internal medicine.

[9]  Jack P. Shonkoff,et al.  An Epidemiologic Profile of Children With Special Health Care Needs , 1998, Pediatrics.

[10]  J. Bruhn.  Primary Care: Americaʼs Health in a New Era , 1999 .

[11]  A. Dietrich,et al.  Primary care physicians' approach to depressive disorders. Effects of physician specialty and practice structure. , 1999, Archives of family medicine.

[12]  J. Mcauley,et al.  Referral Characteristics of Primary Care Physicians for Seizure Patients , 2000, Epilepsia.

[13]  T. Konrad,et al.  Reported response rates to mailed physician questionnaires. , 2001, Health services research.

[14]  J. Hoffman,et al.  Task force 1: the changing profile of congenital heart disease in adult life. , 2001, Journal of the American College of Cardiology.

[15]  H R Rubin,et al.  Reasons for pediatrician nonadherence to asthma guidelines. , 2001, Archives of pediatrics & adolescent medicine.

[16]  D. Blumenthal,et al.  Physicians’ Assessments of Their Ability to Provide High-Quality Care in a Changing Health Care System , 2001, Medical care.

[17]  P. Scal,et al.  Transition for youth with chronic conditions: primary care physicians' approaches. , 2002, Pediatrics.

[18]  Craig M. Schramm,et al.  A consensus statement on health care transitions for young adults with special health care needs. , 2002, Pediatrics.

[19]  L. Powers,et al.  Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs. , 2003, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[20]  D. Zimmerman,et al.  Attitudes of Canadian nephrologists, family physicians and patients with kidney failure toward primary care delivery for chronic dialysis patients. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[21]  T. Wadden,et al.  Primary care physicians' attitudes about obesity and its treatment. , 2003, Obesity research.

[22]  Jay Bhattacharya,et al.  Are the young becoming more disabled? , 2004, Health affairs.

[23]  Joann Elmore,et al.  Coordinating Care across Diseases, Settings, and Clinicians: A Key Role for the Generalist in Practice , 2005, Annals of Internal Medicine.

[24]  C. Johnston,et al.  Family physicians' involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey , 2005, BMC family practice.

[25]  C. Norlin,et al.  Gynecological care for adolescents with disability: physician comfort, perceived barriers, and potential solutions. , 2005, Journal of pediatric and adolescent gynecology.

[26]  B. McCrindle,et al.  Estimates of life expectancy by adolescents and young adults with congenital heart disease. , 2006, Journal of the American College of Cardiology.

[27]  Charles Rohde,et al.  Primary Care Physician Specialty Referral Decision Making: Patient, Physician, and Health Care System Determinants , 2006, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  Terry S. Field,et al.  Knowledge, patterns of care, and outcomes of care for generalists and specialists , 1999, Journal of General Internal Medicine.

[29]  Martin Offringa,et al.  Definitions and measurement of chronic health conditions in childhood: a systematic review. , 2007, JAMA.

[30]  Robert Burke,et al.  A consensus statement on health care transitions for young adults with special health care needs. , 2002, Pediatrics.