Seeing specialists: Roles of parents & providers unclear

January 28, 2014 Volume 20 Issue 2
  • Parents vary widely in views about their responsibilities in getting specialty care for their children.
  • Parents were most divided about who is responsible for choosing the specialist: 52% say primary care providers, 48% say parents.
  • Parents see clinical expertise and training in pediatrics as most important characteristics of specialists, and convenience of appointment less important.

Most children receive health care from a primary care provider (PCP). A PCP is a pediatrician, family physician, or nurse practitioner trained to provide well-child care, as well as care for a broad range of common childhood illnesses. When children show signs or symptoms of a more serious problem, PCPs often refer them to a specialist who has additional training. 
The referral process includes choosing a specialist, setting up the appointment, and providing the necessary information about the child’s condition.  PCPs have different ways of handling specialty referrals, which may or may not match parent expectations. To examine this issue, the C.S. Mott Children’s Hospital National Poll on Children’s Health asked a national sample of parents of children 5-17 years about their preferences for specialist referrals for their children.

Referral to Specialists

Among 1,232 parents, 46% report that at least one child has been referred to a specialist.

When asked whether the parent or the PCP should be responsible for different parts of the referral process, parents have a wide range of views (Figure 1.). Most agree that PCPs should be responsible for providing medical records, and that parents should call to set up the appointment. Parents are divided over who is responsible for choosing the specialist and verifying that the child’s insurance will cover the specialist visit, and making sure the wait time is not too long.

There are no differences in parent views about referral responsibilities based on whether parents have children with a chronic medical condition or have had a prior specialist referral. However, parents of children with Medicaid insurance coverage are more likely than parents of privately insured children to say PCPs should be responsible for choosing the specialist, calling to set up the appointment, and verifying that insurance will cover the specialist care.

In terms of the importance of different characteristics of specialists, parents rate the following as very important:

  • knowing how to take care of the child’s specific condition (89%)
  • having training in pediatrics (80%)
  • being affiliated with a highly-rated hospital (62%)
  • being involved in research so child has access to latest treatment (50%)
  • appointment time convenient for the family schedule (43%)
  • drive time to the specialist (38%)
  • other parents recommending the specialist (38%)

Implications

For a parent, hearing that a child needs to see a specialist is often cause for concern. Confusion about their responsibilities for arranging specialty care can add to parents’ anxiety.

A notable finding from this national survey is the lack of consensus among parents regarding their role in arranging for a specialist appointment—even among those who have previously seen specialists for their children. This finding has two key implications. First, PCPs cannot assume that parents will approach the specialty referral process in similar ways. Second, it may be difficult to establish one set of expectations about specialty referrals that will be acceptable to all parents. 

Another finding from this Poll is that parents of Medicaid children are more likely to want the PCP to be responsible for referral logistics. This may reflect their lack of confidence in navigating the specialty setting, or prior difficulties with providers who do not accept Medicaid patients. Regardless, it is essential for PCPs to understand that their Medicaid patients may have different expectations about their roles in accessing specialty care.

Although parents differ in their perceived roles in arranging a referral appointment, they are consistent about key attributes for specialist physicians: knowing how to take care of the child’s specific condition and having pediatric training. From the parent perspective, clinical expertise trumps affiliation with highly rated institutions or having access to the latest treatment options through research. Even less important are logistical factors such as drive time or appointment convenience.

The take-home messages from this poll are clear. Primary care providers cannot assume that parents understand their responsibilities around making specialty appointments.  Clear communication—ideally, with instructions written in plain language—will be necessary to ensure that parents are able to follow through on specialty referrals.  For parents of children referred for specialty care, it is imperative to ask for clarification about their roles in the process.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by GfK Custom Research, LLC (GfK), for C.S. Mott Children’s Hospital via a method used in many published studies. The survey was administered in November 2013 to a randomly selected, stratified group of adults age 18 and older with a child age 5-17 (n=1,232) from GfK’s web-enabled KnowledgePanel® that closely resembles the U.S. population. The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 54% among the parent panel members contacted to participate. The margin of error is ± 2 to 3 percentage points.

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Acham Gebremariam, MS
Web Editor: Anna Daly Kauffman, BA

Findings from the C.S. Mott Children's Hospital National Poll on Children's Health do not represent the opinions of the investigators or the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.

Questions were answered by adult respondents age 18 and older with a child age 5-17.

Most children see a primary care provider – usually a pediatrician, family doctor, or nurse practitioner – for check-ups and minor illness.

Sometimes, the primary care provider will suggest that the child needs to see a specialist. This could be a medical specialist (like a neurologist, ear-nose-throat doctor, or cardiologist), or a behavioral specialist (like a psychiatrist, psychologist, counselor, or therapist).

Q1. Has a primary care provider ever suggested that your child(ren) needs to see a specialist?
     Yes
     No

Imagine this situation. At a regular check-up, the primary care provider tells you that your child should see a medical specialist for a consultation. It’s not an emergency, but the primary care provider says it’s important to consult with the specialist.

Q2. In setting up the appointment, who would you prefer to take responsibility for the following:

Select one response for each row.

  Parent Primary care provider
Choosing the specialist    
Calling to set up the appointment    
Explaining the reason for the appointment    
Making sure insurance covers that specialist    
Making sure the wait time for the appointment isn't too long    
Providing medical records to the specialist    

Q3. In setting up a specialty appointment for your child, how important would the following be?

Select one response for each row.

  Very important Somewhat important Not important
The primary care provider recommends a specialist who knows how to take care of my child’s specific condition.      
The specialist is affiliated with a highly-rated hospital or health system.      
The specialist has training in pediatrics (the care of children).      
Other parents recommend the specialist.      
The specialist is involved in research, so my child has access to the latest treatments.      
The drive time to the specialist is reasonable.      
The appointment is convenient for our family schedule.      

Participants were also asked demographic questions on gender, race/ethnicity, annual household income, education and insurance status.

All information is the sole property of the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health. It can only be used if there is an acknowledgment that "The information came from, is copyright by and is owned by and belongs to the Regents of the University of Michigan and their C.S. Mott Children's Hospital National Poll on Children's Health. It cannot be republished or used in any format without prior written permission from the University."

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Acham Gebremariam, MS
Web Editor: Anna Daly Kauffman, BA

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