Specialty Referrals Made During Telephone Conversations With Parents: A Study From the Pediatric Research in Office Settings Network

Glade, Gordon B.; Forrest, Christopher B.; Starfield, Barbara; Baker, Alison E.; Bocian, Alison B.; Wasserman, Richard C.

doi:10.1367/1539-4409(2002)002<0093:SRMDTC>2.0.CO;2

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Volume 2, Issue 2 , Pages 93-99, March 2002

Specialty Referrals Made During Telephone Conversations With Parents: A Study From the Pediatric Research in Office Settings Network

Gordon B. Glade, MD
- Address correspondence to Gordon B. Glade, MD, 120 N 1220 E No. 3, American Fork, UT 84003
Christopher B. Forrest, MD, PhD
- From the Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Drs Glade and Wasserman and Ms Baker and Bocian); the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Glade); the Department of Health Care Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md (Drs Forrest and Starfield); and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vt (Dr Wasserman) Dr Glade is in private practice in American Fork, Utah
Barbara Starfield, MD, MPH
- From the Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Drs Glade and Wasserman and Ms Baker and Bocian); the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Glade); the Department of Health Care Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md (Drs Forrest and Starfield); and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vt (Dr Wasserman) Dr Glade is in private practice in American Fork, Utah
Alison E. Baker, MS
- From the Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Drs Glade and Wasserman and Ms Baker and Bocian); the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Glade); the Department of Health Care Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md (Drs Forrest and Starfield); and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vt (Dr Wasserman) Dr Glade is in private practice in American Fork, Utah
Alison B. Bocian, MS
- From the Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Drs Glade and Wasserman and Ms Baker and Bocian); the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Glade); the Department of Health Care Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md (Drs Forrest and Starfield); and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vt (Dr Wasserman) Dr Glade is in private practice in American Fork, Utah
Richard C. Wasserman, MD, MPH
- From the Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Drs Glade and Wasserman and Ms Baker and Bocian); the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Glade); the Department of Health Care Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md (Drs Forrest and Starfield); and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vt (Dr Wasserman) Dr Glade is in private practice in American Fork, Utah

Received 11 April 2001; accepted 5 December 2001.

Objectives.—To characterize variation in pediatricians' telephone referral practices, to identify differences in the types of referrals made during telephone versus office visit encounters, and to examine the impact of referring by telephone on coordination and outcomes of the referral as assessed by physicians.

Methods.—We conducted a prospective study of a consecutive sample of referrals (N = 1856) made from the offices of 142 pediatricians in a national practice-based research network. During 20 consecutive practice-days, physicians completed questionnaires about patients referred during regular business hours. They used office records 3 months later to complete questionnaires about referral outcomes.

Results.—Pediatricians made 1 telephone referral every 5 practice-days, which constituted 27.5% of all referrals they made during office hours. Pediatricians who saw more patients per day, saw more patients in gatekeeping health plans, and referred more during office visits made more telephone referrals than their counterparts. Compared with specialty referrals made during office visits, those occurring during telephone encounters were more frequently at the request of parents or because of insurance administrative guidelines. Office visit referrals were more often made for diagnostic evaluation or a surgical procedure. Referrals made during telephone conversations were less well coordinated: office staff or referring physicians scheduled fewer specialty appointments and were less likely to send information to specialists. Three months after referrals were made, specialist feedback and referring physician satisfaction with specialty care were comparable between the two groups.

Conclusions.—Specialty referrals made during telephone conversations with patients are a regular occurrence in pediatric practice. Changes in the health system that lead to greater demands on primary care physician productivity or more patients in gatekeeping health plans will likely increase the number of referrals made during telephone conversations with parents. Pediatricians are less likely to coordinate telephone referrals than office visit referrals. Pediatricians are frequently unaware whether or not referrals are completed.

KEY WORDS: gatekeeping health plans , physician satisfaction , referral-consultation , telephone medicine