The Pediatric Primary Care-Specialist Interface: A Call For Action

      Infants, children, adolescents, and young adults (hereafter referred to as “children”) are increasingly using specialty medical services, defined herein as other physicians with additional training and expertise in a defined area. Among children ages 3-18 years, the number of ambulatory visits resulting in a referral to another physician more than doubled from 1999 to 2009, increasing from 4.93 to 10.5 million.
      • Mayer M.L.
      • Skinner A.C.
      • Slifkin R.T.
      Unmet need for routine and specialty care: data from the National Survey of Children With Special Health Care Needs.
      At the same time, for several populations of children with need for pediatric specialty care, access has become more difficult.
      • Mayer M.L.
      • Skinner A.C.
      • Slifkin R.T.
      Unmet need for routine and specialty care: data from the National Survey of Children With Special Health Care Needs.
      • Henrickson M.
      Policy challenges for the pediatric rheumatology workforce: part III. the international situation.
      Importantly, care is often fragmented between primary care and specialty clinicians, and coordination of care remains problematic, because of lack of payment for coordination activities, which are often time consuming; providers working in different healthcare systems without common electronic information sharing capabilities; and fee for service payments that encourage visits and discourage efficiencies that decrease duplication of services, as well as other contributing factors.

      Keywords

      Abbreviations:

      EHR ( Electronic health record), FCMH ( Family-centered medical home), PCP ( Primary care provider)
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