Comparing the Self-Reported Referral and Management Preferences of Pediatricians and Family Physicians for Children with Juvenile Rheumatoid Arthritis

GARY L. FREED, SANDRA JEE, LEONARD STEIN, LAURA SPERA, and SARAH J. CLARK

ABSTRACT.

Objective. The symptoms of juvenile rheumatoid arthritis (JRA) are often first recognized by primary care physicians. Little is known about the determinants of the initial management and referral patterns of these physicians for children with JRA. We compared the self-reported preferences and practices of pediatricians (PD) and family physicians (FP) in the diagnosis and management of children with JRA.

Methods. Surveys were mailed to a national random sample of 700 PD and 867 FP. Questions included prior experience with JRA, usual patterns in the diagnosis and management of JRA, perception of the need for guidelines for referral and management of this condition, and physician demographic information. Data analysis included univariate and bivariate analysis.

Results. Response rates were 69% for PD and 49% for FP. Most respondents had seen very few JRA cases in the previous 5 years. Only 1% of respondents reported that they provided all diagnosis and management for patients with JRA. Forty-two percent of PD and 32% of FP refer all JRA diagnosis and management to subspecialists, while 46% of PD and 61% of FP refer only to confirm the diagnosis and guide initial therapy (p = 0.011). More PD than FP (PD 92% vs FP 76%; p = 0.001) referred patients with JRA to pediatric rheumatologists, while more FP than PD referred to general rheumatologists (PD 17% vs FP 37%; p = 0.001). The majority of FP reported feeling more comfortable managing rheumatologic disease in adults than children (82%). Few respondents felt that they were up to date on the latest advances in JRA treatment (PD 10% vs FP 4%; p = 0.024).

Conclusion. Multiple factors may contribute to physicians' referral practice, including a patient's clinical status and the physician's beliefs of inadequacy of training and inability to stay up to date. The pattern of care that children with JRA receive likely will be influenced by initial presentation to a PD or to a FP. (J Rheumatol 2003;30:2700-4)

Key Indexing Terms:

ARTHRITIS
PEDIATRICIAN
FAMILY PHYSICIAN
TREATMENT

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From the Child Health Evaluation and Research (CHEAR) Unit, Ann Arbor, Michigan; and the Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Supported by the Arthritis Foundation.

G.L. Freed, MD, MPH; S. Jee, MD; L. Spera, MS; S.J. Clark, MPH, Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan; L. Stein, MD, Department of Pediatrics, University of North Carolina at Chapel Hill.

Address reprint requests to Dr. G.L. Freed, Division of General Pediatrics, University of Michigan, 300 NIB 6E08, Ann Arbor, MI 48109-0456. E-mail: gfreed@med.umich.edu

Submitted January 22, 2003; revision accepted May 13, 2003.

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