title: Pediatric rheumatology in adult rheumatology practices in Washington state.
abstract: OBJECTIVE
  To determine both the extent to which adult rheumatologists treat children and their level of comfort in doing so.
  
  
  METHODS
  A questionnaire was sent to all 77 physicians in the state of Washington who were listed as adult rheumatologists in the American College of Rheumatology (ACR) directory.
  
  
  RESULTS
  Sixty-six questionnaires (86%) were returned; 50 were identified as being from private-practicing adult rheumatologists and were the focus of this study. Sixty-two percent of the respondents reported that they care for children; predictors included increased exposure to pediatric rheumatology during fellowship (P = 0.003), increased distance from Seattle (P = 0.001), and listing oneself in the ACR directory as treating children (P = 0.03). Most respondents reported feeling discomfort in treating children younger than 6 years of age, treating Kawasaki disease, and treating polyarteritis nodosa, but most reported feeling comfortable treating children with chronic arthritides. Impediments to referring to a pediatric rheumatologist included distance (median distance 35 miles), convenience for the family, personal preference, and experience in caring for children. Twenty-nine percent reported difficulties referring to a pediatric rheumatologist outside of one's managed care plan. Adult rheumatologists expressed interest in continuing medical education dealing with pediatric rheumatology, preferably with a lecture format in their home communities.
  
  
  CONCLUSIONS
  A significant number of adult rheumatologists care for children. Pediatric rheumatologists should provide both educational and consultative support for these adult rheumatologist colleagues.
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Sherry
authors.forename: C A
authors.initials: CA
authors.lastname: Wallace
authors.forename: S J
authors.initials: SJ
authors.lastname: Kahn
mesh_terms: D000328:Adult; D002648:Child; D004496:Education, Continuing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data; D012219:Rheumatology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014861:Washington