title: Generalist-subspecialist communication about children with chronic conditions: an analysis of physician focus groups.
abstract: OBJECTIVE
  To describe barriers and facilitators to effective generalist-subspecialist communication in the care of children with chronic conditions.
  
  
  METHODS
  We conducted 5 focus groups with 14 general pediatricians and 10 pediatric specialty providers to discuss factors that facilitate or obstruct effective communication. The specialty groups included 2 nurse practitioners; the rest were pediatricians from an academic medical center and the surrounding community. We performed a content analysis to generate groups of themes and classify them as barriers or facilitators, and we returned to the participants to solicit their feedback.
  
  
  RESULTS
  We identified 201 themes in 6 domains: the method, content, and timing of communication; system factors; provider education; and interpersonal issues. Barriers to communication mostly involved the method of communication and system factors. Most facilitating themes promoted timely communication, understanding of the reasons for referral and the nature of the child's condition, or appropriate definition of generalist and specialist roles. Participants described numerous examples where communication had direct effects on patient outcomes. Generalists and specialists agreed on many issues, although specialists discussed the pros and cons of curbside consults at length whereas generalists emphasized the importance of their own education in the referral-consultation process.
  
  
  CONCLUSIONS
  Efforts to improve communication between pediatric generalists and specialists in the care of children with chronic conditions should emphasize the importance of timely information transfer. The content of messages is important, but lack of receipt when needed is more of a problem. Improving generalist-subspecialist communication has great potential to improve the quality of care.
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655, USA. stillec@ummhc.org
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stille
authors.forename: Neill
authors.initials: N
authors.lastname: Korobov
authors.forename: William A
authors.initials: WA
authors.lastname: Primack
mesh_terms: D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002908:Chronic Disease / Q000628:therapy*; D003144:Communication Barriers; D019988:Children with Disabilities; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D005246:Feedback; D017144:Focus Groups; D006801:Humans; D033181:Information Dissemination; D033183:Interdisciplinary Communication; D008404:Massachusetts; D009722:Nurse Practitioners; D010371:Pediatric Nursing / Q000458:organization & administration / Q000592:standards; D010372:Pediatrics / Q000458:organization & administration / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*