title: Factors affecting subspecialty referrals by pediatric primary care providers for children with obesity-related comorbidities.
abstract: OBJECTIVE
  To determine referral patterns from pediatric primary care to subspecialists for overweight/obesity and related comorbidities.
  
  
  METHODS
  We used the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to identify overweight/obesity and 5 related comorbidities in primary care visits between 2005 and 2009 by children 6 to 18 years. The primary outcome was whether the visit ended in referral. We used multivariable analysis to examine factors associated with referral.
  
  
  RESULTS
  We identified 34,225 database visits. A total of 17.1% were with overweight (body mass index=85th to 94th percentile) or obese (body mass index≥95th percentile) patients. A total of 7.1% of primary care visits with overweight/obese children ended in referral. Referral was more likely when obesity was the reason for visit (odds ratio=2.83; 95% confidence interval=1.61-4.97) but was not associated with presence of a comorbidity (odds ratio=1.35; 95% confidence interval=0.75-2.44).
  
  
  CONCLUSIONS
  Most overweight or obese children are not referred, regardless of comorbidity status. One reason may be low levels of appropriate diagnosis.
authors.forename: Carolyn O
authors.initials: CO
authors.lastname: Walsh
authors.forename: Carly E
authors.initials: CE
authors.lastname: Milliren
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D015897:Comorbidity; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D016017:Odds Ratio; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D018579:Patient Selection; D063766:Pediatric Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D010372:Pediatrics / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: comorbidity; health care surveys; pediatric obesity; referral and consultation