title: Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States.
abstract: BACKGROUND
  Access to pediatric rheumatology (PR) care is limited, however the impact that limited access to PR has on pediatricians has not been examined. The goal of this study was to investigate barriers to PR referrals and resulting alternative referral patterns among primary pediatricians.
  
  
  METHODS
  A web-based survey was emailed to primary pediatricians practicing in Minnesota, North Dakota, and South Dakota in order to investigate access to PR care issues. Basic descriptive analysis was performed.
  
  
  RESULTS
  The response rate was 15 % (93/609). Twenty-nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9 % (8/92) were more than six hours away. Ninety-two percent (85/92) had referred a patient to PR at least once, but 89 % (83/93) had experienced a situation in which they considered a referral to PR but ultimately did not. Many had referred to other subspecialists instead: 29 % (24/83) to pediatric infectious disease, 20 % to adult rheumatology, and 12 % to pediatric orthopedics, while 34 % managed the patient themselves. Thirty-five percent (32/60) had referred to an adult rheumatologist, commonly due to decreased travel (44 %), while physician preference was never selected as a reason.
  
  
  CONCLUSIONS
  Pediatricians often refer children with possible rheumatic disease to specialists other than PR mainly due to long travel distances. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to PR care.
authors.affiliation: Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN, USA. corr0250@umn.edu.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Correll
authors.affiliation: Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.|University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA.
authors.forename: Logan G
authors.initials: LG
authors.lastname: Spector
authors.affiliation: Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN, USA.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Binstadt
authors.affiliation: Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Vehe
mesh_terms: D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009658:North Dakota; D010372:Pediatrics / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000628:therapy; D012219:Rheumatology / Q000706:statistics & numerical data*; D013023:South Dakota; D011795:Surveys and Questionnaires