title: Pediatrician preferences, local resources, and economic factors influence referral to a subspecialty access clinic.
abstract: Pediatric patients seek timely access to subspecialty care within a complex delivery system while facing barriers: distance, economics, and clinician shortages. Aim We examined stakeholder perceptions about solutions to the access challenge. We engaged over 300 referring primary care pediatricians in the evaluation of Access Clinics at an academic children's hospital.
  
  
  
  Using an anonymous online survey, we asked pediatricians about their and their patients' experiences and analyzed factors that may influence referrals. Findings Referring pediatricians reported satisfaction; they provided feedback about their patients' experiences, physician communication, and referral influences. Distance from the Access Clinic does not correlate with differences in referral volume; living in areas with higher child populations and higher median income is associated with more referrals. Referring pediatricians have strong opinions about referrals, are attuned to patient experiences, and desire bi-directional communication. Multiple factors influence referral to and acceptance of Access Clinics, but external influences have less impact than expected.
authors.affiliation: 1Clinical Assistant Professor of Pediatrics,Sidney Kimmel Medical College of Thomas Jefferson University,Philadelphia,PA,USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Di Guglielmo
authors.affiliation: 2Professor of Pediatrics,Sidney Kimmel Medical College of Thomas Jefferson University,Philadelphia,PA,USA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Greenspan
authors.affiliation: 3Associate Professor of Pediatrics,Sidney Kimmel Medical College of Thomas Jefferson University,Philadelphia,PA,USA.
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Abatemarco
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D000072143:Pediatricians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
keywords: health care access and delivery; practice transformation; subspecialist shortages