TY - JOUR
T1 - Barriers to specialty care and specialty referral completion in the community health center setting
AU - Zuckerman, Katharine E.
AU - Perrin, James M.
AU - Hobrecker, Karin
AU - Donelan, Karen
N1 - Funding Information:
We thank all of the community health center parents, providers, and administrators for their participation in the project. We additionally thank Esteban Barreto, Xin Cai, Gibran Minero, Michelle Connolly, Dianali Rivera, Tara Bryant, and Odeviz Soto for their assistance with data collection. The efforts of E.B., X.C., D.R., T.B., and O.S. were funded by a grant from the CRICO-Risk Management Foundation .
PY - 2013/2
Y1 - 2013/2
N2 - Objective: To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers. Study design: Two months after their child's specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors' offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥4 barriers was associated with incomplete referral. Results: A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors' offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥4 barriers were more likely than those experiencing ≤3 barriers to have incomplete referral. Conclusion: Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals.
AB - Objective: To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers. Study design: Two months after their child's specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors' offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥4 barriers was associated with incomplete referral. Results: A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors' offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥4 barriers were more likely than those experiencing ≤3 barriers to have incomplete referral. Conclusion: Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals.
KW - EHR
KW - Electronic health record
UR - http://www.scopus.com/inward/record.url?scp=84872337170&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872337170&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2012.07.022
DO - 10.1016/j.jpeds.2012.07.022
M3 - Article
C2 - 22929162
AN - SCOPUS:84872337170
SN - 0022-3476
VL - 162
SP - 409-414.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -