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BMC Pediatrics
Published in: BMC Pediatrics 1/2018

Open Access 01-12-2018 | Research article

Changing outpatient referral patterns in a small pediatric nephrology practice

Authors: Coral Hanevold, Susan Halbach, Jin Mou, Karyn Yonekawa

Published in: BMC Pediatrics | Issue 1/2018

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Abstract

Background

We have noted a large number of referrals for abnormal kidney imaging and laboratory tests and postulated that such referrals have increased significantly over time. Understanding changes in referral patterns is helpful in tailoring education and communication between specialists and primary providers.

Methods

We performed a retrospective chart review of new patient referrals to Mary Bridge Children’s Nephrology clinic for early (2002 to 2004) and late (2011 to 2013) cohorts. The overall and individual frequencies of referrals for various indications were compared.

Results

The overall number of new visits was similar for early (511) and late (509) cohorts. The frequency of referrals for solitary kidneys and multi-cystic dysplastic kidneys, microalbuminuria and abnormal laboratory results increased significantly (Odds Ratio (OR) and 95% Confidence Interval of OR: 1.920 [1.079, 3.390], 2.862 [1.023, 8.006], 2.006 [1.083, 3.716], respectively) over the time interval while the proportion of referrals for urinary tract infections (UTIs) and vesicoureteral reflux (VUR) decreased by half (OR: 0.472, 95% CI: 0.288, 0.633). Similarly, referrals for urinary tract dilation and hydronephrosis occurred significantly less often (8% versus 6%, OR: 0.737, 95% CI: 0.452, 1.204) with similar changes in referrals for voiding issues (OR: 0.281, 95% CI: 0.137, 0.575). However, these changes were not statistically significant. Frequencies for other indications showed little variation.

Conclusions

Changes in indications for referral likely reflect evolution of practice in management of UTIs and VUR and increased use of imaging and laboratory testing by pediatric providers. These findings have relevance for ongoing education of pediatricians and support the need for collaboration between primary providers and nephrologists to assure the judicious use of resources.
Literature
1.
Ray KN, Bogen DL, Bertolet M, Forrest CB, Mehrotra A. Supply and utilization of pediatric subspecialties in the United States. Pediatrics. 2014;133(6):1061–9.CrossRefPubMed
2.
Pletcher BA, Rimsza ME, Cull WL, Shipman SA, Shugerman RP, O’Connor KG. Primary care pediatricians’ satisfaction with subspecialty care, perceived supply and barriers to care. J Pediatr. 2010;156(6):1011–5.CrossRefPubMed
3.
Mayer ML. Are we there yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006;118(6):2313–21.CrossRefPubMed
4.
Radina M, Sharma AP, Yarin A, Filler G. Adherence to waiting-time targets for pediatric nephrology clinic referrals. Pediatr Nephrol. 2010;25:311–6.CrossRefPubMed
5.
Abbott M, Paulin H, Sidhu D, Naugler C. Laboratory tests interpretation and use of resources. Can Fam Physician. 2014;60(3):e167–72.PubMedPubMedCentral
6.
Alonso-Cerezo MC, Martin JS, Montes MAG, de la Iglesin VM. Appropriate utilization of clinical laboratory tests. Clin Chem Lab Med. 2009;47(12):1461–5.CrossRefPubMed
7.
Tompane T, Bush R, Dansky T, Huang JS. Diagnostic imaging studies performed in children over a 9-year period. Pediatrics. 2013;131(1):e45–52.CrossRefPubMed
8.
Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr. 2013;25(1):88–94.CrossRefPubMedPubMedCentral
9.
Jackson EC. Urinary tract infections in children: knowledge update and a salute to the future. Pediatr Rev. 2015;36(4):153–64. quiz 165-166CrossRefPubMed
10.
Scheinman JI, Foreman JW, Chan JCM. Perspective of a pediatric nephrology program: an 18 year retrospective. Acta Paediatr Sin. 1997;38(5):352–35.PubMed
11.
Filler G, Payne RP, Orrbine E, Clifford T, Drukker A, McLaine PN. Changing trends in the referral patterns of pediatric nephrology patients. Pediatr Nephrol. 2005;20:603–8.CrossRefPubMed
12.
Freed GL, Dunham KM, Switalski KE, Jones MD, McGuinness GA. Recently trained general pediatricians: perspectives on residency training and scope of practice. Pediatrics. 2009;123:S38–43.CrossRefPubMed
13.
Roberts KB, Subcommittee on urinary tract infections and steering committee on quality improvement and management. Urinary tract infection: clinical practice guidelines for the diagnosis and management of the initial UTI in febrile infants and children 2-24 months. Pediatrics. 2011;128(3):595–610.CrossRefPubMed
14.
Hellerstein S, Linebarger JS. Voiding dysfunction in pediatric patients. Clin Pediatr (Phila). 2003;42:43–9.CrossRef
15.
Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S. Practical consensus guidelines for the management of enuresis. Eur J Pediatr. 2012;171:971–83.CrossRefPubMedPubMedCentral
16.
Cheng AM, Phan V, Geary DF, Rosenblum ND. Outcome of isolated antenatal hydronephrosis. Arch Pediatr Adolesc Med. 2004;158(1):38–40.CrossRefPubMed
17.
18.
Nguyen HT, Benson CB, Bromley B, et al. Multidisciplinary census on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982–99.CrossRefPubMed
19.
Primack WA, Meyers KE, Kirkwood SJ, Ruch-Ross HS, Radabaugh CL, Greenbaum LA. The US pediatric nephrology workforce: a report commissioned by the American Academy of Pediatrics. Am J Kidney Dis. 2015;66(1):33–9.CrossRefPubMed
20.
Lister G. 2011 Joseph W. St Geme Jr lecture: five things I’d like to see changed in American pediatrics, five lessons I’ve learned. Pediatrics. 2012;129(5):961–7.CrossRefPubMed
21.
Wegner SE, Humble CG, Feaganes J, Stiles AD. Estimated savings from paid telephone consultations between subspecialists and primary care physicians. Pediatrics. 2008;122(6):e1136–40.CrossRefPubMed
Metadata
Title
Changing outpatient referral patterns in a small pediatric nephrology practice
Authors
Coral Hanevold
Susan Halbach
Jin Mou
Karyn Yonekawa
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-018-1164-1

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