Beth A Tarini1, Brian J Zikmund-Fisher2, Howard M Saal3, Laurie Edmondson4, Wendy R Uhlmann5. 1. Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Electronic address: btarini@umich.edu. 2. Department of Health Behavior and Health Education and Department of Internal Medicine, University of Michigan, Ann Arbor, MI. 3. Division of Human Genetics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH. 4. Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI. 5. Department of Internal Medicine and Department of Human Genetics, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: To examine the decisions of pediatric primary care physicians about their diagnostic evaluation for a child with suspected global developmental delay (GDD). STUDY DESIGN: A survey was mailed to a sample of pediatricians (n = 600) and family physicians (n = 600) randomly selected from the American Medical Association Physician Masterfile. The survey contained a clinical vignette describing a 9-month-old nondysmorphic boy with GDD. Participants were asked their initial evaluation steps (test, refer, or both test and refer) and what types of referral and/or testing they would pursue. We examined bivariate associations between physician/clinical practice characteristics and participants' evaluation decision. RESULTS: More pediatricians than family physicians completed the survey (response rates: 55% vs 38%). Almost three-quarters of the respondents (74%) reported that their first step in a diagnostic evaluation would be to refer the child without testing, 22% would test only, and 4% would both test and refer. As their initial step, most physicians referred to a developmental pediatrician (58%), and only 5% would refer to a geneticist. The most commonly ordered test was general biochemical testing (64%). The most commonly ordered genetic test was a karyotype (39%). CONCLUSIONS: When evaluating a child with GDD, few primary care physicians would order genetic testing or refer to a genetics specialist as a first evaluation step. Future studies should examine both barriers to and utilization of a genetic evaluation for children with GDD.
OBJECTIVE: To examine the decisions of pediatric primary care physicians about their diagnostic evaluation for a child with suspected global developmental delay (GDD). STUDY DESIGN: A survey was mailed to a sample of pediatricians (n = 600) and family physicians (n = 600) randomly selected from the American Medical Association Physician Masterfile. The survey contained a clinical vignette describing a 9-month-old nondysmorphic boy with GDD. Participants were asked their initial evaluation steps (test, refer, or both test and refer) and what types of referral and/or testing they would pursue. We examined bivariate associations between physician/clinical practice characteristics and participants' evaluation decision. RESULTS: More pediatricians than family physicians completed the survey (response rates: 55% vs 38%). Almost three-quarters of the respondents (74%) reported that their first step in a diagnostic evaluation would be to refer the child without testing, 22% would test only, and 4% would both test and refer. As their initial step, most physicians referred to a developmental pediatrician (58%), and only 5% would refer to a geneticist. The most commonly ordered test was general biochemical testing (64%). The most commonly ordered genetic test was a karyotype (39%). CONCLUSIONS: When evaluating a child with GDD, few primary care physicians would order genetic testing or refer to a genetics specialist as a first evaluation step. Future studies should examine both barriers to and utilization of a genetic evaluation for children with GDD.
Authors: John Peabody; Megan Martin; Lisa DeMaria; Jhiedon Florentino; David Paculdo; Michael Paul; Rena Vanzo; E Robert Wassman; Trever Burgon Journal: PLoS One Date: 2016-12-30 Impact factor: 3.240