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Patients, pediatricians have different views on physician availability

Although patients and pediatricians largely agreed on more than two dozen aspects of what makes a good physician-patient partnership, there were differing views on the subject of physician accessibility, according to data published in the Journal of the American Board of Family Medicine.

The researchers found that 94.89% of surveyed patients identified a physician “being available any time of day or night” as important, but only 44.82% of pediatricians felt the same. In addition, 98.55% of parents felt “avoiding legal issues interfering with pediatrician relationship with parent and child” was important, a sentiment shared by only 61.86% of physicians.

“Partnerships between stakeholders in the health care system can effectively address the needs of individuals and build an environment and community that supports healthy living,” Richard C. Rapp, PhD, and John Pascoe, MD, MPH, of the department of pediatrics at Wright State University Boonshoft School of Medicine, in Dayton, Ohio, wrote. “Consistent with this view, partnership between parents and their child’s health care clinicians has been linked to improved quality of care, satisfaction with care, adherence to recommendations and better medical, environmental and health outcomes.”

The researchers recruited two samples comprising 24 pediatricians from the Southwestern Ohio Ambulatory Research Network (SOAR-Net), a primary care and pediatric practice-based research group, and the Western Ohio Pediatric Society, made up of general pediatricians. In addition, they recruited parents from two SOAR-Net practices, 90 from a privately owned practice in an affluent suburb of Dayton, and 101 from a federally qualified community health center in Springfield.

Pediatricians and parents were asked to review 61 partnership concepts and identify those they considered as being important.

According to the researchers, 42 of the concepts received probability scores of at least 80% in the pediatricians group and both of the parent groups. Of those, 16 were deemed redundant by the researchers, resulting in 26 concepts seen as important by both pediatricians and parents. Those with the highest levels of consensus included:

• Providing parent with skills or information to help parent’s child succeed;
• Being honest with parent, even when there is bad news;
• Treating child and parent with dignity;
• Clearly explaining what the treatment is;
• Making sure parent/youth understand the plan;
• Explaining problem and treatment in terms parent/youth can understand; and
• Making sure the parent/youth really understand the problem/treatment.

Concepts that received high probability scores from parents, but not pediatricians, included:

• Being available any time of day or night;
• Discussing child’s care with other professionals;
• Spending as much time as possible with parent/child;
• Avoiding legal issues interfering with pediatrician relationship with parent and child; and
• Agreeing with physician on treatment on treatment plan.

Concepts with high probability scores from the pediatrician group, but not parents:

• Making recommendations about a course of treatment;
• Involving parent in defining the problem;
• Including the child in a discussion of his/her condition;
• Including an age-appropriate child in planning a course of treatment;
• Giving specific reassuring information;
• Including parent’s recommendations about what should be included in the treatment plan; and
• Giving advice on how to stay healthy in future.

“Although pediatric clinics provided the critical mass necessary to conduct this study, the findings are relevant for all clinicians who treat children, with one notable addition,” Rapp and Pascoe wrote. “Physicians in practices that primarily see adult patients may need to consider the potential differences that exist between adults who are patients and adults who represent the well-being of their children. When considering the parent-identified concepts, family practice physicians, nurse practitioners and physician assistants are faced with the same challenges as pediatricians in establishing partnerships. Large patient loads can limit the opportunity both to spend time with a child patient and to engage parents in a full understanding of a treatment plan. And, like pediatricians, other child health care practitioners must ultimately understand the cultural and individual factors that affect and shape partnerships with parents.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.