Parents unclear about process for specialist care for kids

Most children get their health care from a primary care provider, known as a PCP, but when there are signs or symptoms of a more serious illness, the PCP often refer kids to a specialist.

According to this month's poll, it's a common occurrence. Among the 1,232 parents surveyed in this poll, 46 percent report that at least one of their children has been referred to a specialist.

But when asked about the process of getting specialist care for their child, parents had a wide range of views, says Sarah J. Clark, M.P.H. , associate director of the National Poll on Children's Health and associate research scientist in the University of Michigan Department of Pediatrics.

Parents are divided over who is responsible for choosing the specialist: 52 percent say the PCP and 48 percent say the parent. They also differed in who should verify insurance coverage: 55 percent say the PCP and 45 percent say the parent.

Forty percent of parents say the PCP should make sure the wait time isn't too long for a specialist appointment, but 60 percent say that's the parents' responsibility.

"This poll shows a wide range of views about who is supposed to do what, so it's not unexpected that sometimes the process doesn't work well," says Clark. "If a referral is delayed or it doesn't happen at all, a child's health can be put at risk."

The poll also found that parents of children with Medicaid insurance coverage are more likely than parents of privately-insured children to say PCPs should be responsible for choosing the specialist, calling to set up the appointment, and verifying that insurance will cover the specialist care. Clark says this indicates that PCPs should understand that their Medicaid patients may have different expectations about their roles.

Parents also were asked to rank the importance of different characteristics of specialists, and rated the following as very important:

• knowing how to take care of the child's specific condition (89%)
• having training in pediatrics (80%)
• being affiliated with a highly-rated hospital (62%)
• being involved in research so child has access to latest treatment (50%)
• appointment time convenient for the family schedule (43%)
• drive time to the specialist (38%)
• other parents recommending the specialist (38%)

"For a parent, hearing that a child needs to see a specialist is often cause for concern. Confusion about their responsibilities for arranging specialty care can add to parents' anxiety," says Clark, who also is associate director of the Child Health Evaluation and Research (CHEAR) Unit.

"Primary care providers cannot assume that parents understand their responsibilities around making specialty appointments. Clear communication -- ideally, with instructions written in plain language -- will help parents ensure their kids get the care they need."