General and subspecialist pediatrician perspectives on barriers and strategies for referral: a latent profile analysis

Bohnhoff, James C.; Guyon-Harris, Katherine; Schweiberger, Kelsey; Ray, Kristin N.

doi:10.1186/s12887-023-04400-8

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…A referral is typically required by both the specialty care physician’s office or service provider and the insurance payer. Barriers in communication among PCPs, specialists, and payers, as well as limited access to specialty care providers and services, can extend referral appointment wait times [ 40 , 42 – 44 ]. For conditions like SMA that require immediate evaluation by a specialist to determine if emergent treatment is necessary, prolonged wait times for referral appointments can be especially problematic [ 22 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Barriers to Referral and Appointment Wait Times for the Evaluation of Spinal Muscular Atrophy (SMA): Findings from a Web-Based Physician Survey

Curry,

Cruz,

Belter

et al. 2024

Neurol Ther

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Background Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. Clinical trial data suggest early diagnosis and treatment are critical. The purpose of this study was to evaluate neurology appointment wait times for newborn screening identified infants, pediatric cases mirroring SMA symptomatology, and cases in which SMA is suspected by the referring physician. Approaches for triaging and expediting referrals in the US were also explored. Methods Cure SMA surveyed healthcare professionals from two cohorts: (1) providers affiliated with SMA care centers and (2) other neurologists, pediatric neurologists, and neuromuscular specialists. Surveys were distributed directly and via Medscape Education, respectively, between July 9, 2020, and August 31, 2020. Results Three hundred five total responses were obtained (9% from SMA care centers and 91% from the general recruitment sample). Diagnostic journeys were shorter for infants eventually diagnosed with SMA Type 1 if they were referred to SMA care centers versus general sample practices. Appointment wait times for infants exhibiting “hypotonia and motor delays” were significantly shorter at SMA care centers compared to general recruitment practices ( p = 0.004). Furthermore, infants with SMA identified through newborn screening were also more likely to be seen sooner if referred to a SMA care center versus a general recruitment site. Lastly, the majority of both cohorts triaged incoming referrals. The average wait time for infants presenting at SMA care centers with “hypotonia and motor delay” was significantly shorter when initial referrals were triaged using a set of “key emergency words” ( p = 0.036). Conclusions Infants directly referred to a SMA care center versus a general sample practice were more likely to experience shorter SMA diagnostic journeys and appointment wait times. Triage guidelines for referrals specific to “hypotonia and motor delay” including use of “key emergency words” may shorten wait times and support early diagnosis and treatment of SMA. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-024-00587-9.

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