Barriers and alternatives to pediatric rheumatology referrals: Survey of general pediatricians in the United States

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18 Scopus citations


Access to pediatric rheumatology (PR) care is limited, however the impact that limited access to PR has on pediatricians has not been examined. The goal of this study was to investigate barriers to PR referrals and resulting alternative referral patterns among primary pediatricians. Methods: A web-based survey was emailed to primary pediatricians practicing in Minnesota, North Dakota, and South Dakota in order to investigate access to PR care issues. Basic descriptive analysis was performed. Results: The response rate was 15 % (93/609). Twenty-nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9 % (8/92) were more than six hours away. Ninety-two percent (85/92) had referred a patient to PR at least once, but 89 % (83/93) had experienced a situation in which they considered a referral to PR but ultimately did not. Many had referred to other subspecialists instead: 29 % (24/83) to pediatric infectious disease, 20 % to adult rheumatology, and 12 % to pediatric orthopedics, while 34 % managed the patient themselves. Thirty-five percent (32/60) had referred to an adult rheumatologist, commonly due to decreased travel (44 %), while physician preference was never selected as a reason. Conclusion: Pediatricians often refer children with possible rheumatic disease to specialists other than PR mainly due to long travel distances. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to PR care.

Original languageEnglish (US)
Article number32
JournalPediatric Rheumatology
Issue number1
StatePublished - Jul 29 2015

Bibliographical note

Funding Information:
Statistical support was provided by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114 to the University of Minnesota Clinical and Translational Sciences Institute.

Publisher Copyright:
© 2015 Correll et al.


  • Access to care
  • Pediatric rheumatology
  • Pediatrician


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