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A Prospective Pilot Study of Co-Management of Pediatric Voiding Dysfunction by Pediatric Primary Care Providers and Urologists
John H. Makari, MD1, Jennifer L. Schwab, MD2, Sarah Mazzarese, RN3, Laura Chandhok, MPH4, Karen Rubin, MD5.
1Connecticut Children's Medical Center/ University of Connecticut School of Medicine Division of Urology, Hartford, CT, USA, 2University of Connecticut School of Medicine Department of Pediatrics, Farmington, CT, USA, 3Connecticut Children's Medical Center Division of Urology, Hartford, CT, USA, 4Connecticut Children's Medical Center Department of Research, Hartford, CT, USA, 5Connecticut Children's Medical Center/ University of Connecticut School of Medicine Division of Endocrinology, Hartford, CT, USA.
Background: Pediatric Voiding Dysfunction (PVD) represents a variety of symptoms and diagnoses which are typically non-surgical and may require long-term behavioral modification with repeated reinforcement by healthcare providers. Patient access to pediatric urologic care is often limited. Shared care, or “co-management,” by the primary care provider (PCP) and pediatric urologist may be more appropriate and improve access. In a pilot study, a pediatric urologist and PCP collaboratively developed a structured Co-Management plan for PVD which included a service agreement, office visit templates, an algorithm, diagnostic tools, patient and family-centered materials, and continuing medical education training for PCPs.
Methods: After PCPs participated in a formal CME activity, enrolled patients received initial and follow-up visits with their PCP. Care continued either with PCP if improved or with a pediatric urologist if unimproved. The co-management plan included a service agreement, office visit templates, algorithm, diagnostic tools, patient and family-centered materials, and continuing medical education training for PCPs. We evaluated PCP preparedness after baseline didactics and both PCP and Urologist adherence the management plan.
Results: Six PCPs prospectively enrolled 15 patients (14 female, 1 male; mean age 7.25 years, SD 3.28). Baseline survey indicated that PCPs felt very prepared (5/6) or somewhat prepared (1/6) to provide co- managed care. PCPs completed 88%, ± 7.8%, (mean, SD) of required data fields on initial evaluation notes and 87%, ± 9.2% of required data fields on follow-up notes. Urologists completed 83%, ± 17% of required data fields for referred patients (n=3). 12/15 study patients (80%) have been managed exclusively by the PCP. The 3 patients referred to the specialist were assessed by urologists to be appropriate and high-quality referrals.
Conclusions: Co-management appears to be a viable care delivery model for PVD. In this prospective pilot study, PCPs felt very prepared to provide co-managed care for patients with PVD and both PCPs and Pediatric Urologists demonstrated high levels of adherence to the co-management plan. Most patients were able to be exclusively managed by the PCP, potentially increasing access to Pediatric Urologists.
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