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      National study of continuity clinic satisfaction in pediatric fellowship training

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          Abstract

          Background

          A national online survey was conducted to evaluate pediatric subspecialty fellow satisfaction regarding continuity clinic experience.

          Methods

          An anonymous online survey (SurveyMonkey™) was developed to evaluate demographics of the program, clinic organization, and patient and preceptor characteristics, and to compare fellow satisfaction when fellows were the primary providers with faculty supervision versus attending-run clinics assisted by fellows or a combination of the two models. Pediatric subspecialty fellows in a 3-year Accreditation Council for Graduate Medical Education accredited program in the United States (excluding emergency medicine, neonatology, and critical care) were invited to participate.

          Results

          There were 644 respondents and nearly half (54%) of these had fellow-run clinics. Eighty-six percent of fellows responded that they would prefer to have their own continuity clinics. Higher satisfaction ratings on maintaining continuity of care, being perceived as the primary provider, and feeling that they had greater autonomy in patient management were associated with being part of a fellow-run clinic experience (all P < 0.001). Additionally, fellow-run clinics were associated with a feeling of increased involvement in designing a treatment plan based on their differential diagnosis ( P < 0.001). There were no significant associations with patient or preceptor characteristics.

          Conclusion

          Fellow-run continuity clinics provide fellows with a greater sense of satisfaction and independence in management plans.

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          Most cited references11

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          Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents.

          Over the past 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. The rapid emergence of childhood T2DM poses challenges to many physicians who find themselves generally ill-equipped to treat adult diseases encountered in children. This clinical practice guideline was developed to provide evidence-based recommendations on managing 10- to 18-year-old patients in whom T2DM has been diagnosed. The American Academy of Pediatrics (AAP) convened a Subcommittee on Management of T2DM in Children and Adolescents with the support of the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). These groups collaborated to develop an evidence report that served as a major source of information for these practice guideline recommendations. The guideline emphasizes the use of management modalities that have been shown to affect clinical outcomes in this pediatric population. Recommendations are made for situations in which either insulin or metformin is the preferred first-line treatment of children and adolescents with T2DM. The recommendations suggest integrating lifestyle modifications (ie, diet and exercise) in concert with medication rather than as an isolated initial treatment approach. Guidelines for frequency of monitoring hemoglobin A1c (HbA1c) and finger-stick blood glucose (BG) concentrations are presented. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent peer review before it was approved by the AAP. This clinical practice guideline is not intended to replace clinical judgment or establish a protocol for the care of all children with T2DM, and its recommendations may not provide the only appropriate approach to the management of children with T2DM. Providers should consult experts trained in the care of children and adolescents with T2DM when treatment goals are not met or when therapy with insulin is initiated. The AAP acknowledges that some primary care clinicians may not be confident of their ability to successfully treat T2DM in a child because of the child's age, coexisting conditions, and/or other concerns. At any point at which a clinician feels he or she is not adequately trained or is uncertain about treatment, a referral to a pediatric medical subspecialist should be made. If a diagnosis of T2DM is made by a pediatric medical subspecialist, the primary care clinician should develop a comanagement strategy with the subspecialist to ensure that the child continues to receive appropriate care consistent with a medical home model in which the pediatrician partners with parents to ensure that all health needs are met.
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            Does continuous care from a physician make a difference?

            Continuity of care with a personal health care provider is both an honored and controversial concept. This paper reviews the literature regarding the effect of a continuous relationship with a personal health care provider (longitudinal care) on quality of care using specific selection criteria and methodological standards. Sixteen studies were found of which four provided most of the valid information. Among the studies reviewed, the most common serious methodological problem was inconsistent definitions of continuity. Longitudinal care from a provider has been shown in certain settings to improve patient and staff satisfaction, compliance with medication and with appointments, and patient disclosure of behavioral problems. No ill effects have yet been demonstrated. There is some evidence that having an ongoing provider could reduce the costs of care. From available information, any evolution of the medical care delivery system away from reliance on an ongoing relationship between provider and patient may sacrifice important benefits.
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              Continuity of care is associated with high-quality careby parental report.

              The benefits of continuity of pediatric care remain controversial.
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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                Advances in Medical Education and Practice
                Advances in Medical Education and Practice
                Dove Medical Press
                1179-7258
                2013
                16 September 2013
                : 4
                : 165-169
                Affiliations
                [1 ]Division of Pediatric Endocrinology and Diabetes, The Children’s Hospital at Montefiore, New York, NY, USA
                [2 ]Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
                Author notes
                Correspondence: Rubina A Heptulla, The Children’s Hospital at Montefiore, Division of Pediatric Endocrinology and Diabetes, 3411 Wayne Avenue, Fourth Floor, Bronx, New York, NY 10467, USA, Tel +1 718 920 5473, Fax +1 718 405 5609, Email rubina.heptulla@ 123456einstein.yu.edu
                Article
                amep-4-165
                10.2147/AMEP.S51069
                3791542
                3f24c205-39e6-4a31-91ba-65375a387bfe
                © 2013 Gangat et al. This work is published by Dove Medical Press Ltd, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed.

                History
                Categories
                Original Research

                resident education/training,workforce,pediatric,patient-provider relationship,pediatric outpatient clinic

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