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. 2018 May 22:20:e59.
doi: 10.1017/S146342361800035X.

Complexity in pediatric primary care

Arwa Nasir  1 , Laeth Nasir  2 , Ariel Tarrell  1 , David Finken  1 , Amy Lacroix  1 , Swetha Pinninti  1 , Sheryl Pitner  1 , Molly McCarthy  3
Affiliations

Complexity in pediatric primary care

Arwa Nasir et al. Prim Health Care Res Dev. .

Abstract

Background: The management of patients in primary care is often complicated by the presence of multiple chronic conditions and psychosocial issues that increase the complexity of the encounter and have important impacts on care. There is a paucity of literature on this subject in the pediatric population.

Objectives: The aim of this study was to quantify the burden of chronic conditions in pediatric primary care.

Methods: The problem lists of 3995 randomly selected patients from a community pediatric clinic and an academic hospital-based pediatric clinic in the same metropolitan area were analyzed for the presence and number of any chronic condition.

Results: In total, 53% of patients suffered from at least one chronic problem, 25% had two or more chronic conditions and 5.1% had four or more conditions. Compared with the community clinic, the academic clinic had significantly more children with catastrophic complex conditions (P<0.001). A regression analysis showed a significant positive correlation between the number of chronic medical conditions and mental health diagnoses.

Conclusions: The burden of chronic disease in the pediatric primary care setting may be significantly higher than has been previously suggested. To ensure optimal quality of care, health planners should take into account the high burden of chronic illness, psychosocial issues and multimorbidity among patients in the pediatric primary care setting, as well as the higher complexity profile of patients attending academic clinics.

Keywords: chronic medical complexity; multimorbidity; pediatric primary care; psychosocial morbidity.

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Figures

Figure 1
Figure 1
Relationship between chronic medical and psychosocial/behavioral diagnoses
See this image and copyright information in PMC

References

    1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet 380, 37–43. - PubMed
    1. Branum AM Lukacs SL (2009) Food allergy among children in the United States. Pediatrics 124, 1549–1555. - PubMed
    1. Brett T, Arnold-Reed DE, Popescu A, Soliman B, Bulsara MK, Fine H, Bovell G Moorhead RG (2013) Multimorbidity in patients attending 2 Australian primary care practices. Annals of Family Medicine 11, 535–542. - PMC - PubMed
    1. Britt HC, Harrison CM, Miller GC Knox SA (2008) Prevalence and patterns of multimorbidity in Australia. Medical Journal of Australia 189, 72–77. - PubMed
    1. Campo JV, Jansen-McWilliams L, Comer DM Kelleher KJ (1999) Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. Journal of the American Academy of Child and Adolescent Psychiatry 38, 1093–1101. - PubMed

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