Parental preferences for primary and specialty care collaboration in the management of teenagers with congenital heart disease

Objectives. We examined parental preferences for locus of service delivery for their teenager's congenital heart disease (CHD) and the influence of di sease severity, sociodemographic factors, and insurance on these preference s. Methods. A consecutive sample of parents of teenagers followed in a pediatr ic cardiology clinic completed a mailed questionnaire. Disease severity was classified as low (less than or equal to 1 cardiovascular procedure), mode rate (> 1 cardiovascular procedure), and high (cyanosis or single ventricle physiology). Results. Eighty-six of 148 parents responded (58%): 40, low severity; 36, m oderate severity; and 10, high severity of illness. Parents preferred using primary care providers (PCPs) as a point of first contact for all 11 of 11 general health concerns and 5 of 7 potential cardiovascular-related concer ns: chest pain (52%), syncope (73%), seeming seriously ill (79%), sports ph ysical examination (79%), and endocarditis prophylactic antibiotics (94%). Increasing disease severity was significantly associated with preferring ca rdiologists for 6 of 7 cardiovascular-related concerns. Overall, 58% of par ents viewed their care as a PCP-cardiologist comanagement model versus a ca rdiologist-dominated model. Lower family income (odds ratio [OR]: 1.5; conf idence interval [CI]: 1.0-2.2) and severity of illness (OR: 2.1; CI: 1.0-4. 4) were associated with a comanagement model of health care versus a cardio logist-dominated model. Conclusions. This study suggests that the majority of parents of teenagers with CHD prefer to use their teenager's PCP for all routine health care nee ds and many cardiovascular health needs. Severity of illness and family inc ome are positively associated with greater preference for cardiologist care .