Physicians' reliance on specialists, therapists, and vendors when prescribing therapies and durable medical equipment for children with special health care needs

Objectives. Physicians who care for children with special (health care) nee ds (CWSN) often must prescribe therapies and/or specialized, durable medica l equipment (DME). Given this responsibility and the increasing scrutiny of prescribing practices by various oversight agencies, understanding the ext ent to which pediatricians rely on their own expertise when prescribing the rapies and DME is an important area of research. Methods. As part of an ongoing investigation of physician preparedness for and practice in prescribing therapies, DME, or procedures for CWSN, we mail ed surveys to practicing pediatricians in each of 2 states-Ohio and Mississ ippi-and to a senior resident at all identified pediatric residency-trainin g programs. The surveys polled recipients as to who they would rely on them selves-specialists, therapists or vendors-to make prescription decisions fo r a variety of therapies and DME of increasing complexity. We report result s as proportions of returned and completed questionnaires. Comparisons amon g the 3 groups (pediatricians from Ohio and Mississippi and residents) were made with the use of chi (2) analysis. Results. For some categories of therapy and DME, physicians and residents r eported that they would take an active role in prescription decisions, and their reliance on specialty consultation increased appropriately with the i ncreasing complexity of the device or therapy. However, respondents general ly seemed to share responsibility rather than rely on themselves as sole de cision makers for most categories; fewer than one fourth took sole responsi bility. Reliance on nonphysician health care providers was evident for all categories; in some cases, up to half of the respondents would allow therap ists to take over these decisions, and a small but significant percentage o f physicians would entrust DME prescription decisions to vendors alone. Conclusions. Our findings indicate that many practicing pediatricians and t hose in training may be unwilling to assume sole responsibility in prescrib ing and managing therapies and DME for CWSN. Although the number who would rely on consultation with specialists is somewhat reassuring, we found that a significant percentage would turn to nonphysician health care providers and even vendors to make these decisions in some cases, raising liability i mplications, conflict-of-interest issues, and quality-of-care issues. To pr otect themselves and their patients from fraud and inappropriate prescripti ons and medical management, pediatricians must become increasingly conscien tious about complying with American Medical Association guidelines and fede ral and state laws regarding initiation and supervision of therapies and DM E. We offer some recommendations that may help to address this problem.