Background: As medical complexity of pediatric patients rises, inpatient family care conferences (FCCs) are increasingly utilized to discuss treatment decisions and goals of care with families and multiple care team members. Studies have shown that emotional connections with providers at a FCC increase family satisfaction with these conferences. Proposals for structuring FCCs suggest involvement of patient’s primary care physicians, however, research into the role and value a Primary Care Provider (PCP) can have in these discussions is limited. We seek to better characterize current practices regarding PCP participation in FCCs and identify existing barriers to their attendance.
Methods: Pediatric PCPs and inpatient providers in Southeast Michigan were approached via email to participate in a perspective survey study. The surveys were hosted via Qualtrics. Participation was voluntary and all responses were anonymous. The surveys were distributed to both academic and private practices from May 2022 through September 2022. Discrete data is shown as a percentage of responders with a certain response. Continuous data was viewed as an average, including a standard deviation.
Results: A total of 41 PCP (63% academic medicine setting) and 52 inpatient (52% subspecialists, 26% intensivists, and 21% hospitalist) surveys were completed. Only 34% of PCPs reported ever participating in an inpatient FCC while 51% of inpatient providers reported having had a PCP join. It was most common for the inpatient team (55%) or family (33%) to invite the PCP to attend. Inpatient providers less frequently reported PCPs attending meetings in person (32%) compared to PCPs (75%). Almost ninety percent of PCPs reported they would be somewhat or extremely likely to attend an FCC if invited with 80% reporting not being invited is a key barrier to participation. The majority of inpatient providers (86%) also felt it would be slightly helpful or helpful if a PCP attended. Enhanced relationships with both the family and inpatient medical team along with a better understanding of patient medical care were the most common perceived benefits of PCP involvement in conferences. Inpatient providers most often reported engaging PCPs in FCCs for multidisciplinary discussions and discharge planning. For both groups, clinical schedule or volume (95% PCPs vs 60%) was the most common identified barrier for PCP involvement.
Conclusions: Despite the increasing utilization of FCC during hospital admissions, our surveys demonstrate that PCPs are infrequently involved in these meetings. This is occurring despite PCP’s overall desire to attend these meetings with their patients and shared feeling that their presence would contribute. Further work is needed to address barriers for involvement such as standardized invitations and scheduling innovations. By increasing overall PCP attendance of these meetings, we can then better study the impact they have on overall meeting satisfaction and patient care.