Underlying Rationale and Approach to Treat XXXX in Adolescents by Physicians of Different Specialty.

@entity1 @entity101
OBJECTIVE: To describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with @entity101 . METHODS: We conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each @entity1 was asked to "think aloud" regarding their approach to a hypothetical @entity1 - 12 year old @entity1 with persistent @entity101 for 6 months. Standardized open-ended questions about potential factors that could affect physicians' diagnosis and treatment strategies (e.g., @entity1 age) were used. Interviews were audio-recorded; transcribed verbatim; transcripts were independently coded by 2 investigators; emergent themes identified and inter-coder agreement achieved. Thematic analysis was performed based on grounded theory. RESULTS: Nineteen @entity1 included 5 general pediatricians, 5 pediatric cardiologists, 5 pediatric nephrologists and 4 family physicians. Five themes emerged: 1) Accuracy of blood pressure measurement and @entity101 diagnosis, 2) Shift in the epidemiology of pediatric @entity101 from secondary to primary @entity101 , 3) @entity1 characteristics considered in the decision to initiate workup, 4) Obesity-centered choice of diagnostic tests and lifestyle modifications, and 5) Variable threshold for initiating antihypertensive pharmacotherapy vs. referral to @entity101 specialists. CONCLUSIONS: There is variation across primary care and specialty physicians who provide care for @entity1 and adolescents with @entity101 . Key areas of variability include the willingness to initiate antihypertensive medications, the use of diagnostic tests (e.g., ambulatory blood pressure monitoring), and the perceived need for specialty referral. Further study is needed to assess whether different treatment paradigms result in differential @entity1 outcomes.
