Complexity of pediatric chronic disease: Cross-sectional study with 16,237 patients followed by multiple medical specialties

Abstract

Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems — ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4–16.4) vs. 1.4 (0.1–16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio — OR=8.0; confidence interval of 95% — 95%CI 6–10.7; p<0.001), Palliative/ Pain Care (OR=7.4; 95%CI 5.7–9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4–7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6–8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0–10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8–5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9–3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7–3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1–3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9–4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.