AAP News Vol. 13 No. 5 May 1997, p. 20
© 1997 American Academy of Pediatrics
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MANAGED CARE

Stephen Berman M.D., FAAP

Q&A When caring for a child with special health care needs, are there potential drawbacks to assigning "gatekeeper" responsibilities to pediatric medical sub-specialists specializing in a child's specific condition?

Potential drawbacks and advantages exist in assigning primary care/"gatekeeper" responsibilities to pediatric medical subspecialists when caring for a child with special health care needs. Being a gatekeeper involves serving as the first contact for the family to provide comprehensive primary care and to make appropriate referrals. When physicians are the first contact for the family, systems should be in place which ensure the physician (or a suitable alternative provider) is available for telephone and/or personal consultation 24 hours a day, seven days a week. Comprehensive primary care should include health maintenance and preventive care, as well as services related to acute and chronic illness and injury.