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Lindau ST, Makelarski JA, Abramsohn EM, Beiser DG, Boyd K, Chou C, Giurcanu M, Huang ES, Liao C, Schumm LP, Tung EL. CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention. Am J Public Health 2019; 109:600-606. [PMID: 30789775 DOI: 10.2105/ajph.2018.304905] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. METHODS A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record-generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. RESULTS At 3 months, there was no difference between groups in mental (-1.03; 95% confidence interval [CI] = -3.02, 0.96) or physical HRQOL (0.59; 95% CI = -0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. CONCLUSIONS CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02435511.
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Affiliation(s)
- Stacy Tessler Lindau
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Jennifer A Makelarski
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Emily M Abramsohn
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - David G Beiser
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Kelly Boyd
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Chiahung Chou
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Mihai Giurcanu
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Elbert S Huang
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Chuanhong Liao
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - L Philip Schumm
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Elizabeth L Tung
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
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Bergmans RS, Zivin K, Mezuk B. Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study. J Psychosom Res 2019; 117:22-29. [PMID: 30665592 PMCID: PMC6467465 DOI: 10.1016/j.jpsychores.2018.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes. METHODS Data came from the 2010-2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms. RESULTS Food insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 1.1-2.5) and diabetes-related kidney problems (OR = 1.6; 95% CI = 1.1-2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95% CI = 1.7-2.4) and longitudinally (OR = 1.5, 95% CI = 1.3-1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5% (p-value = .09) of the association with depressive symptoms in 2014. CONCLUSION The relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.
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Affiliation(s)
- Rachel S Bergmans
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States; Department of Veterans Affairs, Ann Arbor, MI, United States
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Thompson T, McQueen A, Croston M, Luke A, Caito N, Quinn K, Funaro J, Kreuter MW. Social Needs and Health-Related Outcomes Among Medicaid Beneficiaries. HEALTH EDUCATION & BEHAVIOR 2019; 46:436-444. [PMID: 30654655 DOI: 10.1177/1090198118822724] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Unmet social needs-including food, housing, and utilities-have been associated with negative health outcomes, but most prior research has examined the health associations with a single unmet need or analyzed samples that were homogeneous along one or more dimensions (e.g., older adults or patients with chronic health conditions). We examined the association between unmet social needs and psychosocial and health-related outcomes in a sample of Medicaid beneficiaries from 35 U.S. states. In 2016-2017, 1,214 people completed an online survey about social needs, demographics, and health-related and psychosocial outcomes. Seven items assessing social needs formed an index in which higher scores indicated higher levels of unmet needs. Participants were eligible if they were ≥18 years and had Medicaid. The sample was predominantly female (87%). Most (71%) lived with at least one child ≤18 years, and 49% were White and 33% were African American. Average age was 36 years ( SD = 13). The most common unmet needs were not enough money for unexpected expenses (54%) and not enough space in the home (25%). Analyses controlling for recruitment method and demographics showed that increasing levels of unmet social needs were positively associated with stress, smoking, and number of chronic conditions, and negatively associated with future orientation, attitudes toward prevention, days of exercise/week, servings of fruits or vegetables/day, and self-rated health (all p < .01). Results add to the evidence about the relationship between unmet social needs and health. Interventions to help meet social needs may help low-income people improve both their economic situations and their health.
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Affiliation(s)
- Tess Thompson
- 1 Washington University in St. Louis, St. Louis, MO, USA
| | - Amy McQueen
- 1 Washington University in St. Louis, St. Louis, MO, USA
| | | | - Alina Luke
- 1 Washington University in St. Louis, St. Louis, MO, USA
| | - Nicole Caito
- 1 Washington University in St. Louis, St. Louis, MO, USA
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54
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Mattson G, Kuo DZ, Yogman M, Baum R, Gambon TB, Lavin A, Esparza RM, Nasir AA, Wissow LS, Apkon S, Brei TJ, Davidson LF, Davis BE, Ellerbeck KA, Hyman SL, Leppert MO, Noritz GH, Stille CJ, Yin L. Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families. Pediatrics 2019; 143:peds.2018-3171. [PMID: 30559121 DOI: 10.1542/peds.2018-3171] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children and youth with special health care needs (CYSHCN) and their families may experience a variety of internal (ie, emotional and behavioral) and external (ie, interpersonal, financial, housing, and educational) psychosocial factors that can influence their health and wellness. Many CYSHCN and their families are resilient and thrive. Medical home teams can partner with CYSHCN and their families to screen for, evaluate, and promote psychosocial health to increase protective factors and ameliorate risk factors. Medical home teams can promote protective psychosocial factors as part of coordinated, comprehensive chronic care for CYSHCN and their families. A team-based care approach may entail collaboration across the care spectrum, including youth, families, behavioral health providers, specialists, child care providers, schools, social services, and other community agencies. The purpose of this clinical report is to raise awareness of the impact of psychosocial factors on the health and wellness of CYSHCN and their families. This clinical report provides guidance for pediatric providers to facilitate and coordinate care that can have a positive influence on the overall health, wellness, and quality of life of CYSHCN and their families.
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Affiliation(s)
- Gerri Mattson
- Children and Youth Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina; and
| | - Dennis Z. Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, New York
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Thompson T, Roux AM, Kohl PL, Boyum S, Kreuter MW. What would help low-income families most? Results from a national survey of 2-1-1 call center professionals. J Child Health Care 2018; 22:670-683. [PMID: 29788775 PMCID: PMC6904533 DOI: 10.1177/1367493518777152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Almost half of young American children live in low-income families, many with unmet needs that negatively impact health and life outcomes. Understanding which needs, proactively addressed, would most improve their lives would allow maternal and child health practitioners and social service providers to generate collaborative solutions with the potential to affect health in childhood and throughout the life course. 2-1-1 referral helplines respond to over 16 million inquiries annually, including millions of low-income parents seeking resources. Because 2-1-1 staff members understand the availability of community resources, we conducted an online survey to determine which solutions staff believed held most potential to improve the lives of children in low-income families. Information and referral specialists, resource managers, and call center directors (N = 471) from 44 states, Puerto Rico, and Canada ranked the needs of 2-1-1 callers with children based on which needs, if addressed, would help families most. Childcare (32%), parenting (29%), and child health/health care (23%) were rated most important. Across all childcare dimensions (e.g. quality affordable care, special needs care), over half of the respondents rated community resources inadequate. Findings will help practitioners develop screeners for needs assessment, prioritize resource referrals, and advocate for community resource development.
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Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne M. Roux
- Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Patricia L. Kohl
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Sonia Boyum
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
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Platt RE, Spencer AE, Burkey MD, Vidal C, Polk S, Bettencourt AF, Jain S, Stratton J, Wissow LS. What's known about implementing co-located paediatric integrated care: a scoping review. Int Rev Psychiatry 2018; 30:242-271. [PMID: 30912463 PMCID: PMC6499629 DOI: 10.1080/09540261.2018.1563530] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study.
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Affiliation(s)
| | | | | | - Carolina Vidal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sonal Jain
- New York Institute of Technology College of Osteopathic Medicine
| | - Julia Stratton
- Vancouver Coastal Health Authority, Pacific Spirit and Raven Song Child and Youth Mental Health Teams
| | - Lawrence S Wissow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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57
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Quinn C, Johnson K, Raney C, Baker J, Topel K, Tschudy MM, Jaganath D, Solomon BS. "In the Clinic They Know Us": Preferences for Clinic-Based Financial and Employment Services in Urban Pediatric Primary Care. Acad Pediatr 2018; 18:912-919. [PMID: 29959085 DOI: 10.1016/j.acap.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To understand views of adolescent and adult caregivers on integrating employment and financial services into a pediatric primary care clinic serving low-income families. METHODS Eighteen in-depth qualitative interviews were conducted among caregivers of pediatric patients. Participants were recruited from those who completed a survey assessing financial and employment needs. Audio-recorded transcripts were analyzed using line-by-line coding of emerging themes. RESULTS Adolescent and adult caregivers expressed difficulty managing financial stress. They cited having a criminal history, limited financial literacy, and lack of available quality jobs as barriers to achieving financial stability. A clinic-based employment and financial program was highly acceptable among potential users for the convenience it offers and the established trust and understanding between patients and clinical providers. Participants preferred one-on-one counseling for sensitive employment and financial issues, although they did believe that some topics, such as building a resume, could be accomplished in group workshops. CONCLUSIONS Caregivers attending a pediatric clinic expressed interest in and anticipated value from clinic-based employment and financial services if implemented services are relevant, accessible, and provide options for group and individualized approaches.
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Affiliation(s)
- Caitlin Quinn
- Department of International Health, Social and Behavioral Interventions , Johns Hopkins Bloomberg School of Public Health.
| | - Karl Johnson
- Krieger School of Arts and Sciences , Johns Hopkins University
| | | | | | | | - Megan M Tschudy
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics , Johns Hopkins School of Medicine, Baltimore, Md
| | - Devan Jaganath
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics , Johns Hopkins School of Medicine, Baltimore, Md; Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California , San Francisco School of Medicine
| | - Barry S Solomon
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics , Johns Hopkins School of Medicine, Baltimore, Md
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Jaganath D, Johnson K, Tschudy MM, Topel K, Stackhouse B, Solomon BS. Desirability of Clinic-Based Financial Services in Urban Pediatric Primary Care. J Pediatr 2018; 202:285-290. [PMID: 30029865 DOI: 10.1016/j.jpeds.2018.05.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 05/01/2018] [Accepted: 05/31/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine the desirability of integrating financial services in pediatric primary care among caregivers and older adolescents. STUDY DESIGN We conducted a cross-sectional study among caregivers and late adolescents 18 years and older attending an urban, pediatric primary care clinic. RESULTS The 221 participants had a mean age of 32.1 years, with 28% of the sample aged 18-25 years. The majority were African American (90.1%), female (83.3%), and single parents (55.1%). More than one-third of the participants (35.8%) reported no household earned income, and 26.7% had a yearly household total income of <$12,000. More than one-half (61.5%) reported financial stress in general, and 67.9% believed that the clinic should provide financial services, including financial education and job workshops. A greater proportion of those who desired clinic-based services were African American (94.7% vs 75%; P < .001) and had a low or middle subjective social status (95.7% vs 83.7%; P = .01). CONCLUSIONS Clinic-based financial services are desired by caregivers and late adolescents in an urban pediatric primary care practice. Prospective studies are needed to assess the long-term impact of integrated services on childhood poverty and family well-being.
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Affiliation(s)
- Devan Jaganath
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA.
| | - Karl Johnson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Megan M Tschudy
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Brian Stackhouse
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Center for Child and Community Health Research, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Barry S Solomon
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Sprecher E, Conroy K, Chan J, Lakin PR, Cox J. Utilization of Patient Navigators in an Urban Academic Pediatric Primary Care Practice. Clin Pediatr (Phila) 2018; 57:1154-1160. [PMID: 29451008 DOI: 10.1177/0009922818759318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Navigating health care systems can be a challenge for families. A retrospective descriptive cohort analysis was conducted assessing referrals to patient navigators (PNs) in one urban academic pediatric primary care practice. PNs tracked referral processes and a subset of PN referrals was assessed for markers of successful referrals. The most common reasons for referral were assistance overcoming barriers to care (46%), developmental concerns (38%), and adherence/care coordination concerns (14%). Significant predictors of referral were younger age, medical complexity, public insurance, male sex, and higher rates of no-show to visits in primary or subspecialist care. The majority of referrals were resolved. The referrals for process-oriented needs were significantly more successful than those for other concerns. PNs were more effective for discrete process tasks than for those that required behavior change by patients or families. Future directions include analysis of cost effectiveness of the PN program and analysis of parent and primary care provider experience.
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Affiliation(s)
- Eli Sprecher
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Kathleen Conroy
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Jenny Chan
- 1 Boston Children's Hospital, Boston, MA, USA
| | | | - Joanne Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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Federico SG, Cull W, Olson L, Garg A, Racine AD, Fisher A, Dreyer B. United States Pediatricians' Attitudes Regarding Public Policies for Low-Income Children and Their Profession's Advocacy Priorities. Acad Pediatr 2018; 18:783-788. [PMID: 29654906 DOI: 10.1016/j.acap.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/22/2018] [Accepted: 04/05/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine pediatricians' attitudes toward public policies for low-income children and the advocacy efforts for the American Academy of Pediatrics (AAP). METHODS Data from the AAP Periodic Survey in October 2014 to March 2015 were used. Respondents ranked 1) attitudes toward government programs, and 2) attitudes toward AAP policies on: income support, housing, education, job training, food, and health care. Results were analyzed according to age, gender, practice location, practice region, type of practice setting, and percent of patients with economic hardship. RESULTS Response rate was 47% (n = 650). Most respondents reported that for children, the government should guarantee health insurance (88.9%), and food and shelter (90.0%). Most also reported that the government should guarantee health insurance (68.9%) and food and shelter (63.9%) for every citizen and to take care of people who cannot take care of themselves. There was variation among the level of support on the basis of practice setting. In multivariable analyses related to supporting the role of government for children and citizens, not being from the Northeast was associated with lower odds of support of children as well as citizens; primary care practices in rural areas were less supportive of government involvement related to all citizens but similar for children; and those younger than 40 and 50 to 59 years of age were more supportive of government guaranteeing enough to eat and a place to sleep for children. More than 55% supported the AAP advocating for income support, housing, education, and access to health care. CONCLUSIONS Pediatricians strongly support government policies that affect child poverty and the provision of basic needs to families. This support should be used to inform professional organizations, advocates, and policy-makers focused on children and families.
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Affiliation(s)
- Steven G Federico
- Denver Health, Department of General Pediatrics, Denver, CO; University of Colorado at Denver-Anschutz Medical Campus, General Pediatrics, Aurora, CO.
| | - William Cull
- American Academy of Pediatrics, Department of Practice and Research, Itasca, IL
| | - Lynn Olson
- American Academy of Pediatrics, Department of Practice and Research, Itasca, IL
| | - Arvin Garg
- Boston University School of Medicine/Boston Medical Center, Department of General Pediatrics, Boston, MA
| | - Andrew D Racine
- Montefiore Health System and Albert Einstein College of Medicine, Pediatrics, Bronx, NY
| | - Amanda Fisher
- American Academy of Pediatrics, Department of Practice and Research, Itasca, IL
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61
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Freeman BK, Coker TR. Six Questions for Well-Child Care Redesign. Acad Pediatr 2018; 18:609-619. [PMID: 29857062 DOI: 10.1016/j.acap.2018.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
Abstract
In the United States, well-child care has the goal of providing comprehensive care to children by addressing developmental, behavioral, psychosocial, and health issues through visits at recommended intervals. The preventive care needs of families can outpace the capacity of clinics and practices to provide it, necessitating a redesign of our well-child care system that aligns the structure of preventive care delivery with the needs of families. Here we focus on 6 questions (the what, when, who, why, how, and where) for well-child care redesign for infants and young children. By addressing these key questions and providing recommendations for advancing well-child care redesign in the clinical and research arenas, we hope to accelerate the process of well-child care redesign. In the current political and socioeconomic environment, continuing with well-child care "as usual" will mean that many families will find that their well-child care visits do not fully address the most pressing needs impacting children's health and well-being. It is time to implement and sustain real change in our system for preventive care.
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Affiliation(s)
- Brandi K Freeman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo (Dr Freeman)
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Center for Diversity and Health Equity, Seattle Children's Hospital, and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash (Dr Coker)
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Connor KA, Duran G, Faiz-Nassar M, Mmari K, Minkovitz CS. Feasibility of Implementing Group Well Baby/Well Woman Dyad Care at Federally Qualified Health Centers. Acad Pediatr 2018; 18:510-515. [PMID: 28919481 DOI: 10.1016/j.acap.2017.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Group care has been shown to be effective for delivery of infant well child care. Centering Parenting (CP) is a model of group dyad care for mothers and infants. CP might improve quality and efficiency of preventive care, particularly for low-income families. Federally qualified health centers (FQHCs) might be optimal sites for implementation, however, facilitators and barriers might be unique. The aim of this qualitative study was to assess stakeholder perspectives on the feasibility of implementing CP in FQHCs in Baltimore. METHODS Semistructured interviews were conducted with mothers, clinicians, staff, and administrators recruited from 2 FQHCs using purposive sampling. Interviews were recorded, transcribed verbatim, and uploaded to Atlas.ti version 7.0 (Atlas.ti Scientific Software Development, GmbH Berlin, Germany) for analysis. Using an inductive thematic analysis approach, 2 investigators coded the transcripts. Matrices of key codes were developed to identify themes and patterns across stakeholder groups. RESULTS Interviews were completed with 26 mothers and 16 clinicians, staff, and administrators. Most participants considered CP desirable. Facilitators included: peer support and education, emphasis on maternal wellness, and increased patient and clinician satisfaction. Barriers included: exposure to "others," scheduling and coordination of care, productivity, training requirements, and cost. Parenting experience did not appear to affect perspectives on CP. CONCLUSIONS Perceptions regarding facilitators and barriers to CP implementation in FQHCs are similar to existing group well-child care literature. The benefit of emphasis on maternal wellness is a unique finding. Maternal wellness integration might make CP a particularly desirable model for implementation at FQHCs, but potential systems barriers must be addressed.
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Affiliation(s)
- Katherine A Connor
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Gabriela Duran
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Mariam Faiz-Nassar
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kristin Mmari
- Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Cynthia S Minkovitz
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
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63
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Beck AF, Cohen AJ, Colvin JD, Fichtenberg CM, Fleegler EW, Garg A, Gottlieb LM, Pantell MS, Sandel MT, Schickedanz A, Kahn RS. Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care. Pediatr Res 2018; 84:10-21. [PMID: 29795202 DOI: 10.1038/s41390-018-0012-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/05/2018] [Accepted: 03/10/2018] [Indexed: 02/06/2023]
Abstract
The social determinants of health (SDoH) are defined by the World Health Organization as the "conditions in which people are born, grow, live, work, and age." Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and "adult diseases" such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.
| | - Alicia J Cohen
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Jeffrey D Colvin
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Caroline M Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
| | - Eric W Fleegler
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvin Garg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Matthew S Pantell
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Megan T Sandel
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Adam Schickedanz
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Robert S Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
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64
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Qualitative Evaluation of Individual and Group Well-Child Care. Acad Pediatr 2018; 18:516-524. [PMID: 29355778 DOI: 10.1016/j.acap.2018.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/02/2018] [Accepted: 01/06/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Individual well care (IWC) is the standard delivery model for well-child care in the United States. Alternative models, such as group well care (GWC), may create opportunities to enhance care for babies. The purpose of this study was to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC. METHODS Since 2014, we have provided both IWC and GWC at an urban academic practice serving a low-income minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n = 32 parents; 7 GWC groups, n = 33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t tests; focus groups were digitally recorded, transcribed, and analyzed to identify themes. RESULTS Both groups had similar demographics: parents were mostly female (91%) and black (>80%); about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment, or stress. IWC parents' themes highlighted ways to improve care delivery, while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits, such as garnering social support and learning from other parents. CONCLUSIONS Parents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.
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65
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Duke NN, Borowsky IW. Adverse childhood experiences: Evidence for screening beyond preventive visits. CHILD ABUSE & NEGLECT 2018; 81:380-388. [PMID: 29803147 DOI: 10.1016/j.chiabu.2018.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 05/28/2023]
Abstract
Primary efforts to screen for adverse childhood experiences (ACE/ACEs) are often focused on the well child/adolescent visit. The purpose of this study was to examine relationships between ACEs and youth likelihood of receiving preventive care. Data are from 126,868 students in the 8th, 9th, and 11th grades who participated in the 2016 Minnesota Student Survey, an anonymous, self-report questionnaire examining youth behaviors, experiences, and perceptions. Logistic regression models were used to determine if 10 types of ACEs, including abuse, household dysfunction, and food and housing insecurity were associated with receipt of recommended preventive medical and dental care after adjustment for demographic covariates and self-reported health. ACEs scores were entered into regression models to test for cumulative impact of adversities on preventive care outcomes. More than one third (38.5%) of youth identified at least one ACE, most commonly having a parent or guardian who had ever been in jail or prison. Each type of ACE was significantly associated with reduced odds of receiving preventive care in the last year. Associations with food insecurity were of greatest magnitude, associated with 0.32 [CI: 0.64-0.72] to 0.54 [CI: 0.44-0.49] decreased odds of receiving care. Each one point increase in the total ACE score was associated with 0.07 [CI: 0.92-0.94] to 0.15 [CI: 0.84-0.86] decreased odds of having had a preventive care visit in the last year. Findings add to the growing literature documenting significant relationships between ACEs and health, in this case, youth missing opportunities to receive recommended surveillance and anticipatory guidance.
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Affiliation(s)
- Naomi N Duke
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St SE, # 385, Minneapolis, MN, USA.
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St SE, # 389, Minneapolis, MN, USA.
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66
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Berman RS, Patel MR, Belamarich PF, Gross RS. Screening for Poverty and Poverty-Related Social Determinants of Health. Pediatr Rev 2018; 39:235-246. [PMID: 29716966 PMCID: PMC5914761 DOI: 10.1542/pir.2017-0123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Rachel Stein Berman
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.,Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Milani R Patel
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.,Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.,Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY
| | - Peter F Belamarich
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.,Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Rachel S Gross
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.,Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
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67
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Hensley C, Heaton PC, Kahn RS, Luder HR, Frede SM, Beck AF. Poverty, Transportation Access, and Medication Nonadherence. Pediatrics 2018; 141:peds.2017-3402. [PMID: 29610400 PMCID: PMC5869333 DOI: 10.1542/peds.2017-3402] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Variability in primary medication nonadherence (PMN), or failure to fill a new prescription, influences disparities and widens equity gaps. This study sought to evaluate PMN across 1 metropolitan area and assess relationships with underlying zip code-level measures. METHODS This was a retrospective observational study using data extracted from 1 regional community pharmacy market-share leader (October 2016-April 2017). Data included patient age, sex, payer, medication type, and home zip code. This zip code was connected to US census measures enumerating poverty and vehicle access, which were treated as continuous variables and within quintiles. The prescription-level outcome was whether prescriptions were not filled within 30 days of reaching the pharmacy. The ecological-level outcome was PMN calculated for each zip code (numerator, unfilled prescriptions; denominator, received prescriptions). RESULTS There were 213 719 prescriptions received by 54 included pharmacies; 12.2% were unfilled. Older children, boys, and those with public insurance were more likely to have prescriptions not filled. Prescriptions originating from the highest poverty quintile were significantly more likely to not be filled than those from the lowest poverty quintile (adjusted odds ratio 1.60; 95% confidence interval 1.52-1.69); a similar pattern was noted for vehicle access (adjusted odds ratio 1.77; 95% confidence interval 1.68-1.87). At the ecological level, there were significant, graded relationships between PMN rates and poverty and vehicle access (both P < .0001); these gradients extended across all medication classes. CONCLUSIONS Poverty and vehicle access are related to significant differences in prescription- and ecological-level PMN across 1 metropolitan area. Pharmacists and pharmacies can be key partners in population health efforts.
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Affiliation(s)
| | - Pamela C. Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Robert S. Kahn
- Department of Pediatrics, College of Medicine and,Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Heidi R. Luder
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Stacey M. Frede
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio;,Kroger Pharmacy, Cincinnati, Ohio
| | - Andrew F. Beck
- Department of Pediatrics, College of Medicine and,Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
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68
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Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources. Matern Child Health J 2018. [PMID: 29525916 DOI: 10.1007/s10995-018-2508-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.
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69
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Byhoff E, Freund KM, Garg A. Accelerating the Implementation of Social Determinants of Health Interventions in Internal Medicine. J Gen Intern Med 2018; 33:223-225. [PMID: 29188543 PMCID: PMC5789112 DOI: 10.1007/s11606-017-4230-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Elena Byhoff
- Tufts Medical Center, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
| | - Karen M Freund
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Arvin Garg
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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70
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Beck AF, Huang B, Wheeler K, Lawson NR, Kahn RS, Riley CL. The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013. J Pediatr 2017; 190:200-206.e1. [PMID: 29144247 PMCID: PMC5708858 DOI: 10.1016/j.jpeds.2017.08.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/30/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. STUDY DESIGN This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. RESULTS Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months. CONCLUSIONS The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.
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Affiliation(s)
- Andrew F. Beck
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A,Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | | | - Nikki R. Lawson
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Robert S. Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Carley L. Riley
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
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71
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O'Malley D, Woods-Jaeger BA, Dowd MD. Building a Collaboration Between a Children's Hospital and an Early Childhood Education and Social Services Center. Curr Probl Pediatr Adolesc Health Care 2017; 47:222-228. [PMID: 28826807 DOI: 10.1016/j.cppeds.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To address toxic stress among children growing up in poverty, an innovative collaboration was developed between a community center, Operation Breakthrough (OB), and a tertiary care children's hospital, Children's Mercy Hospital (CMH). OB started as a day care center but has expanded and developed ways to provide shelter, safety, food, employment, education and health care. CMH is a traditional academic children's hospital that, in recent years, has been looking for ways to better address the social determinants of health. This article describes how the two organizations found ways to work together to capitalize on each other's strengths. Although the two institutions shared some common goals, they had very different organizational structure. We describe how a series of complex negotiations and trust-building exercises eventually led to a robust and unique partnership.
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Affiliation(s)
- Donna O'Malley
- Department of Social Work, Children's Mercy Hospital, Kansas City, MO
| | - Briana A Woods-Jaeger
- Department of Social Work, Children's Mercy Hospital, Kansas City, MO; Division of Developmental and Behavioral Pediatrics, University of Missouri, Kansas City (UMKC) School of Medicine, Kansas City, MO
| | - M Denise Dowd
- Division of Emergency Medicine, Associate Director Office for Faculty Development Medical, Director of Community Programs, Department of Social Work, Children's Mercy, Kansas City, Professor of Pediatrics, UMKC School of Medicine, Kansas City, MO
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72
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Planey B. ACEs and State Maternal Child Health Programs. Acad Pediatr 2017; 17:S30-S31. [PMID: 28865657 DOI: 10.1016/j.acap.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/12/2016] [Accepted: 11/07/2016] [Indexed: 10/18/2022]
Affiliation(s)
- Bradley Planey
- Family Health Branch, Arkansas Department of Health, Little Rock, Ark.
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73
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Palakshappa D, Doupnik S, Vasan A, Khan S, Seifu L, Feudtner C, Fiks AG. Suburban Families' Experience With Food Insecurity Screening in Primary Care Practices. Pediatrics 2017. [PMID: 28634248 DOI: 10.1542/peds.2017-0320] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices. METHODS We conducted 23 semistructured interviews with parents of children <4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved. RESULTS Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs. CONCLUSIONS Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.
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Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, .,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Doupnik
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and
| | | | - Saba Khan
- Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Leah Seifu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bottino CJ, Rhodes ET, Kreatsoulas C, Cox JE, Fleegler EW. Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need? Acad Pediatr 2017; 17:497-503. [PMID: 28302365 DOI: 10.1016/j.acap.2016.10.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/24/2016] [Accepted: 10/10/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. METHODS Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. RESULTS A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). CONCLUSIONS In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs.
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Affiliation(s)
- Clement J Bottino
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Erinn T Rhodes
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Catherine Kreatsoulas
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Mass
| | - Joanne E Cox
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Eric W Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
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75
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Palakshappa D, Vasan A, Khan S, Seifu L, Feudtner C, Fiks AG. Clinicians' Perceptions of Screening for Food Insecurity in Suburban Pediatric Practice. Pediatrics 2017. [PMID: 28634247 DOI: 10.1542/peds.2017-0319] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices. METHODS We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit (N = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement. RESULTS Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit. CONCLUSIONS We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.
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Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, .,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Saba Khan
- Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Leah Seifu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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76
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Palakshappa D, Fiks AG. Implications of Poverty for Practices Serving Suburban Families. Pediatrics 2016; 138:peds.2016-2548. [PMID: 27940719 DOI: 10.1542/peds.2016-2548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, and .,Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, and.,Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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77
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Oberg C, Colianni S, King-Schultz L. Child Health Disparities in the 21st Century. Curr Probl Pediatr Adolesc Health Care 2016; 46:291-312. [PMID: 27712646 DOI: 10.1016/j.cppeds.2016.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The topic of persistent child health disparities remains a priority for policymakers and a concern for pediatric clinicians. Health disparities are defined as differences in adverse health outcomes for specific health indicators that exist across sub-groups of the population, frequently between minority and majority populations. This review will highlight the gains that have been made since the 1990s as well as describe disparities that have persisted or have worsened into the 21st century. It will also examine the most potent social determinants and their impact on the major disparities in mortality, preventive care, chronic disease, mental health, educational outcomes, and exposure to selected environmental toxins. Each section concludes with a description of interventions and innovations that have been successful in reducing child health disparities.
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Affiliation(s)
- Charles Oberg
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Department of Pediatrics, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
| | - Sonja Colianni
- Department of Pediatrics, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
| | - Leslie King-Schultz
- Department of Pediatrics, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
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78
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Beck AF, Solan LG, Brunswick SA, Sauers-Ford H, Simmons JM, Shah S, Gold J, Sherman SN. Socioeconomic status influences the toll paediatric hospitalisations take on families: a qualitative study. BMJ Qual Saf 2016; 26:304-311. [PMID: 27471042 DOI: 10.1136/bmjqs-2016-005421] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/16/2016] [Accepted: 07/09/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stress caused by hospitalisations and transition periods can place patients at a heightened risk for adverse health outcomes. Additionally, hospitalisations and transitions to home may be experienced in different ways by families with different resources and support systems. Such differences may perpetuate postdischarge disparities. OBJECTIVE We sought to determine, qualitatively, how the hospitalisation and transition experiences differed among families of varying socioeconomic status (SES). METHODS Focus groups and individual interviews were held with caregivers of children recently discharged from a children's hospital. Sessions were stratified based on SES, determined by the percentage of individuals living below the federal poverty level in the census tract or neighbourhood in which the family lived. An open-ended, semistructured question guide was developed to assess the family's experience. Responses were systematically compared across two SES strata (tract poverty rate of <15% or ≥15%). RESULTS A total of 61 caregivers who were 87% female and 46% non-white participated; 56% resided in census tracts with ≥15% of residents living in poverty (ie, low SES). Interrelated logistical (eg, disruption in-home life, ability to adhere to discharge instructions), emotional (eg, overwhelming and exhausting nature of the experience) and financial (eg, cost of transportation and meals, missed work) themes were identified. These themes, which were seen as key to the hospitalisation and transition experiences, were emphasised and described in qualitatively different ways across SES strata. CONCLUSIONS Families of lower SES may experience challenges and stress from hospitalisations and transitions in different ways than those of higher SES. Care delivery models and discharge planning that account for such challenges could facilitate smoother transitions that prevent adverse events and reduce disparities in the postdischarge period. TRIAL REGISTRATION NUMBER NCT02081846; Pre-results.
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Affiliation(s)
- Andrew Finkel Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lauren G Solan
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, New York, USA
| | | | - Hadley Sauers-Ford
- Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey M Simmons
- Cincinnati Children's Hospital Medical Center, General and Community Pediatrics, Cincinnati, Ohio, USA
| | - Samir Shah
- Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Gold
- Home Care Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, Lewis G, Osman CJ, Jo Messito M, Wade R, Shonna Yin H, Cox J, Fierman AH. Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Curr Probl Pediatr Adolesc Health Care 2016; 46:135-53. [PMID: 27101890 PMCID: PMC6039226 DOI: 10.1016/j.cppeds.2016.02.004] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.
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Affiliation(s)
- Esther K Chung
- The Department of Pediatrics, The Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Nemours, Wilmington, DE.
| | - Benjamin S Siegel
- The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Arvin Garg
- The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Kathleen Conroy
- The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA
| | - Rachel S Gross
- The Department of Pediatrics, Albert Einstein College of Medicine, The Children׳s Hospital at Montefiore, Bronx, NY
| | - Dayna A Long
- The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA
| | - Gena Lewis
- The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA
| | - Cynthia J Osman
- The Department of Pediatrics, New York University, New York, NY
| | - Mary Jo Messito
- The Department of Pediatrics, New York University, New York, NY
| | - Roy Wade
- The Department of Pediatrics, The Children׳s Hospital of Philadelphia, Philadelphia, PA
| | - H Shonna Yin
- The Department of Pediatrics, New York University, New York, NY
| | - Joanne Cox
- The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA
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80
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Schickedanz A, Coker TR. Surveillance and Screening for Social Determinants of Health-Where Do We Start and Where Are We Headed? Curr Probl Pediatr Adolesc Health Care 2016; 46:154-6. [PMID: 27053041 DOI: 10.1016/j.cppeds.2016.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA.
| | - Tumaini R Coker
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; RAND, Santa Monica, CA
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81
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Dreyer B, Chung PJ, Szilagyi P, Wong S. Child Poverty in the United States Today: Introduction and Executive Summary. Acad Pediatr 2016; 16:S1-5. [PMID: 27044686 DOI: 10.1016/j.acap.2016.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/24/2022]
Affiliation(s)
- Benard Dreyer
- Department of Pediatrics, Developmental-Behavioral Pediatrics, NYU School of Medicine, Bellevue Hospital Center, New York, NY.
| | - Paul J Chung
- Departments of Pediatrics and Health Policy and Management, University of California, UCLA, Los Angeles, Calif; Children's Discovery & Innovation Institute, Mattel Children's Hospital, UCLA, Los Angeles, Calif; RAND Health, The RAND Corporation, Santa Monica, Calif
| | - Peter Szilagyi
- Department of Pediatrics, University of California, Mattel Children's Hospital, UCLA, Los Angeles, Calif
| | - Shale Wong
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital, Aurora, Colo
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