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Short VL, Gannon M, Sood E, Harris G, Kale A, Abatemarco DJ, Hand DJ, Goyal N. Opportunities to Increase Well-Child Care Engagement for Families Affected by Maternal Opioid Use Disorder: Perceptions of Mothers and Clinicians. Acad Pediatr 2023; 23:425-433. [PMID: 35878748 PMCID: PMC9867779 DOI: 10.1016/j.acap.2022.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Previous research suggests gaps in well-child care (WCC) adherence, quality, and effectiveness for children impacted by parental opioid use disorder (OUD). The objective of this study was to gather in-depth information regarding maternal and clinician-reported factors that enhance ("facilitators") or hinder ("barriers") WCC engagement as well as mothers' experiences during WCC visits. METHODS Thirty mothers who were in treatment for OUD and 13 clinicians working at a pediatric primary care clinic participated in this qualitative study. All participants completed one data collection telephone session which involved a brief questionnaire followed by a semi-structured interview. Thematic analyses of the interview transcripts were conducted using an inductive approach. RESULTS Three broad themes were identified as facilitators of WCC by mothers and clinicians, including: 1) continuity in care, 2) addressing material needs, and 3) clinician OUD training and knowledge. Themes identified as barriers to WCC included: 1) stigma toward mothers with OUD, 2) gaps in basic parenting knowledge, 3) competing specialized health care needs, and 4) insufficient time to address all concerns. CONCLUSION WCC programs or clinical pathways designed for families affected by maternal OUD should consider these barriers and facilitators of WCC engagement and affect experiences of WCC for mothers and clinicians.
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Affiliation(s)
- Vanessa L Short
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA.
| | - Meghan Gannon
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Erica Sood
- Nemours Children's Health (E Sood and N Goyal), Wilmington, Del; Department of Pediatrics, Thomas Jefferson University (E Sood and N Goyal), Philadelphia, PA
| | - Grace Harris
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Aditi Kale
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Diane J Abatemarco
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Dennis J Hand
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Neera Goyal
- Nemours Children's Health (E Sood and N Goyal), Wilmington, Del; Department of Pediatrics, Thomas Jefferson University (E Sood and N Goyal), Philadelphia, PA
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Chisolm DJ, Keedy HE, Dolce M, Chavez L, Abrams MA, Sanders L. Do health literacy disparities explain racial disparities in family-centered care for youths with special health care needs? PATIENT EDUCATION AND COUNSELING 2021; 104:887-895. [PMID: 32994106 PMCID: PMC7997812 DOI: 10.1016/j.pec.2020.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the relationship among youth health literacy, parental health literacy, and family-centered care (FCC) for youth with special health care needs (YSHCN) and assess potential racial disparities. METHODS HL and FCC were assessed in 486 Medicaid-enrolled YSHCN (ages 12-18) and their healthcare-responsible parent/caregiver. Analyses assessed racial differences in HL and FCC for parents and youth using logistic regression. RESULTS Half of youth and over 80 percent of parents had adequate HL (REALM score ≥62). Adequate HL was significantly lower in African Americans (AA) for both YSHCN and parents. Only 57 % of parents and 29 % of YSHCN reported FCC. AA YSHCN reported significantly lower levels of FCC compared to White YSHCN. AA parents trended lower for FCC compared to Whites, though the disparity was not significant. AA youth and parents had significantly lower odds of reporting that doctors spent enough time with them compared to Whites. CONCLUSION Results suggest that AA and those with less than adequate health literacy experience lower FCC, however the relationship between race and health literacy does not explain the racial disparity in FCC. PRACTICAL IMPLICATIONS Provider time spent focused on HL may not reduce the racial disparity in FCC, but opportunities for improvement exist.
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Affiliation(s)
- Deena J Chisolm
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Division of Health Services Management and Policy, The Ohio State University, Columbus, OH, USA.
| | - Hannah E Keedy
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Millie Dolce
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Laura Chavez
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Mary Ann Abrams
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Lee Sanders
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
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Short VL, Alexander K, Gannon M, Abatemarco DJ, Goyal NK. What aspects of their child's primary care do mothers value? A qualitative analysis of perspectives of women in treatment for opioid use disorder. Child Care Health Dev 2021; 47:40-46. [PMID: 33016377 DOI: 10.1111/cch.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Preventive paediatric healthcare is essential for infant and child health. Current research, however, suggests that the delivery of routine well child care (WCC) for children affected by maternal opioid use disorder (OUD) could be improved. How mothers perceive interactions with healthcare providers may help identify ways to modify the experience of WCC, which could ultimately improve healthcare utilization, patient satisfaction and clinical outcomes. The objective of this qualitative study was to assess perceptions of WCC among mothers in treatment for OUD. METHODS Four focus group sessions of 4-8 participants each (N = 22) were conducted. All study participants were receiving comprehensive behavioural and physical health support and care plus pharmacotherapy for OUD from a single outpatient treatment centre. Focus groups were semi-structured, with a standardized set of open-ended questions and follow-up prompts to engage participants in a fluid discussion. Participants were asked to identify and discuss important aspects of their youngest child's WCC and what they liked and disliked about their child's WCC. Grounded theory analysis was used to identify themes. RESULTS Several aspects of WCC were identified as important to the mothers. Main themes identified included (1) mother-provider relationship, (2) communication with healthcare team and (3) support for mother's OUD treatment. Participants discussed their desire to be heard and understood and wanted the entire healthcare team and clinic staff to see them as mothers first and foremost, not merely as individuals with OUD. CONCLUSION Future attempts to refine care may consider healthcare models that highlight open communication and personalized care and offer strong support and ongoing encouragement for the mother's OUD treatment and recovery process.
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Affiliation(s)
- Vanessa L Short
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen Alexander
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diane J Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neera K Goyal
- Department of Pediatrics, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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Family Management in Childhood Attention Deficit Hyperactivity Disorder: A Qualitative Inquiry. J Pediatr Nurs 2020; 52:82-90. [PMID: 32005539 DOI: 10.1016/j.pedn.2019.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/02/2019] [Accepted: 09/21/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to better understand how caregivers and families manage childhood Attention Deficit Hyperactivity Disorder (ADHD) in their everyday lives and explore family management factors most relevant to child outcomes, including the child's daily life, condition management effort, condition management ability, and view of condition impact. DESIGN AND METHODS Cross-sectional data from caregivers (N = 50) of children with ADHD (ages 5-12 years) within a large northeastern city were collected, analyzed, and interpreted using directed content analysis and qualitative methods. This inquiry was part of a larger mixed method study which examined the impact of family management on childhood ADHD and how family management factors were related to children's level of impairment across a spectrum of child functioning. RESULTS Thematic summaries based on qualitative descriptive methods highlighted four aspects of family management including: 1) how caregivers contextualized their child's condition in everyday family life, 2) the significant effort required by caregivers to manage their child's ADHD, 3) how caregivers perceived their ability to manage their child's condition, and 4) the impact of ADHD on their child and family's future. CONCLUSIONS Family management is an important concept within pediatric literature and may be extended to further research and practice changes for children with ADHD and their caregivers. PRACTICE IMPLICATIONS Pediatric nurses are at the forefront of working with children and families. Understanding caregiver perspectives in regard to family management is important for strengthening collaborative partnerships with families and improving the care of children with ADHD.
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Perceptions of Pediatric Primary Care Among Mothers in Treatment for Opioid Use Disorder. J Community Health 2019; 44:1127-1134. [DOI: 10.1007/s10900-019-00701-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Anderson AC, Akre E, Chen J. Exploring national trends of patient- and family-centered care among US children. J Child Health Care 2019; 23:200-212. [PMID: 30016885 DOI: 10.1177/1367493518786015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We explored national trends in the receipt of high-quality patient-physician communication and patient empowerment through behavioral health counseling among children in the United States. We used data from the Medical Expenditure Panel Survey from 2010 to 2014. We employed two measures of patient- and family-centered care (PFCC): (1) a composite measure of high-quality patient-physician communication ( n = 34,629) and (2) patient empowerment through behavioral health counseling about healthy eating ( n = 36,527) and exercise ( n = 38,318). We used multivariate logistic regression models to estimate the variation of receiving PFCC by social determinants of health over time. Rates of receiving behavioral health counseling about healthy eating (53-60%) and exercise (37-42%) were lower than the rate of receiving high-quality physician-patient communication (92-93%). Parents were significantly more likely to report receiving high-quality physician-patient communication in 2014 than in 2010 (odds ratio 1.37, confidence interval 1.08-1.67); however, no association was found for empowerment through behavioral health counseling. Low income and parental educational attainment, and lack of insurance were associated with lower odds of receiving behavioral health counseling. Results showed significant variation of physician-patient communication and empowerment by social and demographic factors. The results suggest more providers need to empower parents and their children to self-care through behavioral health counseling.
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Affiliation(s)
- Andrew C Anderson
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
| | - Ellesse Akre
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
| | - Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
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Ballantyne M, Liscumb L, Brandon E, Jaffar J, Macdonald A, Beaune L. Mothers' Perceived Barriers to and Recommendations for Health Care Appointment Keeping for Children Who Have Cerebral Palsy. Glob Qual Nurs Res 2019; 6:2333393619868979. [PMID: 31453266 PMCID: PMC6696835 DOI: 10.1177/2333393619868979] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/01/2022] Open
Abstract
Children with cerebral palsy (CP) require ongoing rehabilitation services to address complex health care needs. Attendance at appointments ensures continuity of care and improves health and well-being. The study's aim was to gain insight into mothers' perspectives of the factors associated with nonattendance. A qualitative descriptive design was conducted to identify barriers and recommendations for appointment keeping. Semi-structured interviews were conducted with 15 mothers of children with CP. Data underwent inductive qualitative analysis. Mothers provided rich context regarding barriers confronted for appointment keeping-transportation and travel, competing priorities for the child and family, and health services. Mothers' recommendations for improving the experience of attending appointments included virtual care services, transportation support, multimethod scheduling and appointment reminders, extended service hours, and increased awareness among staff of family barriers to attendance. The results inform services/policy strategies to facilitate appointment keeping, thereby promoting access to ongoing rehabilitation services for children with CP.
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Affiliation(s)
- Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Laurie Liscumb
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Erin Brandon
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Janice Jaffar
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Andrea Macdonald
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Laura Beaune
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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Lindly OJ, Geldhof GJ, Acock AC, Sakuma KLK, Zuckerman KE, Thorburn S. Family-Centered Care Measurement and Associations With Unmet Health Care Need Among US Children. Acad Pediatr 2017; 17:656-664. [PMID: 28366529 DOI: 10.1016/j.acap.2016.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/19/2016] [Accepted: 10/28/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Family-centered care (FCC), including shared decision making (SDM), has become increasingly emphasized in pediatric health care delivery. Past studies using national surveys have used different FCC measurement approaches without determining their validity. We, therefore, sought to develop an FCC measurement model with Medical Expenditure Panel Survey (MEPS) items previously used to assess FCC or SDM; and to determine temporal associations of FCC with unmet health care need. METHODS Four longitudinal MEPS data files (2007-2011) were combined. The study sample included 15,764 US children aged 0 to 17 years. Eight items assessed FCC, and 5 items assessed unmet health care need. We performed exploratory factor analyses to develop an FCC measurement model and fit a cross-lagged structural equation model to determine temporal associations between FCC and unmet health care need. RESULTS Results supported a 2-factor FCC model including family-provider communication and SDM. The family-provider communication factor was indicated by items reflecting general communication between the child's doctor and family. The SDM factor was indicated by items reflecting decision-making about the child's health care. Adjusted cross-lagged structural equation model results showed family-provider communication and SDM were associated with a reduced likelihood of unmet health care need the following year. Unmet health care need was not significantly associated with family-provider communication or SDM the subsequent year. CONCLUSIONS Study results support differentiating between family-provider communication and SDM as interrelated aspects of FCC in future pediatric health care quality measurement and improvement. Family-provider communication and SDM may reduce the likelihood of unmet health care need the following year among US children.
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Affiliation(s)
- Olivia J Lindly
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore; Divison of General Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore.
| | - G John Geldhof
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore
| | - Alan C Acock
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore
| | - Kari-Lyn K Sakuma
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore
| | - Katharine E Zuckerman
- Divison of General Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore
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Aftyka A, Rozalska-Walaszek I, Wróbel A, Bednarek A, Dąbek K, Zarzycka D. Support provided by nurses to parents of hospitalized children - cultural adaptation and validation of Nurse Parent Support Tool and initial research results. Scand J Caring Sci 2017; 31:1012-1021. [DOI: 10.1111/scs.12426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Anna Aftyka
- Department of Anaesthesiological and Intensive Care Nursing; Faculty of Health Sciences; Medical University of Lublin; Lublin Poland
| | - Ilona Rozalska-Walaszek
- Department of Anaesthesiological and Intensive Care Nursing; Faculty of Health Sciences; Medical University of Lublin; Lublin Poland
| | - Aleksandra Wróbel
- Department of Anaesthesiological and Intensive Care Nursing; Faculty of Health Sciences; Medical University of Lublin; Lublin Poland
| | - Anna Bednarek
- Chair and Department of Paediatric Nursing; Faculty of Health Sciences; Medical University of Lublin; Lublin Poland
| | - Katarzyna Dąbek
- Chair and Clinic of Obstetrics and Gynaecology; Medical University of Lublin; Lublin Poland
- Neonatal Department with Neonatal Intensive Care Unit; Friderick Chopin Clinical Provincial Hospital No 1 in Rzeszów
| | - Danuta Zarzycka
- Chair and Department of Paediatric Nursing; Faculty of Health Sciences; Medical University of Lublin; Lublin Poland
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Racial and Ethnic Disparities in Unmet Need for Pediatric Therapy Services: The Role of Family-Centered Care. Acad Pediatr 2017; 17:27-33. [PMID: 27368126 DOI: 10.1016/j.acap.2016.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether individual elements of family-centered care (FCC) mediate racial/ethnic disparities in parent-reported unmet therapy need. METHODS We conducted a secondary data analysis using the 2009-2010 National Survey of Children With Special Health Care Needs. A total of 6478 black, Hispanic, and white children ages 0 to 5 years had complete data on parent-reported unmet need and FCC. Five measured indicators of FCC included whether the child's health care provider spent enough time with the child (time), listened carefully to the child's parents (listening), was sensitive to family culture and values (sensitivity), delivered information specific to the child's health (information), and helped parents feel like partners (partnership). We performed staged multivariate logistic regression to test the association between race/ethnicity and parent-reported unmet therapy need, and to explore whether this association was mediated by elements of FCC using the Baron-Kenny mediation framework. RESULTS Eighteen percent of children with special health care needs 0 to 5 years old with reported therapy need experienced unmet need. Black and Hispanic children were more likely than white children to have parent-reported unmet therapy need (adjusted odds ratio 1.59, 95% confidence interval 1.08-2.36). This disparity was no longer significant after adjustment for the FCC elements of time, sensitivity, or partnership. CONCLUSIONS The provision of FCC is likely an important factor in meeting the therapy needs of children with developmental delay and in reducing racial/ethnic disparities in parent-reported unmet therapy need. Interventions aimed at fostering parent-provider relationships through improved cultural sensitivity and engagement of parents as partners are necessary to ensure equitable utilization of these services.
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Alsem MW, Ausems F, Verhoef M, Jongmans MJ, Meily-Visser JMA, Ketelaar M. Information seeking by parents of children with physical disabilities: An exploratory qualitative study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:125-134. [PMID: 27914304 DOI: 10.1016/j.ridd.2016.11.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 11/04/2016] [Accepted: 11/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Evidence suggests that parents of children with disabilities feel that not all their information needs are being met, but it remains unclear how parents try to fill these information gaps. AIMS The aim of this study is to describe how parents of children with physical disabilities search for and evaluate information. METHODS Qualitative semi-structured interviews were conducted with 15 parents of children with a disability, aged 1.5-21 years. Data were analysed using thematic analysis. RESULTS There was much variation in information needs between parents. Parents used different sources, depending on the type of information needed, the most important being healthcare professionals, peers, and websites. Peers played an important role in information provision and were the preferred source of experience-based knowledge and support. The Internet is a widely used medium to search for information and to access various sources. There was a general preference for closed Internet communities for peer contact. Information was commonly evaluated by comparing sources. CONCLUSIONS AND IMPLICATIONS Parents use different sources for different information needs, and evaluate information by comparing them. Healthcare professionals and parents can support each other in locating and evaluating information including experience-based knowledge. Healthcare professionals should guide parents in their search for information and experience-based knowledge from peers.
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Affiliation(s)
- M W Alsem
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - F Ausems
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - M Verhoef
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - M J Jongmans
- Department of Child, Family & Education Studies, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands
| | - J M A Meily-Visser
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - M Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
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Sterni LM, Collaco JM, Baker CD, Carroll JL, Sharma GD, Brozek JL, Finder JD, Ackerman VL, Arens R, Boroughs DS, Carter J, Daigle KL, Dougherty J, Gozal D, Kevill K, Kravitz RM, Kriseman T, MacLusky I, Rivera-Spoljaric K, Tori AJ, Ferkol T, Halbower AC. An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation. Am J Respir Crit Care Med 2016; 193:e16-35. [PMID: 27082538 PMCID: PMC5439679 DOI: 10.1164/rccm.201602-0276st] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. PURPOSE To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. METHODS The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. RESULTS Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. CONCLUSIONS Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child's care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available.
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Lindly OJ, Zuckerman KE, Mistry KB. Clarifying the Predictive Value of Family-Centered Care and Shared Decision Making for Pediatric Healthcare Outcomes Using the Medical Expenditure Panel Survey. Health Serv Res 2016; 52:313-345. [PMID: 27072197 DOI: 10.1111/1475-6773.12488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To estimate (1) family-centered care (FCC) and shared decision-making (SDM) prevalence, and (2) associations of FCC and SDM (FCC/SDM) with health care outcomes among U.S. children. DATA SOURCE The Medical Expenditure Panel Survey Household Component (MEPS-HC), a nationally representative survey of the noninstitutionalized, civilian population. STUDY DESIGN Secondary analyses of prospectively collected data on 15,764 U.S. children were conducted to examine FCC/SDM prevalence in year 1 and associations of FCC/SDM in year 1 with health services utilization, medical expenditures, and unmet health care needs in year 2. DATA COLLECTION/EXTRACTION METHODS We combined four MEPS-HC longitudinal files from 2007 to 2011. PRINCIPAL FINDINGS FCC/SDM prevalence in year 1 varied from 38.6 to 93.7 percent, and it was lower for composites with more stringent scoring approaches. FCC/SDM composites with stringent scoring approaches in year 1 were associated with reduced unmet needs in year 2. FCC/SDM, across all year 1 composites, was not associated with health services utilization or medical expenditures in year 2. FCC/SDM year 1 subcomponents describing consensus building and mutual agreement were consistently associated with unmet health care needs in year 2. CONCLUSIONS FCC/SDM composites with stringent scoring approaches measuring consensus building and mutual agreement may have the greatest utility for pediatric health care quality improvement efforts.
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Affiliation(s)
- Olivia J Lindly
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.,Division of General Pediatrics, Oregon Health & Science University, Portland, OR
| | | | - Kamila B Mistry
- Agency for Healthcare Research and Quality, Office of Extramural Research, Education, and Priority Populations, Rockville, MD
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Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways. Matern Child Health J 2015. [DOI: 10.1007/s10995-015-1784-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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The relationship between the medical home and unmet needs for children with autism spectrum disorders. Matern Child Health J 2015; 18:672-80. [PMID: 23793533 DOI: 10.1007/s10995-013-1292-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to examine the relationship between having access to a medical home and unmet needs for specialty care services for children with autism spectrum disorders (ASD). Parents of children enrolled in a national autism registry were invited to complete an online Access to Care Questionnaire. The resulting sample consisted of 371 parents-child dyads. Bivariate and hierarchical regression analyses were conducted to determine whether having a medical home was associated with the number of unmet needs for specialty care. Less than one in five children with ASD had a medical home (18.9%). Nearly all parents reported that their child had a personal doctor or nurse as well as a usual source of care, but less than one-third received coordinated care (29.9%) and less than one-half received family-centered care (47.1%). Many children had unmet needs (63%), and the highest unmet need was for behavioral therapy. Having a medical home was associated with fewer unmet specialty care needs, even after demographic, child and family characteristics were taken into account. Children with ASD who have a medical home are more likely to have adequate access to needed services. Unfortunately, relatively few children have a medical home that includes family-centered and coordinated care. Enhancements in the delivery of primary care for children with ASD may make a real difference in access to needed specialty care services, potentially improving child and family outcomes.
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Auger KA, Simon TD, Cooperberg D, Gay J, Kuo DZ, Saysana M, Stille CJ, Fisher ES, Wallace S, Berry J, Coghlin D, Jhaveri V, Kairys S, Logsdon T, Shaikh U, Srivastava R, Starmer AJ, Wilkins V, Shen MW. Summary of STARNet: Seamless Transitions and (Re)admissions Network. Pediatrics 2015; 135:164-75. [PMID: 25489017 PMCID: PMC4279069 DOI: 10.1542/peds.2014-1887] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine.
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Affiliation(s)
- Katherine A. Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tamara D. Simon
- Division of Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - David Cooperberg
- St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - James Gay
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dennis Z. Kuo
- Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michele Saysana
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. Stille
- General Academic Pediatrics, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, Colorado
| | - Erin Stucky Fisher
- University of California San Diego School of Medicine, San Diego, California
| | - Sowdhamini Wallace
- Section of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Jay Berry
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Daniel Coghlin
- Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vishu Jhaveri
- Blue Cross Blue Shield of Arizona representing Blue Cross Blue Shield Association, Phoenix, Arizona
| | - Steven Kairys
- Jersey Shore Medical Center, Neptune Township, New Jersey
| | - Tina Logsdon
- Children’s Hospital Association, Overland Park, Kansas
| | - Ulfat Shaikh
- University of California Davis Health System, Sacramento, California
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Amy J. Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Victoria Wilkins
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Mark W. Shen
- Dell Medical School, University of Texas Austin, Austin, Texas
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Impact of a family-centered approach on attunement of care and parents' disclosure of concerns: a quasi-experimental study. J Dev Behav Pediatr 2014; 35:292-300. [PMID: 24799267 DOI: 10.1097/dbp.0000000000000062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the importance parents place on family-centered care aspects in Preventive Child Healthcare (PCH) and to evaluate whether a family-centered approach influences the attunement of care to these preferences and the willingness of parents to disclose concerns. METHODS Parents of infants (mean age = 11.4 weeks) attending Dutch PCH participated in the quasi-experimental study. Parents of infants receiving family-centered care (intervention condition) and parents of infants receiving care-as-usual (control condition) filled in a questionnaire regarding the importance of PCH professionals' attitude, parents' empowerment, and monitoring the broad developmental context. They also assessed their experiences regarding these aspects of care. Furthermore, parents rated their willingness to disclose concerns. We compared the 2 conditions, adjusting for background characteristics, and assessed interactions by socioeconomic status (SES) and the child's social-emotional status. RESULTS Data were provided by a sample of 2542 parents of infants receiving family-centered care and 2328 parents of infants receiving care-as-usual (return rate of questionnaires 86%). Parents rated the PCH professionals' attitude as most important and monitoring the broad developmental context as least important. Scores were high in both conditions. Compared with care-as-usual, parents receiving family-centered care reported better attunement of care to their preferences (p < .001, effect sizes = 0.10-0.27). Parents' willingness to disclose concerns was similar in both conditions (p = .09). Effects were stable across SES and child's social-emotional status groups. CONCLUSIONS The family-centered approach improves attunement of care to parents' preferences, but it does not increase their already high willingness to disclose concerns.
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Long WE, Cabral HJ, Garg A. Are components of the medical home differentially associated with child health care utilization, health, and health promoting behavior outcomes? Clin Pediatr (Phila) 2013; 52:423-32. [PMID: 23460651 DOI: 10.1177/0009922813479161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if specific components of the medical home are differentially associated with beneficial child outcomes. METHODS Logistic regression was used to model each component (family-centeredness, comprehensive care, and care coordination) with health care utilization, child health, and health promoting behaviors in 81 232 subjects from the 2003 National Survey of Children's Health. RESULTS Family-centeredness was associated with increased odds of children being read to (adjusted odds ratio [aOR] = 2.16). Comprehensive care was associated with decreased outpatient (aOR = 0.70) and emergency department (aOR = 0.79) sick visits and with increased child health per parental assessment (aOR = 1.50). Care coordination was associated with increased preventive care visits (aOR = 1.41) and increased outpatient (aOR = 1.21) and emergency department (aOR = 1.24) sick visits. Stratification by special health care needs demonstrated similar findings. CONCLUSIONS Comprehensive care was associated with improved child health and health care utilization. Prospective studies are needed to further investigate the differential impact of components of the medical home on child health.
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Affiliation(s)
- Webb E Long
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.
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