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Calixte R, Helzner EP, Islam S, Camacho-Rivera M, Pati S. Unmet Medical Needs and Food Insecurity in Children with Neurodevelopmental Disorders: Findings from the 2019 National Health Interview Survey (NHIS). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121798. [PMID: 36553242 PMCID: PMC9776614 DOI: 10.3390/children9121798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
In the United States, 17% of children ages 3−17 have a developmental disorder. The complexity of care for such children require families to provide a significant amount of health care at home, representing a substantial economic cost. Our study identifies sociodemographic characteristics of children with neurodevelopmental disorders (NDD) that are predictive of unmet medical needs and food insecurity. We modeled the outcomes using a multivariable generalized linear model and a robust Cox proportional hazard model. Among children with NDD, 7.4% reported a delay in obtaining care, 3.6% avoided getting care and 17.3% live in a household that experienced food insecurity. Lack of health insurance and lack of usual source of care increased the risk for cost-related delay in medical care and cost-related avoidance of medical care. Children with NDD whose parents have less than a college degree and those from households with income <$75,000 had increased risk for food insecurity in the past 30 days. Our results underscore the need to implement additional screening to identify children with NDD who are at greater risk for unmet medical and social needs by health care providers and care coordination organizations.
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Affiliation(s)
- Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- Correspondence:
| | - Elizabeth P. Helzner
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Sumaiya Islam
- CUNY School of Medicine, City College of New York, New York, NY 10031, USA
- Department of General Public Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Susmita Pati
- Department ofPediatrics, Renaissance School of Medicine, Stony Brook, NY 11794, USA
- Alan Alda Center for Communicating Science®, Stony Brook University, Stony Brook, NY 11794, USA
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Best S, Vidic N, An K, Collins F, White SM. A systematic review of geographical inequities for accessing clinical genomic and genetic services for non-cancer related rare disease. Eur J Hum Genet 2022; 30:645-652. [PMID: 35046503 DOI: 10.1038/s41431-021-01022-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
Place plays a significant role in our health. As genetic/genomic services evolve and are increasingly seen as mainstream, especially within the field of rare disease, it is important to ensure that where one lives does not impede access to genetic/genomic services. Our aim was to identify barriers and enablers of geographical equity in accessing clinical genomic or genetic services. We undertook a systematic review searching for articles relating to geographical access to genetic/genomic services for rare disease. Searching the databases Medline, EMBASE and PubMed returned 1803 papers. Screening led to the inclusion of 20 articles for data extraction. Using inductive thematic analysis, we identified four themes (i) Current service model design, (ii) Logistical issues facing clinicians and communities, (iii) Workforce capacity and capability and iv) Rural culture and consumer beliefs. Several themes were common to both rural and urban communities. However, many themes were exacerbated for rural populations due to a lack of clinician access to/relationships with genetic specialist staff, the need to provide more generalist services and a lack of genetic/genomic knowledge and skill. Additional barriers included long standing systemic service designs that are not fit for purpose due to historically ad hoc approaches to delivery of care. There were calls for needs assessments to clarify community needs. Enablers of geographically equitable care included the uptake of new innovative models of care and a call to raise both community and clinician knowledge and awareness to demystify the clinical offer from genetics/genomics services.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia. .,Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Nada Vidic
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Kim An
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Felicity Collins
- Clinical Genetics Service, Institute of Precision Medicine and Bioinformatics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Divisions of Genomic Medicine, Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Susan M White
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Melbourne, VIC, Australia
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Families with complex needs: an inside perspective from young people, their carers, and healthcare providers. J Community Genet 2022; 13:293-302. [PMID: 35301684 PMCID: PMC9270528 DOI: 10.1007/s12687-022-00586-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/03/2022] [Indexed: 11/01/2022] Open
Abstract
Complex health needs are demanding and often require additional medical, psychological and social support. All those involved (e.g., patients, carers, professionals) face a unique set of challenges and needs, especially in families where the patient is a child or a young person with a lifelong condition. The aim of the study was to explore carers' and young people's needs when living with long term conditions, as well as the views of the healthcare professionals supporting them. Semi-structured interviews with 30 participants (11 professionals, 10 parents, and 9 young people) were conducted. Interviews focused on 3 main areas-(1) medical needs, (2) psychological needs, and (3) communication needs-and were analyzed using thematic analysis. Four main themes emerged: (1) Acceptance takes time refers to the often long and challenging process of adapting to the diagnosis and living with the condition; (2) Close guidance captures the importance of specialised and long term guidance in accessing and managing the complexities of the medical system; (3) Open communication shows the families' need to be collaboratively connected to healthcare providers and other families facing similar difficulties; and (4) Long-term support underlines the importance of long term formal and informal support strategies. The participants' experiences and views have provided us with insight and guidance for developing and implementing personalized and integrated services. This inside perspective is key for future research aimed at better understanding the impact of complex conditions and meaningful ways to support families throughout their journeys.
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Huang L, Freed GL, Dalziel K. Children With Special Health Care Needs: How Special Are Their Health Care Needs? Acad Pediatr 2020; 20:1109-1115. [PMID: 31981656 DOI: 10.1016/j.acap.2020.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess use and needs for general practitioner, specialist, emergency department, hospital inpatient, and hospital outpatient services for children with special health care needs (CSHCN). To assess the level of CSHCN's needs compared with other children. METHODS Health service use and needs for children aged 4 to 15 years were assessed using the nationally representative Longitudinal Study of Australian Children survey with 25,011 observations. Odds ratios of service use and unmet needs for CSHCN compared to other children were estimated. CSHCN were further grouped as those 1) needing only additional medication, 2) needing only additional medical care, or 3) needing both as defined by the CSHCN screener questions. RESULTS The prevalence of those meeting criteria for CSHCN was 16.1%. In the past 12 months, 77.7% of CSHCN used any general practitioner care and 46.4%, 21.7%, 12.4%, and 15.0%, respectively, used specialty care, emergency department, hospital inpatient, and outpatient services. Approximately half of CSHCN were identified as having special needs due to needing additional medication. Their service use and unmet needs are only slightly elevated. Another group of CSHCN who need both more medication and medical care comprises less than one third of all CSHCN. These children have the highest odds of using specialty care (odds ratio 12.3, P < .001), and of having unmet specialty care need (odds ratio 7.4, P < .001) compared to children without special needs. CONCLUSIONS Our findings highlight the importance of ensuring specialty care for CSHCN, especially the one third with most elevated needs. This estimate might guide future care planning.
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Affiliation(s)
- Li Huang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne (L Huang, GL Freed and K Dalziel), Melbourne, Australia
| | - Gary L Freed
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne (L Huang, GL Freed and K Dalziel), Melbourne, Australia; Division of General Pediatrics, Child Health Evaluation and Research Centre, The University of Michigan (GL Freed), Ann Arbor, Mich
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne (L Huang, GL Freed and K Dalziel), Melbourne, Australia.
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Besterman AD, Sadik J, Enenbach MJ, Quintero-Rivera F, DeAntonio M, Martinez-Agosto JA. The Feasibility and Outcomes of Genetic Testing for Autism and Neurodevelopmental Disorders on an Inpatient Child and Adolescent Psychiatry Service. Autism Res 2020; 13:1450-1464. [PMID: 32662193 DOI: 10.1002/aur.2338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
Diagnostic genetic testing is recommended for children with autism spectrum disorder and other neurodevelopmental disorders. One approach to improve access to genetic testing is to offer it on the inpatient child and adolescent psychiatry (CAP) service. We provided medical genetics education to CAP fellows and retrospectively compared the genetic testing rates and diagnostic yield pre- and post-education. We compared demographics to similar patients who received testing on other clinical services and assessed rates of outpatient genetics follow-up post-discharge. The genetic testing rate on the inpatient CAP service was 1.6% before the educational intervention and 10.7% afterward. Genetic risk factors were identified in 4.3% of inpatients. However, 34.8% had variants of unknown significance. 39.1% of patients who received genetic testing while inpatients were underrepresented minorities, compared to 7.7% of inpatients who received genetic testing from other clinical services. 43.5% of patients were lost to outpatient genetics follow-up. We have demonstrated that it is feasible to provide medical genetics education to CAP fellows on an inpatient service, which may improve genetic testing rates. This preliminary evidence also suggests that genetic testing for inpatients may identify variants of unknown significance instead of well-known neurodevelopmental disorder risk variants. Genetic testing on an inpatient CAP service may also improve access to genetic services for underrepresented minorities, but assuring outpatient follow-up can be challenging. LAY SUMMARY: Genetic testing is recommended for children with autism and related developmental conditions. We provided genetic testing to a group of these children who were in a psychiatric hospital by teaching their doctors how it can be helpful. We identified a genetic risk factor in a small percentage of children and a possible genetic risk factor in a large percentage of children. However, many children did not end up receiving their genetic test results once they left the hospital. These results tell us that the psychiatric hospital may be a good place for children with autism and behavioral problems to get genetic testing, but that it is really important that doctors assure follow-up is feasible for all patients to receive their genetic test results once they leave the hospital. Autism Res 2020, 13: 1450-1464. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Aaron D Besterman
- Department of Psychiatry, UCLA Division of Child and Adolescent Psychiatry, Los Angeles, California, USA.,UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Pediatrics, UCLA Division of Medical Genetics, Los Angeles, California, USA.,UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Joshua Sadik
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Michael J Enenbach
- Department of Psychiatry, UCLA Division of Child and Adolescent Psychiatry, Los Angeles, California, USA.,UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, California, USA.,UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Fabiola Quintero-Rivera
- UCLA David Geffen School of Medicine, Los Angeles, California, USA.,UCLA Department of Pathology and Laboratory Medicine, Los Angeles, California, USA
| | - Mark DeAntonio
- Department of Psychiatry, UCLA Division of Child and Adolescent Psychiatry, Los Angeles, California, USA.,UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, California, USA.,UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Julian A Martinez-Agosto
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Pediatrics, UCLA Division of Medical Genetics, Los Angeles, California, USA.,UCLA David Geffen School of Medicine, Los Angeles, California, USA.,UCLA Department of Human Genetics, Los Angeles, California, USA
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Abstract
PURPOSE OF REVIEW Genome sequencing is now available as a clinical diagnostic test. There is a significant knowledge and translation gap for nongenetic specialists of the processes necessary to generate and interpret clinical genome sequencing. The purpose of this review is to provide a primer on contemporary clinical genome sequencing for nongenetic specialists describing the human genome project, current techniques and applications in genome sequencing, limitations of current technology, and techniques on the horizon. RECENT FINDINGS As currently implemented, genome sequencing compares short pieces of an individual's genome with a reference sequence developed by the human genome project. Genome sequencing may be used for obtaining timely diagnostic information, cancer pharmacogenomics, or in clinical cases when previous genetic testing has not revealed a clear diagnosis. At present, the implementation of clinical genome sequencing is limited by the availability of clinicians qualified for interpretation, and current techniques in used clinical testing do not detect all types of genetic variation present in a single genome. SUMMARY Clinicians considering a genetic diagnosis have wide array of testing choices which now includes genome sequencing. Although not a comprehensive test in its current form, genome sequencing offers more information than gene-panel or exome sequencing and has the potential to replace targeted single-gene or gene-panel testing in many clinical scenarios.
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