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Wesevich A, Jiao MG, Santanam TS, Chung RJ, Uchitel J, Zhang Q, Brindis CD, Ford CA, Counts NZ, Wong CA. Adolescent and Young Adult Perspectives on Quality and Value in Health Care. Acad Pediatr 2023; 23:782-789. [PMID: 36288750 DOI: 10.1016/j.acap.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment. METHODS A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses. RESULTS Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality. CONCLUSIONS When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.
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Affiliation(s)
- Austin Wesevich
- Section of Hematology/Oncology, Department of Medicine, University of Chicago (A Wesevich), Chicago, Ill; Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Megan G Jiao
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Taruni S Santanam
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Richard J Chung
- Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Julie Uchitel
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Qintian Zhang
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Claire D Brindis
- Adolescent and Young Adult National Health Information Center and Philip R. Lee Institute for Health Policy Studies, University of California (CD Brindis), San Francisco, Calif
| | - Carol A Ford
- Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia (CA Ford), Philadelphia, Pa
| | | | - Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC.
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Boyer TL, Sequeira GM, Egan JE, Ray KN, Miller E, Coulter RWS. Binary and Nonbinary Transgender Adolescents' Healthcare Experiences, Avoidance, and Well Visits. J Adolesc Health 2022; 71:438-445. [PMID: 35725539 PMCID: PMC9827712 DOI: 10.1016/j.jadohealth.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 04/23/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To explore differences in healthcare experiences, healthcare avoidance, and well visit attendance between binary and nonbinary transgender adolescents; also, to explore the association between distinct healthcare experiences and healthcare avoidance and well visits. METHODS We surveyed transgender adolescents ages 12-26 (n = 156) recruited from a multidisciplinary gender clinic from July through November 2018. Differences in distinct healthcare experiences by demographics were assessed using multivariable linear regression. Multivariable logistic regression was used to examine independent associations between demographics and lifetime healthcare avoidance and past-year well visit and also, associations between distinct healthcare experiences and lifetime healthcare avoidance and past-year well visit. RESULTS Compared to transfeminine adolescents, more non-affirming healthcare experiences were reported by nonbinary (β = 1.41, 95% confidence interval [CI]: 0.49, 2.33) and transmasculine adolescents (β = 0.78, 95% CI: 0.02, 1.53). Gender-affirming healthcare experiences did not differ by demographics. Transmasculine adolescents had over three times the odds of lifetime healthcare avoidance (adjusted odds ratio [aOR] = 3.58, 95% CI: 1.41, 9.08) than transfeminine peers. Only younger age was associated with past-year well visit (aOR = 3.83, 95% CI: 1.44, 10.17). Non-affirming healthcare experiences were positively associated with healthcare avoidance (aOR = 1.85, 95% CI: 1.47, 2.34). Gender-affirming healthcare experiences were not associated with healthcare avoidance or past-year well visit. DISCUSSION Nonbinary and transmasculine adolescents experienced more non-affirming healthcare experiences than transfeminine adolescents. Non-affirming healthcare experiences were associated with healthcare avoidance, which was disproportionately more prevalent among transmasculine adolescents. Providers must be better equipped to provide inclusive, gender-affirming care to increase receipt of care for transgender adolescents beyond specialized gender clinics.
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Affiliation(s)
- Taylor L Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Gina M Sequeira
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristin N Ray
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Human Papilloma Virus Vaccination in Patients with Rheumatic Diseases in France: A Study of Vaccination Coverage and Drivers of Vaccination. J Clin Med 2022; 11:jcm11144137. [PMID: 35887899 PMCID: PMC9317620 DOI: 10.3390/jcm11144137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 01/27/2023] Open
Abstract
Objectives: To describe human papillomavirus (HPV) vaccination practices in adolescent girls with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA) and to identify barriers to and motivators for vaccination. Methods: Cross-sectional, multicenter study on girls aged 9 to 19 years and their accompanying adults. The measurement criteria were the proportion of girls who were vaccinated against HPV, compliance with the vaccination schedule, factors associated with vaccination, and reasons for vaccination and non-vaccination through a self-administered questionnaire. Results: Seventy-one patients (16 with SLE and 55 with JIA) were included with a mean age of 13 years old (rank 11−18). According to parental questioning, 39% of patients were vaccinated against HPV or in progress (44% and 38% of SLE and JIA, respectively). This rate was 82% for the 22 patients ≥ 15 years of age. The vaccine was administered as often by a general practitioner (39%) as by a hospital pediatrician (also 39%). Two factors were significantly associated with vaccination: Older age (OR 53.68, 95% CI 5.85−429.29, p < 0.001) and previous hepatitis B vaccination (OR 4.97, 95% CI 1.03−24.01, p = 0.040). Recommendation of the vaccine by a health professional and fear of HPV-related diseases were the main facilitators. Lack of knowledge about the vaccine, lack of recommendation by a health professional, and fear of vaccine side effects were the main barriers. Conclusions: HPV vaccination coverage remains insufficient among patients with autoimmune disease. Education and awareness of health professionals about HPV infections are crucial elements in vaccine acceptance.
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Lackova Rebicova M, Dankulincova Veselska Z, Madarasova Geckova A, Jansen DEMC, van Dijk JP, Reijneveld SA. Are Adverse Childhood Experiences Associated With Being in the System of Care? Front Psychol 2022; 13:909737. [PMID: 35814085 PMCID: PMC9263823 DOI: 10.3389/fpsyg.2022.909737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAdverse childhood experiences (ACEs) can cause serious mental problems in adolescents and therefore may expected to be associated with higher use of psychosocial care, potentially varying by type of specific ACE. The aim of our study is to explore the association of the number of ACE and types of specific ACE with entering and using psychosocial care.MethodsWe used data from the Slovak Care4Youth cohort study, comprising 509 adolescents from 10 to 16 years old (mean age 13.2 years, 48.6% boys). We used logistic regression models adjusted for age, gender, and family affluence to explore the associations of number and type of specific ACE with the use of psychosocial care.ResultsHaving three or more ACE as well as experiencing some specific ACE (death of a mother/father, death of somebody else you love, problems of a parent with alcohol or drugs, conflicts or physical fights between parents, and separation/divorce of parents) increased the likelihood of using psychosocial care. Regarding experience with the death of somebody else you love, we found a decreased likelihood of the use of psychosocial care.ConclusionExperiencing ACE above a certain threshold (three or more) and parent-related ACE increase the likelihood of adolescent care use.
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Affiliation(s)
- Miriama Lackova Rebicova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovakia
- Department of Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Miriama Lackova Rebicova,
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovakia
- Department of Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovakia
- Department of Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Danielle E. M. C. Jansen
- Theoretical Sociology - Department Sociology, Faculty of Behavioural and Social Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovakia
- Department of Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czechia
| | - Sijmen A. Reijneveld
- Department of Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Peixoto AMCDL, Melo TQD, Ferraz LAA, Santos CDFBF, Godoy FD, Valença PADM, Menezes VAD, Colares V. Demand for health services or professionals among adolescents: a multilevel study. CIENCIA & SAUDE COLETIVA 2021; 26:2819-2827. [PMID: 34231694 DOI: 10.1590/1413-81232021267.08582021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the demand for health services or professionals by adolescents with individual determinants and contextual variables (school teaching modality and Social Vulnerability Index). Data were collected from March to June 2018, in state public schools in Olinda, Pernambuco, Brazil, through a structured questionnaire with questions from the Youth Risk Behavior Survey (YRBS) and the National School Health Survey (PeNSE). Among the 2,454 adolescents, the proportion of those looking for a health service was higher among women; in adolescents whose mothers had a minimum of nine schooling years; in the physically active; and whose parents did not receive a family aid (Bolsa Família). We observed that the contextual variables did not influence the demand for health services among adolescents. In the third model of the multilevel analysis, which analyzed the individual variables, we observed that only females (OR=1,80), having a mother with schooling greater than or equal to 9 years of study (OR=1,30), not receiving Bolsa Família (OR=1,23), and physically active (OR=1,32) were associated with an increased demand for health services or professionals.
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Affiliation(s)
| | | | - Livia Almeida Amaral Ferraz
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada, Universidade de Pernambuco. Recife PE Brasil
| | | | - Fabiana de Godoy
- Programa de Pós-Graduação em Hebiatria, Universidade de Pernambuco. Recife PE Brasil
| | | | | | - Viviane Colares
- Programa de Pós-Graduação em Hebiatria, Universidade de Pernambuco. Recife PE Brasil
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Most ZM, Warraich GJ, James L, Costello K, Dietz S, Lamb GS, Evans AS. Missed Opportunity Encounters for Early Diagnosis of HIV Infection in Adolescents. Pediatr Infect Dis J 2021; 40:e106-e110. [PMID: 33165279 DOI: 10.1097/inf.0000000000002971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Early diagnosis of HIV infection improves patient outcomes and reduces transmission. Adolescents make up one-fifth of new HIV diagnoses in the United States. We sought to quantify the number of missed opportunity encounters (MOEs) before HIV diagnosis for adolescents at a pediatric hospital (PediHosp) and a proximate adult hospital which employs universal HIV screening in its emergency department (ED) (CountyHosp). METHODS An observational study at 2 academic tertiary care hospitals in the United States that included all adolescents 13-20 years old with a new diagnosis of behaviorally-acquired HIV infection from 2006 to 2017. MOE were defined as any encounter at PediHosp or CountyHosp after the latter of the individual's 13th birthday or the date 3 months after the individual's most recent negative HIV screen, and before the encounter of HIV diagnosis. Comparisons were made by site of diagnosis and location of MOE. RESULTS Two-hundred five subjects met inclusion criteria: 68% male, 76% Black and 81% men who have sex with men. There were 264 MOE, the proportion of adolescent ED encounters that were MOE at the PediHosp ED was 8.3 MOE per 10,000 encounters and the proportion at the CountyHosp ED was 1.2 (relative risk = 6.7; 95% CI: 4.1-11.0; P < 0.001). CONCLUSIONS MOE for HIV diagnosis in adolescents occur frequently and are greater in number at a PediHosp as compared with a similar adult setting with universal screening. Universal HIV screening protocols at PediHosp may identify HIV-positive adolescents earlier.
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Affiliation(s)
- Zachary M Most
- From the Department of Pediatrics, Division of Pediatric Infectious Disease, University of Texas Southwestern Medical Center and
- Department of Pediatrics, Children's Health Dallas, Dallas, Texas
| | - Gohar J Warraich
- Department of Pediatrics, Children's Health Dallas, Dallas, Texas
- Regional Hospitalist Program, Nationwide Children's Hospital, Columbus, Ohio
| | - Lorraine James
- University of Texas Southwestern Medical Center, Dallas, Texas
- Pediatric Residency Program, Children's Hospital of Los Angeles, Los Angeles, California
| | - Kathleen Costello
- Department of Pediatrics, Children's Health Dallas, Dallas, Texas
- Department of Pediatrics, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Stephen Dietz
- Department of Pediatrics, Children's Health Dallas, Dallas, Texas
- Department of Pediatrics, Division of Pediatric Hospitalist Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gabriella S Lamb
- Department of Pediatrics, Children's Health Dallas, Dallas, Texas
- Department of Pediatrics, Division of Infectious Disease, Boston Children's Hospital and
- Harvard Medical School, Boston, Massachusetts
| | - Amanda S Evans
- From the Department of Pediatrics, Division of Pediatric Infectious Disease, University of Texas Southwestern Medical Center and
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Samohyl M, Babjakova J, Vondrova D, Jurkovicova J, Stofko J, Kollar B, Hirosova K, Filova A, Argalasova L. Factors Associated with Non-Attendance at Dental Preventive Care in Slovak High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031295. [PMID: 33535551 PMCID: PMC7908624 DOI: 10.3390/ijerph18031295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the factors associated with the avoidance of dental preventive care in high school students and their parents in the framework of The Youth and Parents Risk Factor Behavior Survey in Slovakia, the ongoing cross-sectional school-based survey of students and their parents or legal representatives. The data were collected using two separate standardized questionnaires: (i) the questionnaire for students (n = 515) and (ii) the questionnaire for parents (n = 681). The study group included 57 high school students (54.4% males) who did not visit the dentist for preventive care in the previous year. The control group included 458 students (35.8% males) who visited a dentist for preventive care at least once in the previous year. A significantly higher number of males (54.4%), older adolescents, and young adults (21.8%; 20.0%) were not visiting dental preventive care regularly. Incomplete family (56.1%), stressful situations at home (17.5%), and feeling unwell were the factors contributing to the avoidance of dental preventive care. More than 34.5% of adolescents and young adults were not visiting either dental preventive care or pediatric preventive care (adjusted odds ratio (AOR) = 5.14; 95% confidence interval (CI) = 2.40, 10.99). Children of divorced mothers and mothers with household income lower than EUR 900 had significantly higher dental care avoidance in bivariate analysis. A significantly higher percentage of fathers from the exposed group were not visiting dental preventive care regularly (47.8%, p < 0.05). The results of the study can be used as an educational intervention step focusing on the parental influence on adolescent and young adults' behavior and as a challenge for the improvement of dental preventive care in older adolescents and young adults.
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Affiliation(s)
- Martin Samohyl
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Jana Babjakova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Diana Vondrova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Jana Jurkovicova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Juraj Stofko
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, The University of St. Cyril and Methodius in Trnava, Námestie Jozefa Herdu 577/2, 917 01 Trnava, Slovakia;
| | - Branislav Kollar
- Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Mickiewiczova 13, 813 69 Bratislava, Slovakia;
| | - Katarina Hirosova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Alexandra Filova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Lubica Argalasova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
- Correspondence: ; Tel.: +421-905-209-114
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DeJonckheere M, Zhao A, Lane J, Plegue MA, Ranalli L, Wagner E, Riley M. Results of a National Text Message Poll of Youth: Perspectives on Primary Care. J Adolesc Health 2020; 67:814-820. [PMID: 32620346 DOI: 10.1016/j.jadohealth.2020.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a significant interest in improving adolescent access to primary care, yet limited attempts to incorporate youth feedback within these efforts. The purpose of this study was to describe the experiences related to primary care among a large national sample of adolescents to improve patient-centered care. METHODS Youth were sent open-ended text message prompts via an ongoing study of 14- to 24-year-olds in the U.S. Text responses were analyzed using qualitative thematic analysis, including descriptive coding, consensus building, and theme development. Secondary quantitative analyses were conducted to determine differences by demographics. RESULTS Of 1,123 eligible participants, 789 (70.2%) responded to at least one prompt. Four themes were developed: (1) youth recognized the importance of primary care, but barriers exist that limited their utilization; (2) youth felt that improving convenience would increase the use of primary care; (3) youth were unsure how to transition between primary care settings; and (4) feeling respected was essential to youth having positive experiences in a primary care health care setting. Older youth and those identifying as female, nonbinary, or transgender were more likely to report previous bad experiences with primary care. CONCLUSIONS Our findings describe barriers and possible solutions to primary care among youth. Because attitudes toward health and health care are established during adolescence, a transformation is needed to create more patient-centered care that aligns with young people's values and experiences. Thus, primary care providers have the opportunity to positively impact the health of young people today and the adults of the future.
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Affiliation(s)
| | - Aisling Zhao
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jenni Lane
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lauren Ranalli
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Ellen Wagner
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Margaret Riley
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
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Ferrin SN, Grout RW, Lewis Gilbert A, Wilkinson TA, Cheng ER, Downs SM, Aalsma MC. Caregiver Comfort in Adolescents Independently Completing Screening Tablet-Based Questionnaires at Primary Care Visits. J Adolesc Health 2019; 65:799-804. [PMID: 31522906 PMCID: PMC7358079 DOI: 10.1016/j.jadohealth.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/18/2019] [Accepted: 07/10/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE The objective of this study was to assess caregiver comfort regarding adolescent completion of computerized health screening questionnaires created for adolescents. METHODS We conducted a mixed-method, cross-sectional survey of caregivers of adolescent patients (n = 104) aged 12-18 years who had a medical visit between June 2017 and August 2017. Topics assessed included who completed the questionnaire, caregiver comfort and concern regarding questionnaire data, and caregiver reasons for involvement in completing the questionnaire. A one-way analysis of variance was used to compare the age of the adolescent and caregiver involvement in the questionnaire. RESULTS The majority of adolescents (64%) reported independent completion of the questionnaire. Thirteen percent of caregivers completed the questionnaire with no involvement of the adolescent and 23% reported that caregivers and adolescents completed the questionnaire in tandem. The majority of caregivers (84%) were comfortable with adolescents completing the questionnaire. A variety of reasons were identified for caregivers completing the questionnaire (time constraints, 22%; adolescent requested caregiver help, 19%; caregiver desired to answer questions, 14%; caregiver did not realize that the questionnaire was intended for the adolescent, 11%; caregiver believed that the adolescent was too young to respond alone, 11%). Caregiver comfort with adolescent completing the questionnaire increase with age. CONCLUSION We found the reason most caregivers gave for completing the questionnaires were related to clinic processes (e.g. time constraints). Caregivers were more likely to complete the questionnaire with younger adolescents. Thus, pediatricians should consider how to best prepare families for initial questionnaires in primary care.
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Affiliation(s)
- Stephanie N. Ferrin
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Randall W. Grout
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana,Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Amy Lewis Gilbert
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tracey A. Wilkinson
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - Erika R. Cheng
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen M. Downs
- Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana,Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Matthew C. Aalsma
- Adolescent Behavioral Health Research Program, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Abidin LS, Fitriyani P, Setiawan A. Correlations between adolescents’ perceptions of family health tasks and adolescents’ smoking behaviors in Indonesia. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Green C, Jung HY, Wu X, Abramson E, Walkup JT, Ford JS, Grinspan ZM. Do Children with Special Health Care Needs with Anxiety have Unmet Health Care Needs? An Analysis of a National Survey. Matern Child Health J 2019; 23:1220-1231. [PMID: 31292839 DOI: 10.1007/s10995-019-02759-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe differences in health care needs between Children with Special Health Care Needs (CSHCN) with and without anxiety and examine the association between anxiety and unmet health care needs. METHODS We analyzed data from the 2009/2010 national survey of CSHCN. The independent variable was anxiety. The main outcomes were health care needs and unmet needs. Covariates included demographics, other co-morbid conditions, and the presence and quality of a medical home. We used bivariate analyses and multivariable logistic regression to assess the relationships among anxiety, covariates, and the outcomes. We stratified our analysis by age (6-11 years, 12-17 years). Propensity score matched paired analysis was used as a sensitivity analysis. RESULTS Our final sample included 14,713 6-11 year-olds and 15,842 12-17-year-olds. Anxiety was present in 16% of 6-11 year-olds and 23% or 12-17 year-olds. In bivariate analyses, CSHCN with anxiety had increased health care needs and unmet needs, compared to CSHCN without anxiety. In multivariable analyses, only children 12-17 years old with anxiety had increased odds of having an unmet health care need compared to those children without anxiety (OR 1.44 [95% CI 1.17-1.78]). This was confirmed in the propensity score matching analysis (OR 1.12, [95% CI 1.02-1.22]). The specific unmet needs for older CSHCN with anxiety were mental health care (OR 1.54 [95% CI 1.09-2.17]) and well child checkups (OR 2.01 [95% CI 1.18-3.44]). CONCLUSION Better integration of the care for mental and physical health is needed to ensure CSHCN with anxiety have all of their health care needs met.
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Affiliation(s)
- Cori Green
- New York Presbyterian/Weill Cornell Medicine Department of Pediatrics, 525 East 68th Street, Room 628b, Box 139, New York, NY, 10065, USA.
| | - Hye-Young Jung
- New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
| | - Xian Wu
- New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
| | - Erika Abramson
- New York Presbyterian/Weill Cornell Medicine Department of Pediatrics, 525 East 68th Street, Room 628b, Box 139, New York, NY, 10065, USA.,New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
| | - John T Walkup
- Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Zachary M Grinspan
- New York Presbyterian/Weill Cornell Medicine Department of Pediatrics, 525 East 68th Street, Room 628b, Box 139, New York, NY, 10065, USA.,New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
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12
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Bonville CA, Domachowske JB, Suryadevara M. A quality improvement education initiative to increase adolescent human papillomavirus (HPV) vaccine completion rates. Hum Vaccin Immunother 2019; 15:1570-1576. [PMID: 31166137 DOI: 10.1080/21645515.2019.1627822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
HPV vaccine uptake is low, nationwide. Quality improvement (QI) principles have the potential to change practice; however, not all providers are confident with QI skills. We developed an educational program designed to enhance QI skills and improve HPV vaccination rates. Five pediatric practices participated in the pilot initiative. Training consisted of presentations regarding QI methods, data tracking and analysis, and system changes to reduce missed opportunities. Monthly for 6 months, participants performed chart audits, captured data, printed run charts, and developed, implemented, and tracked interventions. Outcome measures included rates of HPV vaccine completion and missed opportunities. A second phase included eight different pediatric practices who received similar training. Outcome measures included rates of HPV vaccine initiation and completion. Over the 6 months, mean HPV vaccine completion rates increased (45% to 65%) and missed opportunities for HPV vaccination decreased (45% to 19%) in the pilot program. When the program was replicated in phase 2, an increase was seen in both HPV vaccine initiation (46% to 61%) and completion (62% to 94%) rates. Combining QI education with workflow-focused strategies was associated with a reduction in missed opportunities and a substantial increase in HPV vaccine completion rates.
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Affiliation(s)
- Cynthia A Bonville
- a Department of Pediatrics, SUNY Upstate Medical University , Syracuse , NY , USA
| | - Joseph B Domachowske
- a Department of Pediatrics, SUNY Upstate Medical University , Syracuse , NY , USA
| | - Manika Suryadevara
- a Department of Pediatrics, SUNY Upstate Medical University , Syracuse , NY , USA
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13
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Adams SH, Park MJ, Twietmeyer L, Brindis CD, Irwin CE. Young Adult Preventive Healthcare: Changes in Receipt of Care Pre- to Post-Affordable Care Act. J Adolesc Health 2019; 64:763-769. [PMID: 30850314 DOI: 10.1016/j.jadohealth.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Young adults have unique health and health care needs. Although morbidity and mortality stem largely from preventable factors, they lack a structured set of preventive care guidelines. The Affordable Care Act (ACA), enacted in 2010, increased young adult insurance coverage, prohibited copayments for preventive visits among privately insured and for many preventive services. The objectives were to evaluate pre- to post-ACA changes in young adults' past-year well visits and, among those using a past-year health care visit, the receipt of preventive services. METHODS We used pooled Medical Expenditure Panel Survey data, comparing pre-ACA (2007-2009, N = 10,294) to post-ACA (2014-2016, N = 10,567) young adults aged 18-25 years. Bivariable and multivariable stratified logistic regression, adjusting for sociodemographic covariates, were conducted to determine differences in well visits and in preventive services among past-year health care utilizers: blood pressure and cholesterol checks, influenza immunization, and all three received. RESULTS Past-year well visits increased from pre-ACA (28%) to post-ACA (32%), p < .001. Increases were noted for most demographic subgroups with greatest increases among males, Asian, and highest income subgroups. Larger pre- to post-ACA increases were found for most of the preventive services, p < .05, including the receipt of all three services (7% vs. 16%), p < .001, among past-year health care utilizers. CONCLUSION Following ACA implementation, young adults experienced modest increases in well visit rates and larger increases in most preventive services received. Overall rates of both remain low. Building on these improvements requires concerted efforts that account for young adults' unique combination of health care issues and challenges in navigating an adult health care system.
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Affiliation(s)
- Sally H Adams
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Charles E Irwin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
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14
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Anderson VR, Ouyang F, Tu W, Rosenman MB, Wiehe SE, Aalsma MC. Medicaid Coverage and Continuity for Juvenile Justice–Involved Youth. JOURNAL OF CORRECTIONAL HEALTH CARE 2019; 25:45-54. [DOI: 10.1177/1078345818820043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marc B. Rosenman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C. Aalsma
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Thakkar MY, Hao L, Marcell AV. Adolescents' and Young Adults' Routine Care Use: The Role of Their Mothers' Care Use Behaviors. J Adolesc Health 2019; 64:107-115. [PMID: 30314866 PMCID: PMC6309640 DOI: 10.1016/j.jadohealth.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Little is known whether mothers' own care use is differentially associated with their adolescents' routine care use by gender. The main purpose of this study is to examine whether mothers' healthcare use prospectively predicts their adolescents' routine care use stratified by gender, after controlling for predisposing (child's age, race/ethnicity, region of residence, urbanicity, and mother's age at child's birth), enabling (mother's education, adolescent and mother health insurance), and need (child health status) factors. METHODS In 2018, a prospective analysis was conducted using data from 5,040 adolescents aged 9-24 and their mothers who completed the two-generation National Longitudinal Survey of Youth in 2006 (first interview) and 2008 (second interview). Findings include percentages and adjusted odds ratios of the factors that predict adolescents' self-report of routine care use in the past year measured at the second interview. RESULTS In 2008, over half of participants reported a routine doctor visit during the prior 12 months and this varied by gender; more females (68.7%) had a visit than males (53.5%). Factors that independently predicted a greater odds of adolescents' routine doctor visits included mothers with routine doctor visits at both interviews or the second interview only, and adolescents' health insurance and past routine visit, regardless of gender. Males aged 18-20 and 21-24 years had lower odds of having a routine doctor visit than males aged 9-11 years. CONCLUSIONS This study provides evidence for the potential role that mothers' care use can play in their adolescents' routine care use, especially for their sons, independent of insurance status.
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Affiliation(s)
| | - Lingxin Hao
- Krieger School of Arts and Sciences, Baltimore, Maryland
| | - Arik V Marcell
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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16
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Adams SH, Park MJ, Twietmeyer L, Brindis CD, Irwin CE. Association Between Adolescent Preventive Care and the Role of the Affordable Care Act. JAMA Pediatr 2018; 172:43-48. [PMID: 29114725 PMCID: PMC5833515 DOI: 10.1001/jamapediatrics.2017.3140] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/18/2017] [Indexed: 11/14/2022]
Abstract
Importance Despite decades of adolescent preventive well visit and services promotion (Guidelines for Adolescent Preventive Services and Bright Futures), rates are below recommended levels and little is known of the effect of the Patient Protection and Affordable Care Act (ACA) implementation on these care rates. Objectives To use Medical Expenditure Panel Survey data to determine (1) whether adolescent well visit rates increased from the pre-ACA period to post-ACA period, and (2) whether caregivers' reports of past-year preventive services delivery increased from the pre- to post-ACA period among adolescents with any past-year health care visit. Design, Setting, and Participants Secondary data analysis of 2007-2009 (before ACA implementation) and 2012-2014 (after ACA implementation) Medical Expenditure Panel Survey data on the differences in well visits and preventive services. Data were collected through computer-assisted personal interviews of caregivers of a nationally representative sample of a noninstitutionalized US population (n = 25 695 10- to 17-year-old adolescents). Main Outcomes and Measures For objective 1, pre- to post-ACA period differences in past-year well visits: (1) stratified bivariable logistic regressions identifying subgroup rate differences and (2) multivariable analyses controlling for demographic factors. For objective 2, pre- to post-ACA period differences in caregiver reports of preventive services receipt, including time alone with clinician: (1) bivariable (year differences) and (2) multivariable logistic regressions controlling for demographic variables. Results A total of 6279 (50.9%) and 6730 (50.8%) participating adolescents in the pre- and post-ACA period data were male, respectively. Under objective 1, we found that well-visit rates increased from 41% to 48% post-ACA implementation (odds ratio, 1.3; 95% CI, 1.2-1.5); minority and low-income groups had the greatest increases. Under objective 2, we found that among those with any past-year visit, most preventive services rates (8 of 9) increased post-ACA implementation (range, 2%-9%, absolute), with little or no change when controlling for demographic variables. Time alone with clinicians increased 1%, significant only when covariates were controlled (adjusted odds ratio, 1.2; 95% CI, 1.0-1.3). Conclusions and Relevance Despite modest to moderate increases, with greatest gains for underserved youth, adolescent preventive care rates remain low, highlighting the need for increased efforts to bring adolescents into well care and improve clinician delivery of preventive care within their practices.
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Affiliation(s)
- Sally H. Adams
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
| | - M. Jane Park
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
| | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
| | - Claire D. Brindis
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
- Philip R. Lee Institute for Health Policy Studies,
University of California, San Francisco
| | - Charles E. Irwin
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
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17
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Gundewar A, David R, Frey SM, Fagnano M, Halterman JS. Underutilization of Preventive Asthma Visits Among Urban Children With Persistent Asthma. Clin Pediatr (Phila) 2017; 56:1312-1318. [PMID: 28155330 PMCID: PMC6085754 DOI: 10.1177/0009922816685816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
National guidelines recommend that children with persistent asthma have at least 2 preventive asthma visits (PAVs) per year. We sought to determine the percent of urban children with persistent asthma who had a PAV in the past year, and to identify differences in demographics, health-related variables, and management associated with PAVs. Using data from 530 children (3-10 years) participating in a school-based asthma trial, we found that only 25% of children had at least 1 PAV, with only 5% receiving ≥2 visits. Having a PAV was not associated with demographics or health-related variables. Importantly, having a PAV was associated with having a preventive medication, taking that medication daily, and having a medication adjustment. Although PAVs were associated with actions to improve asthma control and management, these visits were underutilized in this sample. This highlights the need for novel methods to ensure access and deliver care to this vulnerable pediatric population.
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Affiliation(s)
- Anisha Gundewar
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Rebecca David
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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18
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Masoumi M, Shahhosseini Z. Self-care challenges in adolescents: a comprehensive literature review. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2016-0152/ijamh-2016-0152.xml. [PMID: 28599383 DOI: 10.1515/ijamh-2016-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/21/2017] [Indexed: 11/15/2022]
Abstract
Background Adolescence is the period of accepting self-care responsibility. Many severe diseases that cause early mortality are rooted in adolescence. Hence, adolescence is the definitive time for preventive interventions such as self-care behaviors. In addition to the benefits of self-care behaviors, evidence shows that adolescents face barriers in performing self-care behaviors. Objective The aim of the current study to review the self-care challenges for adolescents. Methods Databases such as Google Scholar, ScienceDirect, PubMed, Web of Science, Scientific Information Database and Scopus were searched to extract papers published from 1994 to 2016 based on the inclusion criterion. The inclusion criterion was English language papers from famous authors on self-care behaviors in adolescents. Results The results of the current study showed that adolescents face cultural (two subcategories, beliefs and convictions, knowledge), socio-economic (five subcategories, family, healthcare providers, peers, social support, economic status) and personal (three subcategories, mental health, gender, ethnicity) challenges. Conclusions Self-care behaviors in adolescents are influenced by biological, psychological, economic and social factors. As this is a multifactorial process, people who deal with adolescents should have enough knowledge regarding adolescent health status and also learn how to perceive the role of culture in self-care behaviors of the adolescents.
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Affiliation(s)
- Maryam Masoumi
- Research Student Committee, Mazandaran University of Medical Science, Nasibeh Nursing and Midwifery Faculty,Sari, Iran
| | - Zohreh Shahhosseini
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty,Mazandaran University of Medical Sciences, Sari, Iran
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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19
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Harris SK, Aalsma MC, Weitzman ER, Garcia-Huidobro D, Wong C, Hadland SE, Santelli J, Park MJ, Ozer EM. Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go? J Adolesc Health 2017; 60:249-260. [PMID: 28011064 PMCID: PMC5549464 DOI: 10.1016/j.jadohealth.2016.10.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/06/2016] [Accepted: 10/11/2016] [Indexed: 01/22/2023]
Abstract
We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care.
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Affiliation(s)
- Sion K Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Matthew C Aalsma
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Diego Garcia-Huidobro
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Department of Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Charlene Wong
- Division of Adolescent Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John Santelli
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California; Office of Diversity and Outreach, University of California, San Francisco, San Francisco, California.
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