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Min J, Bonett S, Tam V, Makeneni S, Goldstein ND, Wood S. Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19. Am J Prev Med 2024; 67:210-219. [PMID: 38417592 PMCID: PMC11260531 DOI: 10.1016/j.amepre.2024.02.016] [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: 11/19/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic. METHODS This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023. RESULTS The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to prep-andemic levels (-3.6 pp in the late-pandemic period, p<0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p<0.001), controlling for sex, age, insurance type and clinic characteristics. CONCLUSIONS Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.
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Affiliation(s)
- Jungwon Min
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Spandana Makeneni
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Sarah Wood
- Clinical Futures and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Boswell EK, Crouch E. Brief Report: Rural-Urban Differences in Disability Prevalence, Healthcare Services Utilization, and Participation in Special Education. J Autism Dev Disord 2024:10.1007/s10803-024-06434-y. [PMID: 38941047 DOI: 10.1007/s10803-024-06434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/29/2024]
Abstract
Previous research has found that rural children are more likely to be disabled but are less likely to receive care. Both rural and disabled children were significantly impacted by the pandemic, particularly in terms of service utilization. Therefore, this study seeks to identify rural-urban differences in the prevalence of various disability indicators and in the receipt of educational and healthcare services. Data from 12,828 children aged 2-17 who participated in the 2021-2022 National Health Interview Survey (NHIS) was used to examine rural-urban differences in three different disability indicators and in education and health services utilization. Disability indicators included the Washington Group Short Set Composite Disability Indicator, a developmental disability indicator, and a neurodivergence indicator. Bivariate analysis, via Rao-Scott chi-square tests, was used to examine rural-urban disparities. Compared to their urban counterparts, rural children were more likely to have a positive Washington Group Short Set Composite Disability Indicator (14.3% vs. 10.6%) and neurodivergence indicator (17Ð.3% vs. 14.1%). Rural children with disabilities were more likely to have received prescription medication for behavioral, mental, or emotional health or concentration in the past year than urban children (34.2% vs. 25.9%). There was no rural-urban difference in the prevalence of developmental disabilities or other forms of health care use and special education participation. This report highlights the need for further investigation into underlying causes of rural-urban disparities in the prevalence of disabilities, as well as the need for continued support for programs and policies designed to support rural children with disabilities.
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Affiliation(s)
- Emma K Boswell
- Rural and Minority Health Research Center, University of South Carolina, 220 Stoneridge Dr, Columbia, SC, 29210, USA.
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, University of South Carolina, 220 Stoneridge Dr, Columbia, SC, 29210, USA
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Chilukuri N, Links AR, Prichett L, Tschudy M, Showell N, Polk S, Perrin EM, Hughes HK. Comparison of Telemedicine Usage at Two Distinct Medicaid-Focused Pediatric Clinics. Telemed J E Health 2024. [PMID: 38938205 DOI: 10.1089/tmj.2023.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Objective: To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Methods: Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Results: Out of 17,142 total visits, 13% of encounters at Site A (n = 987) and 25% of encounters at Site B (n = 2,421) were conducted using telemedicine. Around 13.8% of well-child care (n = 1,515/10,997), 36.2% of mental health care (n = 572/1,581), and 25.0% of acute care/follow-up (n = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Conclusions: Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.
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Affiliation(s)
- Nymisha Chilukuri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Anne R Links
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Prichett
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Megan Tschudy
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nakiya Showell
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Polk
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eliana M Perrin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Helen K Hughes
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lin A, Chung S. Understanding Pediatric Surge in the United States. Pediatr Clin North Am 2024; 71:395-411. [PMID: 38754932 DOI: 10.1016/j.pcl.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
The concepts of pediatric surge in the United States continue to evolve from a theoretic framework to practical implementation. As disasters become more frequent, ranging from natural to human-caused, children remain a vulnerable population. The coronavirus disease 2019 pandemic and the 2022 to 2023 tripledemic respiratory surge revealed advances and continued challenges in our ability to care for a large influx of pediatric patients. Understanding pediatric surge through the framework of the 4 S's (space, staff, stuff, and systems/structures) can identify gaps at multiple levels.
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Affiliation(s)
- Anna Lin
- Pediatric Hospital Medicine, Stanford Medicine Children's Health; Department of Pediatrics, Stanford School of Medicine.
| | - Sarita Chung
- Disaster Preparedness, Division of Emergency Medicine, Boston Children's Hospital; Pediatric and Emergency Medicine, Harvard Medical School
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Strachan C, Kugler E, Devgan K, Nestor J, Afridi F, Raju R, Hunter K, Ahmed R. Intravenous iron infusions in pediatric patients: A retrospective review of efficacy and safety. J Investig Med 2024; 72:457-464. [PMID: 38429647 DOI: 10.1177/10815589241238219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Pediatric iron deficiency anemia (IDA) is often treated with oral iron supplementation as the first-line therapy despite poor adherence. This single-institution retrospective chart review of pediatric patients was conducted to assess the safety, efficacy, and adherence of intravenous (IV) iron infusions compared to oral iron therapy in patients who had failed a trial of oral iron supplementation. We reviewed medical records of patients aged 1-21 with IDA who received at least one IV iron infusion at Cooper University Hospital between 2016 and 2021. Paired t-tests compared pre-infusion and post-infusion hematologic indices of hemoglobin (Hgb), mean corpuscular volume, red blood cell count, red cell distribution width, ferritin, total iron binding capacity, iron stores, and iron saturation. We compared adherence and adverse reactions to both oral iron supplementation and IV iron infusions using McNemar's test. A total of 107 subjects were included (mean age of 12.7 years). Hgb, ferritin, iron, and iron saturation between pre-infusion and post-final infusion significantly improved (p < 0.001). Hgb, ferritin, and iron improved when subcategorizing by race and etiology of IDA. Adherence to IV iron infusions (70.1%) was significantly greater than adherence to oral iron therapy (43.0%). There were also significantly fewer adverse effects with IV iron infusions (3.7%) compared to oral iron (77.9%). We demonstrated the safety, efficacy, and improved adherence of IV iron infusions compared to oral iron supplementation for treatment of pediatric IDA in patients who were unable to tolerate oral iron supplementation. Future studies could compare adherence to multiple doses of IV iron infusions in contrast with other single-dosing IV iron formulations.
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Affiliation(s)
| | - Emmalee Kugler
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Kartik Devgan
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jennifer Nestor
- Pediatric Critical Care, Nemours Children's Hospital Dupont, Wilmington, DE, USA
| | - Faraz Afridi
- Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Riya Raju
- Department of Pediatrics, Children's Regional Hospital at Cooper University Hospital, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Hospital, Camden, NJ, USA
| | - Rafat Ahmed
- Department of Pediatric Hematology, Children's Regional Hospital at Cooper University Hospital, Camden, NJ, USA
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Hildenbrand AK, Amaro CM, Bear B, Soprano CM, Salamon KS. Exploring Referral and Service Utilization Patterns Within an Outpatient Interdisciplinary Pediatric Chronic Pain Program. J Pain Res 2024; 17:525-533. [PMID: 38333433 PMCID: PMC10849913 DOI: 10.2147/jpr.s430411] [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: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose We examine referral sources and clinical characteristics for youth presenting to an outpatient interdisciplinary pediatric chronic pain program. Patients and Methods Referral data were extracted from the electronic health record. PROMIS Pediatric Anxiety and Pain Interference Scales were administered at an initial evaluation visit. Results The program received 1488 referrals between 2016 and 2019, representing 1338 patients, with increasing volume of referrals over time. Referrals were primarily from orthopedics (19.6%), physical medicine and rehabilitation (18.8%), neurology (14.4%), and rheumatology (12.6%). Patients referred were primarily female (75.4%), White (80.1%), English-speaking (98.4%) adolescents (median=15.0 years). Of those referred, 732 (54.7%) attended an interdisciplinary evaluation (ie, with ≥2 disciplines). Adolescent anxiety was within the expected range by self-report (N=327, MT-score=55.67) and parent proxy-report (N=354, MT-score=57.70). Pain interference was moderately elevated by self-report (N=323, MT-score=61.52) and parent proxy-report (N=356, MT-score=64.02). There were no differences between patients referred who attended versus did not attend an interdisciplinary evaluation based on age, sex, ethnicity, or language. A smaller than expected proportion of referred Black patients (44%, P=0.02) and patients referred from orthopedics (40%) or pulmonology (11%) attended an evaluation, whereas a larger than expected proportion of those referred from physical medicine and rehabilitation (78%) were evaluated (P<0.001). Conclusion Results highlight the demand for outpatient interdisciplinary pediatric chronic pain treatment. Findings can inform decisions related to staffing and service design for pediatric hospitals that aim to establish or grow outpatient pediatric chronic pain programs.
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Affiliation(s)
- Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Division of Behavioral Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina M Amaro
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Benjamin Bear
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Catherine M Soprano
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Division of Diagnostic Referral, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
| | - Katherine S Salamon
- Division of Behavioral Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Cook N, McGrath BM, Navale SM, Koroukian SM, Templeton AR, Crocker LC, Zyzanski SJ, Bensken WP, Stange KC. Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022). J Am Board Fam Med 2024; 36:916-926. [PMID: 37857445 PMCID: PMC10843627 DOI: 10.3122/jabfm.2023.230081r1] [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: 03/01/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. OBJECTIVE To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). METHODS We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. RESULTS There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. CONCLUSION Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.
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Affiliation(s)
- Nicole Cook
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS).
| | - Brenda M McGrath
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Suparna M Navale
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Siran M Koroukian
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Anna R Templeton
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Laura C Crocker
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Stephen J Zyzanski
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Wyatt P Bensken
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Kurt C Stange
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
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Sborov KD, Haruno LS, Raszka S, Poon SC. Racial and Ethnic Disparities in Pediatric Musculoskeletal Care. Curr Rev Musculoskelet Med 2023; 16:488-492. [PMID: 37548870 PMCID: PMC10497489 DOI: 10.1007/s12178-023-09860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW This article provides a review of recent published research studying racial, ethnic, and socioeconomic disparities in pediatric musculoskeletal care. RECENT FINDINGS Disparities in pediatric musculoskeletal care are demonstrated in two general realms: access to care and health outcomes. Though initiatives have been proposed or enacted to address disparities, underrepresented minorities and patients from lower socioeconomic statuses continue to face barriers across the spectrum of orthopedic care and poorer ultimate outcomes after both non-operative and operative management. Minority pediatric patients and those from lower socioeconomic statuses experience delays across the spectrum of orthopedic care for both urgent and non-urgent conditions. They wait longer between injury date and initial orthopedic evaluation, longer to receipt of diagnostic imaging, and longer to ultimate treatment than their counterparts. When finally able to obtain musculoskeletal care and treatment, they are at higher risk of poor in-hospital outcomes and inpatient complications, worse patient reported outcomes, and suboptimal pain management. In the outpatient setting, they receive less physical therapy and follow-up clinic visits, resulting in greater stiffness and strength deficits, and are ultimately less likely to meet return to sport criteria.
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Affiliation(s)
- Katherine D. Sborov
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Lee S. Haruno
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Samuel Raszka
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Selina C. Poon
- Shriners Children’s Southern California, 909 S. Fair Oaks Ave, Pasadena, CA 91105 USA
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