Child/youth, family and public engagement in paediatric services in high-income countries: A systematic scoping review

Background

Patient and public engagement in paediatric health‐care decision making is under‐researched, and there is a lack of systematically reviewed literature in this area.

Objective

To examine the extent, range and nature of published research investigating the engagement of children/youth, families and the public in paediatric service improvement, to summarize key aspects of the research identified and to identify gaps to help inform future research needs.

Methods

Literature was sought in MEDLINE, EMBASE, PsycINFO and CINAHL. Eligible articles presented research focused on patient, family and public engagement strategies in the paediatric health‐care setting. Two reviewers extracted and charted data and analysed findings using a descriptive numerical summary analysis and a thematic analysis.

Results

From 4331 articles, 21 were eligible. Most were from the United States. The majority of studies were undertaken in hospital settings and used quantitative methods. Various patient and public engagement strategies/interventions were examined, including shared decision‐making tools, questionnaires, youth councils/family advisory groups, patient portals and online networks. Most of the studies examined child/youth/parent satisfaction, with fewer investigating treatment outcomes or service improvement. The majority of studies investigated an engagement strategy at the ‘individual treatment’ level of engagement. Regarding the continuum of engagement, most of the studies were at either the ‘consultation’ or ‘involvement’ stage.

Conclusion

Future research needs to focus on the investigation of engagement strategies delivered in primary care, and the use of more qualitative and mixed methods approaches is recommended. There is a gap in the area of engagement strategies directed towards ‘service design and resources’ and ‘macro/policy’ levels.

Leveraging Time With Lifestyle-Based Group Visits

Many challenges in reversing the chronic disease epidemic boil down to a lack of available time. Without time, implementing effective lifestyle medicine therapies and creating a therapeutic partnership between provider and patient is ineffectual. Although useful, the individual medical appointment model alone has not proved to "bend the cost curve" or improve morbidity. Lifestyle-based group visits (LBGVs) are extended clinical encounters that allow physicians and their patients to exchange valuable information regarding optimal chronic disease management within a supportive group format. Clinically, LBGVs improve patient knowledge scores and chronic disease outcome measures. Operationally, they reduce lobby wait times, increase available new and established patient appointment slots (ie, improving access), and improve provider and patient satisfaction measures. LBGVs simultaneously improve patient lives, disease management costs, and practice revenue when used in primary care and specialty practices. By providing personalized lifestyle education coupled with in-depth behavior modification support from a provider and a peer group with similar successes and struggles, group visits reduce symptomatology and reverse disease progression without expensive medications, procedures, and technologies. Despite perceived obstacles, the group medical appointment model is easy to implement and provides consistent benefits in settings ranging from residency programs to cash-based boutique practices.

Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as Treatment for Pediatric Obesity in an Underserved Community

BACKGROUND

This is a retrospective cohort study to evaluate a novel group medical visit (GMV) program using an empowerment curriculum as treatment for pediatric obesity in a federally qualified community health center.

METHODS

Biometric and self-reported data were reviewed from 417 overweight or obese children ages 5-18 attending the pediatric obesity empowerment model GMV program (POEM-GMV) at least twice during a 3-year period. Variables were evaluated using paired means t-test. Pearson's correlation test was used to evaluate variables and the BMI z-score. Subanalysis by gender was performed.

RESULTS

The average participant was 10.48 ± 2.53 years old and participated for 301 ± 287 days. BMI z-score reduced from 2.99 ± 0.96 to 2.88 ± 0.88 (p < 0.0001). Overall, 62.6% of participants had improved weight outcome. Statistically significant improvement was noted in stress, exercise, beverage consumption, fast food intake, television viewing, and bedtime. Stress and beverage consumption had the highest correlation with BMI z-score. By sex, 71.4% of boys (n = 196; p < 0.0001) and 54.8% (n = 221; p < 0.014) of girls realized a reduction in BMI z-score, 61.2% (p < 0.001) of boys and 47.1% (p = 0.097) of girls had a reduction in their percent overweight.

CONCLUSIONS

POEM-GMV may be a useful approach in the treatment of pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.

An evaluation of physicians' engagement of children with asthma in treatment-related discussions

Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.

The relationship between patient-provider communication and quality of life for children with asthma and their caregivers

OBJECTIVE

This study examined whether patient-provider communication is associated with asthma-related quality of life (QOL) and asthma outcomes among children with asthma and their caregivers.

METHODS

Children ages 8-16 years with asthma and their caregivers (n = 296) were recruited at five pediatric practices in North Carolina. Children and caregivers reported demographic and clinical characteristics immediately after an audio-taped medical visit with their health care provider. During a home visit that took place 1 month after the medical visit, children and caregivers reported asthma-related QOL, and caregivers reported child asthma outcomes, including asthma symptom days and missed school days. Generalized estimating equations were used to determine whether patient-provider communication during the medical visit was associated with child and caregiver QOL and child asthma outcomes 1 month later.

RESULTS

On average, providers asked caregivers 4.5 questions and asked children 3 questions per visit, whereas caregivers and children asked less than 1 question per visit. Providers asked children more asthma-related questions, caregivers reported better QOL and fewer asthma symptom days 1 month later. Children and caregivers with higher asthma-management self-efficacy at the office visit reported better QOL 1 month later.

CONCLUSIONS

Mirroring national guideline recommendations, our results suggest that providers should ask children about their asthma during medical visits. Future longitudinal studies should conduct mediation analyses to determine whether asking children asthma-related questions during medical visits increases children's asthma management self-efficacy and ultimately improve outcomes, such as QOL, health care utilization, symptom days and missed school days.