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de Sousa RCR, de Paula WKAS, Alves FAP, de Albuquerque MIN, Albuquerque GA, Coriolano-Marinus MWDL. Continuing education on child development in primary care: healthcare workers' perspectives. Rev Esc Enferm USP 2023; 57:e20230189. [PMID: 38131442 PMCID: PMC10743572 DOI: 10.1590/1980-220x-reeusp-2023-0189en] [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] [Received: 06/26/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To analyze the contributions of a continuing education with Primary Health Care professionals that promotes child development. METHOD A continuing education intervention, utilizing a qualitative approach, was conducted among healthcare workers at a Primary Health Care facility in a low-income neighborhood in the city of Recife. The intervention consisted of eight workshops conducted between July and October 2019, with the participation of fifteen healthcare workers. All data from the focus groups were recorded, transcribed, and analyzed thematically using Bronfenbrenner's bioecological model as the theoretical framework. RESULTS Through the continuing education intervention, healthcare professionals were able to reflect on their work processes and personal lives and propose actions to improve child development. CONCLUSION The study findings highlight the significant impact of such interventions in changing perceptions and professional practices related to child development. Overall, this research provides valuable insights into the effectiveness of continuing education interventions for promoting healthy child development in primary care settings.
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Alexander K, Mazza D. Routine developmental screening in Australian general practice: a pilot study. BMC PRIMARY CARE 2023; 24:143. [PMID: 37430184 DOI: 10.1186/s12875-023-02093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Parents' Evaluation of Developmental Status, (PEDS), is a validated screening tool designed for primary health care clinicians to assess child development. Despite widespread use by local government child-nurse services, PEDS has not been tested in Australian general practice. We examined the effect of an intervention that aimed to use PEDS to improve documented assessment of child developmental status during routine general practice consultations. METHODS The study took place in a single general practice in Melbourne, Australia. The intervention included training of all general practice staff regarding PEDS processes and provision of PEDS questionnaires, scoring and interpretation forms. Mixed methods incorporated audits of clinical records of young children (1 to ≤ 5 years) before and after the intervention, and written questionnaires and a focus group (informed by the Theoretical Domains Framework and COM-B model) with receptionists, practice nurses and general practitioners. RESULTS Documented developmental status more than doubled after the intervention with almost one in three (30.4%) records documenting the PEDS tool. Overall, staff responses to questionnaires indicated that PEDS processes had been successfully implemented, half of the staff felt PEDS had developed their professional skills and clinicians expressed confidence using the tool (71%). Thematic analysis of the focus group transcript revealed divided reactions to PEDS screening with most barriers arising from general practitioners' motivation to use PEDS tools and perceptions of environmental constraints. CONCLUSIONS A team-practice intervention that applied PEDS training and implementation, more than doubled documented rates of child developmental status during routine visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance and long-term sustainability of PEDS use in practices.
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Affiliation(s)
- Karyn Alexander
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Danielle Mazza
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Bromley J, Sherrard S, Atkinson D, Marley JV, Henderson‐Yates L, Griffiths E. Early childhood development practices in a remote Aboriginal Community Controlled Health Services setting. Aust J Rural Health 2022; 30:860-869. [PMID: 35802805 PMCID: PMC10083997 DOI: 10.1111/ajr.12900] [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] [Received: 12/24/2021] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Supporting Early Childhood Development (ECD) is an Australian national priority. Aboriginal children in Western Australia's Kimberley region have much higher rates of developmental concerns at school entry than non-Aboriginal children. We aimed to describe ECD practices in the participating service; document follow-up of identified developmental concerns; and identify barriers and enablers to incorporating ECD practices into clinic activity. DESIGN Mixed-method design incorporating clinical audit and staff interviews. SETTING An Aboriginal Community Controlled Health Service (ACCHS) in the Kimberley region. PARTICIPANTS A total of 176 children receiving primary health care through the participating ACCHS; interviews with five ACCHS staff members. MAIN OUTCOME MEASURES Frequency of developmental enquiry by age and domain; follow-up of identified developmental concerns; and barriers and enablers to ECD practices. RESULTS Developmental enquiry was documented for 114 of 176 eligible children (65%), including in 80% of ACCHS child health assessments. Standardised ECD assessments were less common. Staff were aware of the importance of developmental enquiry, however, barriers to increasing ECD practices included a lack of resources and structured staff education, time pressures and a lack of role clarity between the ACCHS and government community health clinic. CONCLUSIONS This study provides insight into ECD practices in an ACCHS setting, highlighting the potential of primary health care to have an enhanced role in ECD if appropriate systems, training and tools are provided. A lack of role clarity across services, combined with poor communication between services, creates a potential risk for missed opportunities to support ECD.
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Affiliation(s)
- Jane Bromley
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - Stephanie Sherrard
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - David Atkinson
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - Julia V. Marley
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
- Kimberley Aboriginal Medical ServicesBroomeWAAustralia
| | | | - Emma Griffiths
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
- Kimberley Aboriginal Medical ServicesBroomeWAAustralia
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Alexander KE, Mazza D. Improving assessment of child development: Results of a quality improvement intervention in general practice. J Paediatr Child Health 2020; 56:1053-1059. [PMID: 32073191 DOI: 10.1111/jpc.14813] [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] [Received: 07/04/2019] [Revised: 12/20/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022]
Abstract
AIMS Parents' Evaluation of Developmental Status (PEDS) is a validated tool used to assess child development that has not previously been tested in Australian general practice. We examined the effect of a Quality-Improvement intervention in a single general practice in Melbourne, Australia, that aimed to use this tool to improve the documented assessment of child developmental surveillance during vaccination visits. METHODS Mixed methods incorporated audits of clinical records of children aged 1-5 years, before and after intervention, written questionnaires and a focus group (informed by the theoretical domains framework and Capability, Opportunity, Motivation-Behaviour (COM-B model)) with clinical and non-clinical staff. RESULTS After 6 months, developmental surveillance more than doubled and was documented in more than one in three visits (34.1%). Almost one in five (18.6%) vaccination visits included the PEDS tool. Overall, the tool was positively received with staff expressing high levels of comfort asking parents to complete it (92.8%), increasing development of professional skills (71.4% staff) and confidence (55% clinicians) detecting developmental delays. Thematic analysis of the focus group transcript revealed underlying barriers arising from the practice environment, staff capabilities and motivation. CONCLUSIONS In a whole of practice Quality-Improvement intervention that applied PEDS training and implementation, including the receptionist in the medical team more than doubled documented rates of child developmental surveillance during vaccination visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance.
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Affiliation(s)
- Karyn E Alexander
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
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Lu CL, Hsu YH, Su WL, Damayanti NA, Chen CW, Lin YJ, Tsai KS, Li CY. Urban-rural disparity of preventive healthcare utilisation among children under the universal health insurance coverage in Taiwan: a national birth cohort analysis. Public Health 2020; 182:102-109. [PMID: 32247105 DOI: 10.1016/j.puhe.2020.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/18/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In the context of universal health insurance coverage, this study aimed to determine whether urban-rural inequality still exists in preventive health care (PHC) amongst children in Taiwan. STUDY DESIGN Prospective cohort study. METHODS A total of 184,117 mothers and their children born in 2009 were identified as the study cohort. The number of children born in urban, satellite and rural areas was 40,176, 57,565 and 86,805, respectively. All children were followed for 7 years, before which a total of seven times PHC were provided by Taiwan's National Health Insurance (NHI) programme. Ordinal logistic regression models were used to associate urbanisation level with the frequency of PHC utilisation. Stratified analyses were further performed in accordance with the children's birth weight and the mothers' birthplace. RESULTS Children from satellite areas had higher utilisation for the first four scheduled PHC visits. Children living in urban areas received more PHC for the fifth and sixth scheduled visits. Compared with those from rural areas, children in satellite areas exhibited a small but significant increase in odds in PHC utilisation, with a covariate-adjusted odds ratio (aOR) of 1.04 and 95% confidence interval (CI) of 1.02-1.06. By contrast, no significant difference was observed between rural and urban areas (aOR = 1.01). Further stratified analyses suggest more evident urban-rural difference in PHC utilisation amongst children with low birth weight and foreign-born mothers. CONCLUSIONS Given a universal health insurance coverage and embedded mechanisms in increasing the availability of healthcare resources in Taiwan, a slight urban-rural difference is observed in PHC utilisation amongst children. Hence, sociodemographic inequality in utilisation of PHC still exists. This issue should be addressed through policy intervention.
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Affiliation(s)
- C L Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan
| | - Y H Hsu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - W L Su
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - N A Damayanti
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - C W Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Y J Lin
- Department of Pediatrics, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - K S Tsai
- Department of Pediatrics, Tainan Sinlau Hospital, Tainan, Taiwan
| | - C Y Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Yacoob Z, Cook C, Kotovicz F, Kram JJ, Klumph M, Stanley M, Hunter P, Baumgardner DJ. Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment. J Patient Cent Res Rev 2020; 7:47-56. [PMID: 32002447 PMCID: PMC6988711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Immunization rates in many cities in the United States remain suboptimal compared to Healthy People 2020 Goals and are lower than national averages. This study aimed to determine whether a lecture-based educational intervention targeted at nurses and medical assistants would improve vaccination rates. METHODS We conducted a quality improvement study in two urban academic family medicine clinics serving a predominantly Medicaid patient population as well as a sizable proportion of refugees. The intervention consisted of 3 lectures that were delivered to clinic nurses and medical assistants. Vaccinations in 1689 patients - 872 in the 3-month preintervention period, 817 in the 3-month postintervention period - were analyzed. RESULTS Following the educational intervention, a statistically significant increase was seen only in human papillomavirus vaccine immunization rates for 13-18-year-olds (from 90.7% [n=54] to 100% [n=45]; P=0.036). When the results were stratified by clinic, only 1 site showed statistically significant increases in: pneumococcal polysaccharide vaccine (23-valent) for high-risk 19-to-64-year-olds (from 36.4% [n=154] to 47.8% [n=136]; P=0.049); Haemophilus influenzae type B vaccine for 2-month-to-5-year-olds (from 91.1% [n=112] to 97.3% [n=111]; P=0.048); and meningococcal conjugate vaccine (quadrivalent) for 13-18-year olds (from 85.2% [n=27] to 100% [n=26]; P=0.042). No increases were seen for our study's refugee patient population (n=171), and a significant decrease of the second-dose measles, mumps, and rubella vaccine (P=0.036) occurred in this subcohort. CONCLUSIONS Ultimately, this quality improvement study demonstrated that educational interventions alone have a limited impact on increasing immunization rates.
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Affiliation(s)
- Zeeshan Yacoob
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Christopher Cook
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Fabiana Kotovicz
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Jessica J.F. Kram
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Marianne Klumph
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Marisa Stanley
- Eau Claire City-County Health Department, Eau Claire, WI
| | - Paul Hunter
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- City of Milwaukee Health Department, Milwaukee, WI
| | - Dennis J. Baumgardner
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
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Alexander KE, Brijnath B, Biezen R, Hampton K, Mazza D. Preventive healthcare for young children: A systematic review of interventions in primary care. Prev Med 2017; 99:236-250. [PMID: 28279679 DOI: 10.1016/j.ypmed.2017.02.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/19/2017] [Accepted: 02/25/2017] [Indexed: 10/20/2022]
Abstract
High rates of preventable health problems amongst children in economically developed countries have prompted governments to seek pathways for early intervention. We systematically reviewed the literature to discover what primary care-targeted interventions increased preventive healthcare (e.g. review child development, growth, vision screening, social-emotional health) for preschool children, excluding vaccinations. MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched for published intervention studies, between years 2000 and 2014, which reflected preventive health activities for preschool children, delivered by health practitioners. Analysis included an assessment of study quality and the primary outcome measures employed. Of the 743 titles retrieved, 29 individual studies were selected, all originating from the United States. Twenty-four studies employed complex, multifaceted interventions and only two were rated high quality. Twelve studies addressed childhood overweight and 11 targeted general health and development. Most interventions reported outcomes that increased rates of screening, recording and recognition of health risks. Only six studies followed up children post-intervention, noting low referral rates by health practitioners and poor follow-through by parents and no study demonstrated clear health benefits for children. Preliminary evidence suggests that multi-component interventions, that combine training of health practitioners and office staff with modification of the physical environment and/or practice support, may be more effective than single component interventions. Quality Improvement interventions have been extensively replicated but their success may have relied on factors beyond the confines of individual or practice-led behaviour. This research reinforces the need for high quality studies of pediatric health assessments with the inclusion of clinical end-points.
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Affiliation(s)
- Karyn E Alexander
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia.
| | - Bianca Brijnath
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
| | - Ruby Biezen
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
| | - Kerry Hampton
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
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