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Coker TR, Gregory EF, McCord M, Cholera R, Bakken H, Chapman S, Anwar E, Lee J, Henry S, Chamberlain LJ. Integrating community health workers in early childhood well-child care: a statement from the Pediatric Academic Societies Maternal Child Health: First 1,000 days Special Interest Group. BMC PRIMARY CARE 2024; 25:345. [PMID: 39333888 PMCID: PMC11428482 DOI: 10.1186/s12875-024-02582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/21/2024] [Indexed: 09/30/2024]
Abstract
This statement from the Pediatric Academic Societies Maternal Child Health: First 1,000 Days Special Interest Group provides an overview of the rationale, evidence, and key action steps needed to engage Community Health Workers (CHWs) into team-based well-child care (WCC) for families in low-income communities. CHWs have been defined as public health workers who have a trusted and valued connection to a community. Integrating CHWs into early childhood WCC can allow for greater cultural relevancy for families, reduce the burden on clinicians to provide the wide range of WCC services, many of which do not require the expertise of a high-level clinician, and improve preventive care services to families during the vulnerable but critical period of early childhood. There are evidence-based approaches to integrating CHWs into early childhood WCC, as well as payment models that can support them. Implementation and spread of these models will require collaboration and engagement across health systems, clinics, payors, and CHWs; flexibility for local adaptation of these models to meet the needs of clinics, practices, CHWs, and communities; publicly available training resources for CHW education; and research findings to guide effective implementation that incorporates parent and caregiver engagement as well as sustainable payment models.
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Affiliation(s)
| | | | - Mary McCord
- NYC Health+Hospitals/Gotham Health and Sydenham, New York City, NY, USA
| | - Rushina Cholera
- Duke Margolis Center for Health Policy, Duke University School of Medicine, Durham, NC, USA
| | - Hayes Bakken
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steve Chapman
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | | | | | - Shauntée Henry
- NYC Health+Hospitals/Gotham Health and Sydenham, New York City, NY, USA
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Coker TR, Gottschlich EA, Burr WH, Lipkin PH. Early Childhood Screening Practices and Barriers: A National Survey of Primary Care Pediatricians. Pediatrics 2024; 154:e2023065552. [PMID: 39034835 DOI: 10.1542/peds.2023-065552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends screening during the first 3 years of life for developmental risk/delay, maternal depression, and social determinants of health (SDOH) using standardized tools. Adoption of these guidelines has been gradual, and barriers to screening are as varied as pediatric practices are themselves. METHODS We analyzed 2019 American Academy of Pediatrics Periodic Survey data. The survey included pediatricians' screening practices for developmental delay, maternal depression, and SDOH, and barriers to screening. We used Cochran's Q and McNemar's tests to compare barriers across topics, and χ2 tests and multivariable logistic regression to examine the relationship between barriers and screening practices. RESULTS The survey response rate was 46.9% (n = 688). Most pediatricians reported screening/surveilling for developmental delay (98.1%), maternal depression (83.2%), and SDOH (76.7%), but fewer used standardized instruments to do so (59.0%, 44.9%, 12.6%, respectively). Those not screening/only surveilling for maternal depression were more likely to report that screening is not an appropriate role for the pediatrician and difficulty prioritizing time. For SDOH, those not screening/only surveilling were more likely to report instruments not available in the electronic health record, lack of knowledge regarding referral options, and lack of treatment options for positive screens. CONCLUSIONS Rates of standardized screening, and barriers pediatricians encounter, have important implications for improving quality of early childhood preventive care. Opportunities include expanding the primary care team and integrating screening tools into the electronic health record. Programs to support social needs and maternal mental health could be strengthened to ensure robust referral options are available.
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Affiliation(s)
- Tumaini R Coker
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | | | | | - Paul H Lipkin
- Kennedy Krieger Institute/Johns Hopkins University School of Medicine, Baltimore, Maryland
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Schor EL. Capitated, Multisector, Universal Preventive Health Care for Children and Youth. JAMA Pediatr 2024; 178:215-216. [PMID: 38190181 DOI: 10.1001/jamapediatrics.2023.5929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
This Viewpoint discusses the need to reorganize the provision of well-child care whereby responsibility for services is formally divided and coordinated and funding is free from traditional, risk-based health insurance.
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Kong WY, Queen TL, Gottfredson O'Shea N, Heisler-MacKinnon J, Liu A, Ozawa S, Brewer NT, Gilkey MB. Impact of visit characteristics on intention to recommend HPV vaccine: An experiment with US health care professionals. Prev Med 2024; 179:107841. [PMID: 38160884 PMCID: PMC10872220 DOI: 10.1016/j.ypmed.2023.107841] [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: 10/23/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Presumptive recommendations that assume parents want to vaccinate can increase human papillomavirus (HPV) vaccine uptake. We sought to examine how visit characteristics affect health care professionals' (HCPs) intention to use this evidence-based recommendation style. METHODS In 2022, we conducted an online experiment with 2527 HCPs who had a role in adolescent vaccination in the United States. Participants read 1 of 8 randomly assigned vignettes about a well-child visit. Using a 2 × 2 × 2 between-subjects factorial design, the vignettes varied the following visit characteristics: patient age (9 vs. 12-year-old), prior parental vaccine refusal (yes vs. no), and time pressure on the HCP (low vs. high). HCPs reported on their intention to use a presumptive HPV vaccine recommendation, as well as on related attitudes, subjective norms, and self-efficacy. Analyses used 3-way analysis of variance and parallel mediation. RESULTS Participants were pediatricians (26%), family/general medicine physicians (22%), advanced practitioners (24%), and nursing staff (28%). Overall, about two-thirds of HCPs (64%) intended to use a presumptive recommendation. Intentions were higher for older children (b = 0.23) and parents without prior vaccine refusal (b = 0.39, both p < 0.001). Time pressure had no main effect or interactions. HCPs' attitudes and self-efficacy partially mediated effects of patient age and prior vaccine refusal (range of b = 0.04-0.28, all p < 0.05). CONCLUSION To better support visits with younger children and parents who have refused vaccines, HCPs may need more training for making presumptive recommendations for HPV vaccine. Reinforcing positive attitudes and self-efficacy can help HCPs adopt this evidence-based recommendation style.
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Affiliation(s)
- Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Nisha Gottfredson O'Shea
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Amy Liu
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Sachiko Ozawa
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina, United States of America; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
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Lima HK, Ganio Molinari M, Hoffman JB, Akers L, Evans KI, Licata A. Factors Associated with Provider Practices Related to Infant Feeding in Primary Care Settings: Results from a Pilot Survey. Nutrients 2024; 16:179. [PMID: 38257073 PMCID: PMC10818912 DOI: 10.3390/nu16020179] [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: 11/29/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
In 2020, only 25.6% of dyads in the US were exclusively breastfeeding at six months. Previous research has shown that breastfeeding continuation improves when patients receive both prenatal and postpartum support. Additionally, breastfeeding self-efficacy can be directly impacted by interactions with primary healthcare providers. To facilitate improved lactation support and positive interactions with providers related to infant feeding in the primary care setting, a 49-question survey was utilized to conduct a retrospective, cross-sectional study. Using multiple regression analysis, the researchers tested a model to determine if certain factors could predict patients receiving lactation education in the primary care setting. The full model was statistically significant and accounts for 81.8% of the variance (R2 = 0.818, F (7, 21) = 9.015, p < 0.001, CI = 0.728 to 0.910). Variables that contributed significantly to the model included provider age, provider years of experience in maternal-child health, population density of the practice, and average provider preparedness and comfort with lactation support and medical management. As the only modifiable predictor significantly contributing to the model, future research is necessary to develop educational interventions to improve provider preparedness and comfort with lactation support and medical management. Such interventions may significantly improve the frequency of lactation education in primary care settings.
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Affiliation(s)
- Hope K. Lima
- Department of Human Nutrition, Winthrop University, Rock Hill, SC 29733, USA; (M.G.M.); (J.B.H.); (K.I.E.); (A.L.)
| | - Meghan Ganio Molinari
- Department of Human Nutrition, Winthrop University, Rock Hill, SC 29733, USA; (M.G.M.); (J.B.H.); (K.I.E.); (A.L.)
- Novant Health Presbyterian Medical Center, Charlotte, NC 28204, USA
| | - Jessie B. Hoffman
- Department of Human Nutrition, Winthrop University, Rock Hill, SC 29733, USA; (M.G.M.); (J.B.H.); (K.I.E.); (A.L.)
| | - Lisa Akers
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA;
| | - Karin I. Evans
- Department of Human Nutrition, Winthrop University, Rock Hill, SC 29733, USA; (M.G.M.); (J.B.H.); (K.I.E.); (A.L.)
| | - Ashley Licata
- Department of Human Nutrition, Winthrop University, Rock Hill, SC 29733, USA; (M.G.M.); (J.B.H.); (K.I.E.); (A.L.)
- School of Public Health, Samford University, Homewood, AL 35229, USA
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Kleffman N, Snyder K, Pedersen MRL, Dong J, Pereira-Burbach A, Dinkel D. Value of video-based education to enhance infant motor development. Early Hum Dev 2024; 188:105921. [PMID: 38134548 DOI: 10.1016/j.earlhumdev.2023.105921] [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] [Received: 09/28/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Parents play a vital role in promoting infant motor development and physical activity; however, there is little information available to parents on how to support healthy movement. Therefore, the purpose of this study was to assess the feasibility of implementing video-based education to improve infant physical activity and motor development. METHODS This multiple case study consisted of semi-structured interviews with mothers (n = 12) and early childhood experts (n = 5, e.g., pediatrician, home visitor). Participants watched pre-recorded videos and answered questions which were developed following Bowens and colleagues guide for designing feasibility studies. Data were analyzed using a directed content analysis approach. RESULTS Most mothers (91.7 %) reported they were highly likely to recommend the videos to others and said the best way to share these videos would be through an app or social media (83.3 %) or health care entities (e.g., hospital, pediatrician, 75 %). Half of mothers (50 %) reported they would be interested in seeing videos once a month or once every couple of months. Further, all experts agreed parents would be somewhat or highly likely to use the videos and a majority (80 %) stated they were highly likely to recommend and share videos like these. Experts' top suggestions for sharing the videos was through an app/social media (40 %) and credible websites (40 %). DISCUSSION Overall, the videos appear feasible for mothers. Both groups primarily suggested that videos be disseminated through social media, online, or through an app. Future research should engage parents and healthcare providers in developing videos.
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Affiliation(s)
- Nicole Kleffman
- University of Nebraska at Omaha, School of Health and Kinesiology, 6001 Dodge Street, Omaha, NE 68182, USA; University of Nebraska Medical Center, Department of Health and Rehabilitation Sciences, 4200 Emile St., Omaha, NE 68198, USA.
| | - Kailey Snyder
- University of Nebraska Medical Center - Munroe Meyer Institute, Department of Education and Child Development, 6902 Pine St., Omaha, NE 68131, USA.
| | - Marlene Rosager Lund Pedersen
- University of Southern Denmark, Department of Sports Sciences and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark.
| | - Jenny Dong
- University of Nebraska at Omaha, School of Health and Kinesiology, 6001 Dodge Street, Omaha, NE 68182, USA.
| | | | - Danae Dinkel
- University of Nebraska at Omaha, School of Health and Kinesiology, 6001 Dodge Street, Omaha, NE 68182, USA.
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Ng AE, Tkach N, Alcalá HE. A window of opportunity: Adverse childhood experiences and time alone with a provider in the United States. Prev Med 2023; 175:107675. [PMID: 37633601 DOI: 10.1016/j.ypmed.2023.107675] [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: 04/18/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND To date, there is limited literature on the relationship between Adverse Childhood Experiences (ACEs) and the quality of health care provider encounters. This is key, as people with a history of ACEs have a greater burden of illness. METHODS This study uses data from the 2020-2021 National Survey of Children's Health to examine relationships between ACEs and (1) spending less than ten minutes with a health care provider, and (2) spending time alone with a health care provider. RESULTS In general, our results suggested most ACEs were associated with higher odds of a provider spending <10 min with a child during their last preventative care visit, while ACEs were inconsistently related to spending time alone with a provider. Each additional ACE was found to be associated with higher odds of both outcomes. CONCLUSIONS This work emphasizes the importance of ACEs screening in a health care setting and may set the groundwork for future research investigating mechanisms within these associations. Given the established link between health care quality and patient-provider trust, and health outcomes, intervention work is needed to develop healthcare practices that may encourage the length and quality of health care provider visits.
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Affiliation(s)
- Amanda E Ng
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, United States of America
| | - Nicholas Tkach
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, United States of America
| | - Héctor E Alcalá
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States of America; Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States of America.
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Miller HL, Thomi M, Patterson RM, Nandy K. Effects of Intersectionality Along the Pathway to Diagnosis for Autistic Children With and Without Co-occurring Attention Deficit Hyperactivity Disorder in a Nationally-Representative Sample. J Autism Dev Disord 2023; 53:3542-3557. [PMID: 35749001 PMCID: PMC9789199 DOI: 10.1007/s10803-022-05604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/26/2022]
Abstract
Children with complex behavioral profiles (e.g., ASD + ADHD) may experience delays in obtaining a final diagnosis. Low-resource or underrepresented groups may be at even greater risk for delayed diagnosis. We assessed the effect of sociodemographic factors, symptom complexity and co-occurring conditions, and identifier of first symptoms on diagnostic trajectories among children aged 3-17 years diagnosed with ASD (n = 52) or ASD + ADHD (n = 352) from a nationally-representative sample. Race/ethnicity and gender disparities were evident in both groups. Race, symptom complexity, and co-occuring conditions predicted age of final diagnosis and wait time between first concern and final diagnosis, both of which were staggeringly high. Results suggest a complex influence of sociodemographic factors on the diagnostic pathway, and risk of health disparities as a function of intersectionality.
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Affiliation(s)
- Haylie L Miller
- School of Kinesiology, University of Michigan, 830 N. University Ave., SKB 4120, Ann Arbor, MI, 48109, USA.
- Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA.
| | - Morgan Thomi
- Graduate School of Biomedical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Rita M Patterson
- Department of Osteopathic Manipulative Medicine/Family Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Karabi Nandy
- Department of Biostatistics & Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
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Okobi OE, Akahara PF, Nwachukwu OB, Egbuchua TO, Ajayi OO, Oranu KP, Ibanga IU. Analyzing Best Practices for Pediatric Well-Child Clinic Visits in the United States for Children Aged Three to Five Years: A Review. Cureus 2023; 15:e45194. [PMID: 37842432 PMCID: PMC10576162 DOI: 10.7759/cureus.45194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Inadequate routine healthcare check-up visits for children aged three to five years impose substantial economic and social burdens due to morbidity and mortality. The absence of regular well-child visits and vaccinations leads to avoidable diseases, underscoring the need for a renewed emphasis on childhood immunizations and check-ups. Out of 160 articles initially screened after removing duplicates, 45 were chosen for full-text review following initial title and abstract screening by two independent reviewers. Afterward, 20 studies met the predefined inclusion criteria during the final assessment of full-text articles, and data were systematically extracted from these selected studies using standardized forms to ensure accuracy and consistency. Well-child visits promote holistic development, health, and well-being in children aged three to five years. Following established guidelines and evidence-based practices, healthcare professionals provide assessments, vaccinations, and guidance for a healthy future. Despite challenges, well-child visits are vital for preventive care, empowering informed decisions for children's growth and development. The benefits of well-child visits encompass growth monitoring, anticipatory guidance, and preventive measures, crucial for children with chronic illnesses. Key components include comprehensive assessments, developmental screenings, vision and hearing evaluations, immunizations, health education, and counseling. In the case of juvenile diabetes, parental education is paramount. Parents need to understand the intricacies of insulin administration, including proper dosage calculation based on glucose measurements, meal planning, and the importance of timing insulin injections. Implementing guidelines and principles by organizations such as Bright Futures and the American Academy of Pediatrics ensures holistic care, parent involvement, and evidence-based practices. This review explores best practices and guidelines for such visits, emphasizing their role in monitoring and promoting children's development.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Onyinyechukwu B Nwachukwu
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Family Medicine, American International School of Medicine Georgetown, Guyana, USA
| | - Thelma O Egbuchua
- Pediatrics and Neonatology, Delta State University Teaching Hospital, Oghara, NGA
| | - Olamide O Ajayi
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Kelechukwu P Oranu
- Obstetrics and Gynecology, Kenechukwu Specialist Hospital and Maternity Enugu, Enugu, NGA
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Pedraza DF. Childcare appointment at the Family Health Strategy in municipalities in the inland region of the State of Paraíba, Brazil. CIENCIA & SAUDE COLETIVA 2023; 28:2291-2302. [PMID: 37531537 DOI: 10.1590/1413-81232023288.06022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/17/2023] [Indexed: 08/04/2023] Open
Abstract
This article aims to evaluate the childcare appointments by health professionals working at the Family Health Strategy in municipalities in the State of Paraíba, compare the performance by health team type (The Mais Médicos Program or conventional), and analyze the association of client satisfaction with the developed actions. This cross-sectional study evaluated the structural conditions of health units, the work process of health professionals, and client satisfaction, observing childcare appointments in 22 health teams. Poor employment relationships and professionals' knowledge about child growth curves were highlighted in the structure. In the 175 appointments observed, we detected neglect in completing the Child Health Booklet (CHB), obtaining data on food consumption, and guidance practices. Only 36% of the appointments were classified with adequate duration. There was greater satisfaction for appointments developed in health teams of the Mais Médicos Program, with longer duration and better performance in guidance practices. The implementation of childcare appointments reveals significant gaps that can influence maternal satisfaction.
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Affiliation(s)
- Dixis Figueroa Pedraza
- Programa de Pós-Graduação em Saúde da Família, Rede Nordeste de Formação em Saúde da Família (RENASF), Universidade Estadual da Paraíba (UEPB). R. das Baraúnas 351, Campus Universitário, Bodocongó. 58109-753 Campina Grande PB Brasil.
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Coker TR, Liljenquist K, Lowry SJ, Fiscella K, Weaver MR, Ortiz J, LaFontaine R, Silva J, Salaguinto T, Johnson G, Friesema L, Porras-Javier L, Guerra LJS, Szilagyi PG. Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial. JAMA 2023; 329:1757-1767. [PMID: 37120800 PMCID: PMC10150321 DOI: 10.1001/jama.2023.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
Importance An intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care. Objective To examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age. Design, Setting, and Participants A cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled. Intervention Five clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care. Main Outcomes and Measures There were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care. Results Of the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income <$30 000). The majority (855/914; 94%) of the children (mean age, 4.4 months at parental enrollment) were insured by Medicaid. Of the 914 parents who remained eligible and enrolled, 785 (86%) completed the 12-month follow-up interview. Parents of children treated at the intervention clinics (n = 375) reported receiving more anticipatory guidance than the parents of children treated at the usual care clinics (n = 407) (mean score, 73.9 [SD, 23.4] vs 63.3 [SD, 27.8], respectively; adjusted absolute difference, 11.01 [95% CI, 6.44 to 15.59]). There was no difference in ED use (proportion with ≥2 ED visits) between the intervention group (n = 376) and the usual care group (n = 407) (37.2% vs 36.1%, respectively; adjusted absolute difference, 1.2% [95% CI, -5.5% to 8.0%]). The effects of the intervention on the secondary outcomes included a higher amount of psychosocial assessments performed, a greater number of parents who had developmental or behavioral concerns elicited and addressed, increased attendance at well-child visits, and greater parental experiences with the care received (helpfulness of care). Conclusions and Relevance The intervention resulted in improvements in the receipt of preventive care services vs usual care for children insured by Medicaid by incorporating community health workers in a team-based approach to early childhood well-child care. Trial Registration ClinicalTrials.gov Identifier: NCT03797898.
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Affiliation(s)
- Tumaini R. Coker
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Kendra Liljenquist
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Sarah J. Lowry
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, New York
| | | | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles
| | - Rachel LaFontaine
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Javier Silva
- School of Public Health, University of Washington, Seattle
| | - Taylor Salaguinto
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando, California
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Liljenquist K, Hurst R, Guerra LS, Szilagyi PG, Fiscella K, Porras-Javier L, Coker TR. Time Spent at Well-Child Care Visits for English- and Spanish-Speaking Parents. Acad Pediatr 2023; 23:359-362. [PMID: 35768034 PMCID: PMC10676270 DOI: 10.1016/j.acap.2022.06.009] [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: 01/03/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To measure duration of well-child care (WCC) visits at 2 federally qualified health centers (FQHCs), across 10 clinic sites, and determine if differences exist in visit duration for English- and Spanish-speaking parents. METHODS Upon arrival to their child's 2- to 24-month well visit, a research team member followed families throughout their visit noting start and end times for a series of 5 WCC visit tasks. The average time to complete each visit task for the entire sample was then calculated. Mann-Whitney U tests were run to determine if task completion time differed significantly between English- and Spanish-speaking parents. RESULTS The total sample included 199 parents of infants and children between 2 and 24 months old. Over one third of the sample spoke Spanish as their primary language (37%). The average visit time was 77 minutes (standard deviation [SD] = 48). Median time spent with the clinician was 14 minutes (SD = 5). Clinician visit time was significantly different U = 2608, P < .001, r = 0.38 between English- (median = 15 minutes) and Spanish (median = 11 minutes)-speaking parents. No other significant differences were identified. DISCUSSION Our findings align with previous studies showing the average time spent with a clinician during a WCC visit was 15 minutes. Further, the average time with a clinician was less for Spanish-speaking parents. With limited visit length to address child and family concerns, re-designing the structure and duration of WCC visits is critical to best meet the needs of families living in poverty, and may ensure that Spanish-speaking parents receive appropriate guidance and support without time limitations.
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Affiliation(s)
- Kendra Liljenquist
- Department of Pediatrics, University of Washington School of Medicine (K Liljenquist and TR Coker), Seattle, Wash; Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash.
| | - Rachel Hurst
- Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash
| | - Laura Sotelo Guerra
- Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA (PG Szilagy and L Porras-Javier), Los Angeles, Calif
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry (K Fiscella), Rochester, NY
| | - Lorena Porras-Javier
- Department of Pediatrics, David Geffen School of Medicine at UCLA (PG Szilagy and L Porras-Javier), Los Angeles, Calif
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine (K Liljenquist and TR Coker), Seattle, Wash; Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash
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13
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Shanahan ME, Austin AE, Berkoff MC. Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect. CHILD MALTREATMENT 2022; 27:218-224. [PMID: 34319172 PMCID: PMC9003754 DOI: 10.1177/10775595211031651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment (N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention.
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Affiliation(s)
- Meghan E. Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Meghan Shanahan, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 421 Pittsboro Street, CB# 7445, Chapel Hill, NC 27599-7445, USA.
| | - Anna E. Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Molly C. Berkoff
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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14
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Buka SL, Beers LS, Biel MG, Counts NZ, Hudziak J, Parade SH, Paris R, Seifer R, Drury SS. The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care. Pediatrics 2022; 149:186907. [PMID: 35503309 PMCID: PMC9847420 DOI: 10.1542/peds.2021-053509l] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.
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Affiliation(s)
- Stephen L. Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island,Address correspondence to Stephen Buka, ScD, Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI 02912. E-mail:
| | - Lee S. Beers
- Children’s National Hospital, Washington, District of Columbia,Child Health Advocacy Institute, Washington, District of Columbia
| | - Matthew G. Biel
- Departments of Psychiatry and Pediatrics, Georgetown University School of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Nathaniel Z. Counts
- Mental Health America, Alexandria, Virginia,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, The Bronx, New York
| | - James Hudziak
- Division of Child Psychiatry, Vermont Center for Children, Youth, and Families, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island,Bradley/Hasbro Children’s Research Center, Bradley Hospital, East Providence, Rhode Island
| | - Ruth Paris
- Boston University School of Social Work, Boston, Massachusetts
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stacy S. Drury
- Departments of Psychiatry,Pediatrics, Tulane University, New Orleans, Louisiana,Children’s Hospital New Orleans, New Orleans, Louisiana
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15
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Garland A, Keller H, Quail P, Boscart V, Heyer M, Ramsey C, Vucea V, Choi N, Bains I, King S, Oshchepkova T, Kalashnikova T, Kroetsch B, Steer J, Heckman G. BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial. Age Ageing 2022; 51:6552807. [PMID: 35325020 PMCID: PMC8946666 DOI: 10.1093/ageing/afac049] [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: 09/24/2021] [Revised: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. Objective Assess a comprehensive, person-centred ACP approach. Design Unblinded, cluster randomised trial. Setting Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. Subjects 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. Methods The intervention was a structured, \documentclass[12pt]{minimal}
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}{}$\sim$\end{document}60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. Results The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). Conclusions Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.
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Affiliation(s)
- Allan Garland
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Keller
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Patrick Quail
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Michelle Heyer
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Clare Ramsey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Vucea
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nora Choi
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ikdip Bains
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Seema King
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tatiana Oshchepkova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Brittany Kroetsch
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica Steer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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16
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Platt RE, Acosta J, Stellmann J, Sloand E, Caballero TM, Polk S, Wissow LS, Mendelson T, Kennedy CE. Addressing Psychosocial Topics in Group Well-Child Care: A Multi-Method Study With Immigrant Latino Families. Acad Pediatr 2022; 22:80-89. [PMID: 33992841 PMCID: PMC8589857 DOI: 10.1016/j.acap.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Group Well-Child Care (GWCC) has been described as providing an opportunity to enhance well-being for vulnerable families experiencing psychosocial challenges. We sought to explore benefits and challenges to the identification and management of psychosocial concerns in Group Well-Child Care (GWCC) with immigrant Latino families. METHODS We conducted a case study of GWCC at an urban academic general pediatric clinic serving predominantly Limited English Proficiency Latino families, combining visit observations, interviews, and surveys with Spanish-speaking mothers participating in GWCC, and interviews with providers delivering GWCC. We used an adapted framework approach to qualitative data analysis. RESULTS A total of 42 mothers and 9 providers participated in the study; a purposefully selected subset of 17 mothers was interviewed, all providers were interviewed. Mothers and providers identified both benefits and drawbacks to the structure and care processes in GWCC. The longer total visit time facilitated screening and education around psychosocial topics such as postpartum depression but made participation challenging for some families. Providers expressed concerns about the effects of shorter one-on-one time on rapport-building; most mothers did not express similar concerns. Mothers valued the opportunity to make social connections and to learn from the lived experiences of their peers. Discussions about psychosocial topics were seen as valuable but required careful navigation in the group setting, especially when fathers were present. CONCLUSIONS Participants identified unique benefits and barriers to addressing psychosocial topics in GWCC. Future research should explore the effects of GWCC on psychosocial disclosures and examine ways to enhance benefits while addressing the challenges identified.
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Affiliation(s)
- Rheanna E Platt
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center (RE Platt), Baltimore, Md.
| | - Jennifer Acosta
- Department of Pediatrics/Centro Sol, Johns Hopkins Bayview Medical Center (J Acosta, S Polk), Baltimore, Md; Maryland Department of Health, Center for HIV/STI Capacity Building and Integration (J Acosta), Baltimore, Md
| | - Julia Stellmann
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (J Stellman, CE Kennedy), Baltimore, Md
| | | | - Tania Maria Caballero
- Department of Pediatrics, Johns Hopkins Bayview Medical Center (TM Caballero), Baltimore, Md
| | - Sarah Polk
- Department of Pediatrics/Centro Sol, Johns Hopkins Bayview Medical Center (J Acosta, S Polk), Baltimore, Md
| | - Lawrence S Wissow
- University of Washington School of Medicine/Seattle Children's Hospital (L Wissow), Seattle, Wash
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (T Mendelson), Baltimore, Md
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (J Stellman, CE Kennedy), Baltimore, Md
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17
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Zhang X, Huang Y, Lee J, Ganta R, Chandawarkar A, Linwood SL. Measuring Telehealth Visit Length and Schedule Adherence Using Videoconferencing Data. Telemed J E Health 2021; 28:976-984. [PMID: 34748431 DOI: 10.1089/tmj.2021.0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The ability to measure clinical visit length is critical for operational efficiency, patient experience, and accurate billing. Despite the unprecedented surge in telehealth use in 2020, studies on visit length and schedule adherence in the telehealth setting are nonexistent in the literature. This article aims to demonstrate the use of videoconferencing data to measure telehealth visit length and schedule adherence. Materials and Methods: We used data from telehealth video visits at four clinical specialties at Nationwide Children's Hospital, including behavioral health (BH), speech pathology (SP), physical therapy/occupational therapy (PT/OT), and primary care (PC). We combined videoconferencing timestamp data with visit scheduling data to calculate the total visit length, examination length, and patient wait times. We also assessed schedule adherence, including patient on-time performance, examination on-time performance, provider schedule deviations, and schedule length deviations. Results: The analyses included a total of 175,876 telehealth video visits. On average, children with BH appointments spent a total of 57.2 min for each visit, followed by PT/OT (50.8 min), SP (42.1 min), and PC (25.0 min). The average patient wait times were 4.1 min (BH), 2.7 min (PT/OT), 2.8 min (SP), and 3.1 min (PC). The average examination lengths were 48.8 min (BH), 44.5 min (PT/OT), 34.9 min (SP), and 16.6 min (PC). Regardless of clinical specialty, actual examination lengths of most visits were shorter than the scheduled lengths, except that appointments scheduled for 15 min tended to run overtime. Conclusions: Videoconferencing data provide a low-cost, accurate, and readily available resource for measuring telehealth visit length and schedule adherence.
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Affiliation(s)
- Xu Zhang
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Yungui Huang
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer Lee
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Divisions of Clinical Informatics and Section of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rajesh Ganta
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Aarti Chandawarkar
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Divisions of Clinical Informatics and Section of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Simon Lin Linwood
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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18
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Corredor MM, Thorvilson M, Ristagno EH, Pittock S, Kellund A, Homme J, Creo A. Is the Childless Pediatrician Less Confident? Assessment of Physician Confidence in Providing Parenting Advice and Introduction of a Novel Approach to Anticipatory Guidance Training. Clin Pediatr (Phila) 2021; 60:447-451. [PMID: 34416836 DOI: 10.1177/00099228211039951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Schor EL, Bergman D. Pediatric Preventive Care: Population Health and Individualized Care. Pediatrics 2021; 148:peds.2020-049877. [PMID: 34433687 DOI: 10.1542/peds.2020-049877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Well-child care is a near-universal service for young children toward which a great deal of time and professional resources are devoted but for which there is scant evidence of effectiveness in routine practice. It is composed of many components, the value of which likely varies with the quality of their provision and the needs and priorities of the children and families who receive them. Achieving more efficient and effective preventive care will require that pediatric practices segment the population they serve and design schedules and staffing to match patients' health, well-being, personal and social circumstances, and service needs. Care should be individualized and include essential screening, tests, procedures, and education on the basis of assessment of patients' and families' needs and priorities. The traditional schedule of individual, comprehensive preventive care visits should be reconsidered and replaced with a schedule that allows complete care to be provided over a series of visits, including those for acute and chronic care. Preventive pediatric care should be provided in family-centered, team-based practices with strong linkages to other providers in the community who serve and support children and families. Care should make use of the wide variety of modalities that exist, and face-to-face time should be reserved for those services that are both important and uniquely responsive to in-office intervention. This model of preventive care will require changes in training, responsibilities and reimbursement of health care team members, and enhanced communication and collaboration among all involved, especially with families.
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Affiliation(s)
- Edward L Schor
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - David Bergman
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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20
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Koschmann KS, Peden-McAlpine CJ, Chesney M, Mason SM, Hooke MC. Urban, Low-Income, African American Well-Child Care: Comparison of Parent and Healthcare Provider Experiences and Expectations. Matern Child Health J 2021; 25:1677-1688. [PMID: 34403070 DOI: 10.1007/s10995-021-03213-4] [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] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Urban, low-income, African American children and parents report lower quality primary care and face negative social determinants of health. High-quality well-child care is critical for this population. The purpose of this qualitative study was to compare and contrast parent and health care provider experiences of well-child care for urban, low-income, African American families to better understand the complex factors involved in care quality and health outcomes. METHODS Two data sets were analyzed using conventional content analysis, parent focus group data, and provider interviews. After analysis, results were sorted into similar categories, and convergence coding was completed to identify areas of agreement, partial agreement, dissonance, and silence. RESULTS Thirty-five parents took part in four focus groups, and nine providers were interviewed. Following convergence coding, five categories and 31 subcategories were identified. The five categories included: social determinants of health, sources of advice and support, challenges with the healthcare system, parent-provider relationships, and anticipatory guidance topics. CONCLUSIONS FOR PRACTICE Triangulation demonstrated convergence between parents and providers understanding of the concepts and functions of well-child care, however the prominence and meaning varied within each category and sub-category. The variance in agreement, areas of silence, and dissonance shed light on why the population reports lower overall quality primary care.
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Affiliation(s)
- Kara S Koschmann
- Department of Nursing, St. Catherine University, 2004 Randolph Avenue, St. Paul, MN, 55105, USA.
| | | | - Mary Chesney
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Susan M Mason
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mary C Hooke
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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21
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Appiah J, Barlow L, Mmonu NA, Makarov DV, Sugarman A, Matulewicz RS. A National Assessment of the Association Between Patient Race and Physician Visit Time During New Outpatient Urology Consultations. Urology 2021; 162:63-69. [PMID: 34380056 DOI: 10.1016/j.urology.2021.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/07/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine if there is an association between patient race and physician time spent with the patient during outpatient urology consultations. METHODS We identified all adult urology new outpatient visits in the National Ambulatory Medical Care Survey dataset for 2012-2016. Patient race was dichotomized as White or non-White. Our primary outcome was time spent during the visit between the patient and urologist. Using population-level weighting, we compared differences in mean time spent during visits with White and non-White patients. Mixed-effects linear regression was used to adjust for confounding factors and to account for clustering among individual physicians. Secondary outcomes included number of services provided and if ancillary providers were seen. RESULTS Over the 5 year period, 1668 raw visits met criteria and were used to estimate 21million new outpatient urology visits nationwide. 80% of all visits were with White patients. Mean physician time spent among visits with white patients was 23.9 minutes and 24.4 minutes for non-White patients. There was no difference in number of services provided but visits with non-white patients were less likely to include an ancillary provider. After adjustment, there was no significant difference in mean time spent with the urologist among visits with White and non-White patients (difference 0.9 minutes, 95% CI: -0.6-2.4). There were also no differences in adjusted mean time spent among return visits or new visits for hematuria, urologic cancers, or BPH. CONCLUSION We found no statistically significant difference in time spent with a urologist during outpatient office consultations between White and non-White patients.
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Affiliation(s)
- Jude Appiah
- Department of Urology, New York University Grossman School of Medicine, New York, NY, USA
| | - LaMont Barlow
- Department of Urology, New York University Grossman School of Medicine, New York, NY, USA; Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA; VA New York Harbor Healthcare System, New York, NY, USA
| | - Nnenaya A Mmonu
- Department of Urology, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danil V Makarov
- Department of Urology, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; VA New York Harbor Healthcare System, New York, NY, USA
| | - Allison Sugarman
- Department of Urology, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Richard S Matulewicz
- Department of Urology, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; VA New York Harbor Healthcare System, New York, NY, USA.
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22
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Hutton JS, Huang G, Wiley C, DeWitt T, Ittenbach RF. Randomized Trial of a Mobile App Introduced During Well-Visits to Enhance Guidance for Reading With Young Children. Acad Pediatr 2021; 21:977-987. [PMID: 34020099 DOI: 10.1016/j.acap.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate feasibility, usability and efficacy of a mobile parenting app (Rx for Success; RxS) to enhance reading guidance provided to parents of young children during well-visits. METHODS This trial was conducted at a clinic serving primarily families of Hispanic ethnicity and low-socioeconomic status (SES) where Reach Out and Read (ROR) is standard practice. It involved 252 parent-child dyads in 2 age groups (~6-months old, ~18-months old) randomized during well-visits to receive RxS or a children's book modeling alternatives to screen time (Control) by research coordinators. RxS involves videos, activities and "push" messages. Follow-up assessments were conducted approximately 6 months later, including impression and use, shared reading behaviors, child language and screen time. RESULTS A total of 217 dyads completed both visits (110 RxS, 107 Control). Time to introduce RxS was under 3 minutes and 32% of parents experienced largely minor performance issues. Parent impression of RxS was favorable for both age groups at baseline and follow-up, though use was infrequent, attributable to a desire for more relevant and updated content. Significant findings favoring RxS included shared reading as a favorite activity, more frequent shared reading reported at 12 months and higher language scores at 24 months. Screen time was equivalent between cohorts, exceeding American Academy of Pediatrics guidelines. CONCLUSIONS A mobile app introduced to parents of young children from low-SES backgrounds was feasible during well-visits, rated as helpful, and effective to enhance shared reading at younger and language at older ages. While a potentially impactful enhancement to ROR, features needing improvement were identified.
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Affiliation(s)
- John S Hutton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio; Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio.
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center (G Huang and RF Ittenbach), Cincinnati, Ohio
| | - Catherine Wiley
- Community Health Center at Connecticut Children's Hospital (C Wiley), Hartford, Conn
| | - Thomas DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio; Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center (G Huang and RF Ittenbach), Cincinnati, Ohio
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Hersch DE, Uy MJA, Ngaw SM, Loth KA. Primary care providers' perspectives on initiating childhood obesity conversations: a qualitative study. Fam Pract 2021; 38:460-467. [PMID: 33677525 PMCID: PMC8414925 DOI: 10.1093/fampra/cmaa144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) are in a critical position for identifying, preventing and treating childhood obesity. However, a one-size-fits-all approach does not exist for having conversations about weight with families. A better understanding of how PCPs can address paediatric patients' weight concerns is needed in order to develop effective guidelines and trainings. OBJECTIVE To describe PCPs preferences and behaviours regarding weight-related conversations with paediatric patients' and their families. METHODS Twenty PCPs affiliated with the University of Minnesota, USA, were recruited to participate in semi-structured interviews. Transcripts were analysed using inductive thematic analysis. RESULTS PCP's identified well-child visits as the most appropriate time for weight-related discussions with families. Physicians described what approaches/elements they perceived to work best during conversations: collaboration, empathy, health-focused and objective measures. CONCLUSIONS Overall, PCPs were more comfortable with weight-related discussions during annual well-child visits and rarely initiated them during an acute visit or the first encounter with a patient. Objective measures, such as growth charts, were often utilized to start discussions. Considering a large proportion of well-child visits are missed, alternative opportunities to have discussions about healthy lifestyle behaviours should be explored. The integral role PCPs play in paediatric obesity warrants further research.
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Affiliation(s)
- Derek E Hersch
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Marc James A Uy
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Hutton JS, DeWitt T, Hoffman L, Horowitz-Kraus T, Klass P. Development of an Eco-Biodevelopmental Model of Emergent Literacy Before Kindergarten: A Review. JAMA Pediatr 2021; 175:730-741. [PMID: 33720328 DOI: 10.1001/jamapediatrics.2020.6709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Literacy has been described as an important social determinant of health. Its components emerge in infancy and are dependent on genetic, medical, and environmental factors. The American Academy of Pediatrics advocates a substantial role for pediatricians in literacy promotion, developmental surveillance, and school readiness to promote cognitive, relational, and brain development. Many children, especially those from minority and underserved households, enter kindergarten unprepared to learn to read and subsequently have difficulty in school. OBSERVATIONS Emergent literacy is a developmental process beginning in infancy. Component skills are supported by brain regions that must be adequately stimulated and integrated to form a functional reading network. Trajectories are associated with genetic, medical, and environmental factors, notably the home literacy environment, which is defined as resources, motivation, and stimulation that encourage the literacy development process. Eco-biodevelopmental models are advocated by the American Academy of Pediatrics, and these models offer insights into the neurobiological processes associated with environmental factors and the ways in which these processes may be addressed to improve outcomes. Emergent literacy is well suited for such a model, particularly because the mechanisms underlying component skills are elucidated. In addition to cognitive-behavioral benefits, the association of home literacy environment with the developing brain before kindergarten has recently been described via neuroimaging. Rather than a passive approach, which may subject the child to stress and engender negative attitudes, early literacy screening and interventions that are administered by pediatric practitioners can help identify potential reading difficulties, address risk factors during a period when neural plasticity is high, and improve outcomes. CONCLUSIONS AND RELEVANCE Neuroimaging and behavioral evidence inform an eco-biodevelopmental model of emergent literacy that is associated with genetic, medical, and home literacy environmental factors before kindergarten, a time of rapid brain development. This framework is consistent with recommendations from the American Academy of Pediatrics and provides insights to help identify risk factors and signs of potential reading difficulties, tailor guidance, and provide direction for future research.
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Affiliation(s)
- John S Hutton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Thomas DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lauren Hoffman
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tzipi Horowitz-Kraus
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Educational Neuroimaging Center, Faculty of Education in Science and Technology, Technion, Haifa, Israel.,Faculty of Biomedical Engineering, Technion, Haifa, Israel
| | - Perri Klass
- Department of Pediatrics, New York University School of Medicine, New York
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25
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Soukup J, Zierhut HA, Ison HE. Universal Cholesterol Screening among Pediatric Primary Care Providers within California and Minnesota: A Qualitative Assessment of Barriers and Facilitators. J Pediatr 2021; 233:175-182.e2. [PMID: 33662342 DOI: 10.1016/j.jpeds.2021.02.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess current pediatric cholesterol screening practices, and attitudes, among pediatric primary care providers (PCPs) via qualitative semistructured interviews designed to identify barriers and facilitators to universal cholesterol screening practices recommended by the National Heart Blood and Lung Institute and the American Academy of Pediatrics. STUDY DESIGN An online survey and subsequent 30-minute semistructured phone interview were completed with PCPs from regions in Northern California and Minnesota (survey n = 25, interview n = 12). Interviews were qualitatively analyzed using the consolidated framework for implementation research to categorize barriers, facilitators, and strategies to increase pediatric cholesterol screening among PCPs. RESULTS PCPs from California (n = 8) and Minnesota (n = 4) consistently identified cost of cholesterol screening, particularly the cost of time due to competing visit priorities, as a barrier. A supportive learning environment, feelings of self-efficacy, access to resources, and well-established clinical networks with specialists (eg, cardiologists) were facilitators to screening. The perceived level of endorsement behind cholesterol screening within the clinic, perceived validity of national guidelines, and ability to adapt guidelines to existing clinical workflow were notable differentiators between high vs low self-reported screen rates. CONCLUSIONS Findings of this study suggest that efforts to increase universal pediatric cholesterol screening will likely require the development of strategies to increase provider education about the long-term benefits of cholesterol screening (knowledge and beliefs), and ensuring providers feel supported and empowered when assessing/acting on the results of this screening (self-efficacy, engaging leaders, networks, and communication).
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Affiliation(s)
- Jenna Soukup
- Department of Genetics, Cell Biology, & Development, University of Minnesota - Twin Cities, Minneapolis, MN
| | - Heather A Zierhut
- Department of Genetics, Cell Biology, & Development, University of Minnesota - Twin Cities, Minneapolis, MN
| | - Hannah E Ison
- Stanford Center for Inherited Cardiovascular Disease, Stanford Health Care, Stanford, CA; Division of Cardiology in the Department of Pediatrics, Stanford Medicine, Stanford, CA.
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26
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Gaskin E, Yorga KW, Berman R, Allison M, Sheeder J. Pediatric Group Care: A Systematic Review. Matern Child Health J 2021; 25:1526-1553. [PMID: 33961210 DOI: 10.1007/s10995-021-03170-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe characteristics and outcomes of Group Well-Child Care programs and provide recommendations for future research. METHODS Informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an electronic references database, manual search of bibliographies and peer-reviewed journals, and general Internet search were conducted including research published up to July 2019. English language, peer-reviewed research, with provision of medical care were included. Studies without published outcomes, not specific to well-child care, or included only one visit were excluded. Nineteen articles met review criteria. Study quality was assessed using the Downs and Black tool for rigor. RESULTS Programs typically included an individual medical examination, check-in, and group discussion. Demographics varied by race, ethnicity, age, income level, education and parity, though many were used specifically with underserved populations. Group size ranged from 3 to 10 and lasted an average of 1.5 h over a period of 6-24 months. Evidence suggests group well-child care is as effective as individual care with improvement noted for health-care utilization, weight outcomes, and more content covered. Design elements such as patient-led discussion, self-check-in, inclusion of other family members, and use of a variety of health care professionals and para-professionals may influence these outcomes. CONCLUSIONS Group well-child care is useful in providing efficient and patient-centered care and shows promise for use in underserved populations. Future research should utilize more rigorous study design and include evaluations of program components and group processes to address implementation challenges and determine effectiveness.
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Affiliation(s)
- Emily Gaskin
- Prevention Research Center at University of Colorado, Aurora, USA. .,Department of Pediatrics, School of Medicine, Prevention Research Center for Family and Child Health, University of Colorado, Mail Stop 8410, 13121 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Kim Weber Yorga
- Prevention Research Center at University of Colorado, Aurora, USA.,Nurse-Family Partnership National Service Office, Denver, USA
| | - Rebecca Berman
- Prevention Research Center at University of Colorado, Aurora, USA
| | - Mandy Allison
- Obstetrics and Gynecology and Pediatrics at University of Colorado School of Medicine, Aurora, USA.,Children's Hospital School Health Program, Aurora, USA
| | - Jeanelle Sheeder
- Obstetrics and Gynecology and Pediatrics at University of Colorado School of Medicine, Aurora, USA
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27
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Friedman S, Calderon B, Gonzalez A, Suruki C, Blanchard A, Cahill E, Kester K, Muna M, Elbel E, Purushothaman P, Krause MC, Meyer D. Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study. Matern Child Health J 2021; 25:1265-1273. [PMID: 33939054 DOI: 10.1007/s10995-021-03146-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: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Multiple barriers exist to delivering efficient, effective well child care, especially in low-income, immigrant communities. Practice redesign strategies, including group well child care, have shown promise in improving care delivery and healthcare outcomes. To assess the feasibility of a group well child care program at multiple urban, academic practices caring for underserved, mostly immigrant children, and to evaluate health outcomes and process measures compared to traditional care. METHODS Prospective, intervention control study with participants recruited to group well child care visits or traditional visits during the first year of life. A culturally sensitive curriculum was designed based on American Academy of Pediatrics (AAP) recommendations. Process and health outcomes were analyzed via patient surveys and medical record information. RESULTS One hundred and one families enrolled in group care and 74 in traditional care. Group care participants had higher rates of all recommended postpartum depression screening and domestic violence screening (65% vs 37%, 38% vs 17% respectively), higher anticipatory guidance retention (67% vs 37%) and higher patient satisfaction with their provider. The group care redesign did not increase length of time spent in clinic. CONCLUSIONS FOR PRACTICE Group well child care is a feasible method for practice redesign, which allows for increased psychosocial screening and anticipatory guidance delivery and retention compared to traditional visits, for low income, predominantly immigrant families. Parental satisfaction with group care is higher and these visits provide greater face-to-face time with the provider, without increasing time spent in the practice.
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Affiliation(s)
- Suzanne Friedman
- Department of Pediatrics, Columbia University Irving Medical Center, 622 W168th St. VC4-417, New York, NY, 10032, USA.
| | - Bianca Calderon
- Department of Pediatrics, Albert Einstein College of Medicine, New York, USA
| | - Amanda Gonzalez
- Department of Pediatrics, NewYork Presbyterian-Columbia University Pediatric Residency Program, New York, USA
| | - Caitlyn Suruki
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Ashley Blanchard
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Erin Cahill
- Department of Pediatrics, NewYork Presbyterian-Columbia University Pediatric Residency Program, New York, USA
| | - Kristen Kester
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Martha Muna
- Department of Pediatrics, University of California San Francisco, Berkeley, USA
| | - Erin Elbel
- Department of Medicine, Boston Children's Hospital, Boston, USA
| | - Priya Purushothaman
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - M Christine Krause
- Department of Pediatrics, Columbia University Irving Medical Center, 622 W168th St. VC4-417, New York, NY, 10032, USA
| | - Dodi Meyer
- Department of Pediatrics, Columbia University Irving Medical Center, 622 W168th St. VC4-417, New York, NY, 10032, USA
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Abstract
The development of health is a cumulative, dynamic, and lifelong process responding to a variety of biological and behavioral influences, of which those in childhood are especially influential and, indeed, formative. Reflecting the balance of positive and adverse experiences during childhood, initial trajectories for future health and development emerge. Preventive pediatric care can anticipate and respond to those experiences and the personal and social circumstances in which they occur. These actions can promote better health and prevent chronic illness during adulthood. Building on the life course health development framework, ways to positively affect patterns of individual and population health practice are identified. Maximizing the opportunity to influence children's health over their lifetime will require purposeful partnerships with other entities with which children and their families interact as well as improvements in pediatric care processes. The latter includes expanding the databases that drive service (such as registries, care plans, and referrals) and adopting proactive, strengths-based, patient and family-centered, comprehensive, multidisciplinary models of care.
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Affiliation(s)
- Edward L Schor
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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29
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Fenick AM, Leventhal JM, Gilliam W, Rosenthal MS. A Randomized Controlled Trial of Group Well-Child Care: Improved Attendance and Vaccination Timeliness. Clin Pediatr (Phila) 2020; 59:686-691. [PMID: 32107935 DOI: 10.1177/0009922820908582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC. Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, P < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care. As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.
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30
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Ebert KD, Ochoa-Lubinoff C, Holmes MP. Screening school-age children for developmental language disorder in primary care. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:152-162. [PMID: 31262202 PMCID: PMC6938570 DOI: 10.1080/17549507.2019.1632931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Purpose: To evaluate the feasibility, preliminary diagnostic accuracy and reliability of a screening tool for developmental language disorder (DLD) in early school-age children seen in a paediatric primary care setting.Method: Sixty-six children aged 6-8years attending well-child visits at a large urban paediatric clinic participated. Parents completed a five-item questionnaire and children completed a 10-item sentence repetition task. A subset of participants (n = 25) completed diagnostic testing for DLD. Exploratory cut-offs were developed for the parent questionnaire, the child sentence repetition task and the combined score.Result: The screening tool could be reliably implemented in 2 min by personnel without specialty training. The best diagnostic accuracy measures were obtained by combining the parent questionnaire and child sentence repetition task. The tool showed strong internal consistency, but the parent and child scores showed only moderate agreement.Conclusion: The screening tool is promising for utilisation in primary care clinical settings but should first be validated in larger and more diverse samples. Both the parent and child components of the screening contributed to the preliminary findings of high sensitivity and specificity found in this study. Screening for DLD in school age children can increase awareness of an under-recognised disorder.
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Affiliation(s)
- Kerry Danahy Ebert
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL, USA
| | | | - Melissa P Holmes
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
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31
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Carsley S, Prowse R, Richmond SA, Manson H, Moloughney BW. Supporting public health practice in healthy growth and development in the Province of Ontario, Canada. Public Health Nurs 2020; 37:412-421. [PMID: 32173954 DOI: 10.1111/phn.12719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND As public health services are modernized in Ontario, Canada, there is a need to inform the system-level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence-based planning and programming in Healthy Growth and Development (HGD) across Ontario. METHODS AND DESIGN A situational assessment was conducted with key informants from public health and other HGD fields. SAMPLE Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. RESULTS Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high-priority topics. CONCLUSION Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system-wide needs.
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Affiliation(s)
- Sarah Carsley
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rachel Prowse
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah A Richmond
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather Manson
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - Brent W Moloughney
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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32
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Garcia TB, O'Leary ST. Dismissal policies for vaccine refusal among US physicians: a literature review. Hum Vaccin Immunother 2020; 16:1189-1193. [PMID: 32078411 DOI: 10.1080/21645515.2020.1724742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Childhood vaccination is one of the greatest public health achievements of the 20th century, yet increasingly, parents question the safety of and need for vaccines. This has led to increased rates of vaccine delay and refusal and outbreaks of vaccine-preventable diseases. Physicians struggle with how to respond to families who refuse vaccines, as there are few known effective interventions to convince a family to vaccinate. In the United States, the practice of dismissing families for vaccine refusal appears to be increasing as a strategy for dealing with vaccine refusal. In this review, we review the literature surrounding this controversial practice, starting with the impact that vaccine-refusing families have on medical practices, followed by a review of dismissal policies of US physicians, and ending with a discussion of the ethics of this practice.
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Affiliation(s)
- Tamara B Garcia
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
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Stadnick NA, Martinez K, Aarons GA, Lee D, Van-Cleave J, Brookman-Frazee L. Pediatric Primary Care Perspectives on Integrated Mental Health Care for Autism. Acad Pediatr 2020; 20:1140-1147. [PMID: 32205263 PMCID: PMC7502427 DOI: 10.1016/j.acap.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Timely identification of mental health needs and linkage to services is critical to provide comprehensive care for children with autism spectrum disorder (ASD). Pediatric primary care is well-positioned to facilitate this process through integrated care approaches. As a first step toward mental health integration, this study applied the Exploration, Preparation, Implementation, and Sustainment framework to characterize determinants of implementing integrated care practices for ASD. METHODS Sixty pediatric primary care providers and leaders from 3 organizations completed focus groups and surveys about identification of mental health needs in children with ASD and access to mental health services. Findings were integrated to examine convergence (ie, do the 2 methods confirm or find similar results) and expansion (ie, do the 2 methods provide insights beyond either method alone). RESULTS Results converged regarding 3 primary influences to integrated care practices for ASD: 1) limited specialized mental health referral options for ASD, 2) unique structural characteristics of the mental health system act as barriers to accessing care, and 3) caregivers differ in the degree to which they understand co-occurring mental health conditions and pursue recommended services. Qualitative results provided expansion by highlighting unique implementation considerations (eg, alignment with health care delivery priorities and values) based on primary care characteristics. CONCLUSIONS Findings confirm need for a tailored approach for linking children with ASD to appropriate mental health treatment. Results yield insight into the needs for organizational capacity to support integrated care and provide direction toward adapting an integrated mental health care model for children with ASD.
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Yingling ME. Participation in Part C Early Intervention: One Key to an Earlier Diagnosis of Autism Spectrum Disorder? J Pediatr 2019; 215:238-243. [PMID: 31351680 DOI: 10.1016/j.jpeds.2019.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether participation in a state early intervention program is associated with reduction in the age of diagnosis of autism spectrum disorder (ASD). STUDY DESIGN State agency, Medicaid, and Census data were integrated for children with ASD enrolled in a Medicaid waiver between February 2007 and March 2015 (N = 1613). Ordinary least squares regression was used to estimate the relationship between participation in a state early intervention program and their age of diagnosis of ASD. RESULTS The model explained 34% of variation in age of diagnosis (F[17,1595] = 49.20, P < .0001, adj R2 = 0.34). After adjustment for key variables, compared with children who did not participate in early intervention, children who did participate were diagnosed 2 years earlier (β = -23.97, P < .0001). CONCLUSIONS Although conducted in only 1 state, this study suggests that participation in early intervention programs may be instrumental in earlier diagnosis of ASD. These findings underscore the importance of identifying children who qualify for early intervention programs, the value of encouraging childhood professionals (eg, early care providers and educators) to refer given documented barriers to pediatrician referral, and the need for research that identifies the mechanisms by which programs may promote earlier diagnosis (eg, service coordination, parent support).
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35
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Hajebrahimi S, Janati A, Arab-Zozani M, Sokhanvar M, Haghgoshayie E, Siraneh Y, Bahadori M, Hasanpoor E. Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-05-2019-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeVisit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.Design/methodology/approachMEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.FindingsOf 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8,I2=81.27,p=0.891) and patients’ gender (Q=55.98, df=11,I2=80.35,p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5,I2=87.88,p=0.170).Originality/valueIn this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.
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36
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National Referral and Treatment Patterns Among Mental Health Pediatric Primary Care Visits. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:86-93. [PMID: 31542836 DOI: 10.1007/s10488-019-00972-9] [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: 10/25/2022]
Abstract
The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits (N = 2056). Results of a logistic regression indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD (OR = 4.75, SE = 1.37). Other characteristics associated with increased likelihood of referral were those with comorbid mental health conditions (OR = 2.20, SE = 0.84) and those from a metropolitan area (OR = 2.23, SE = 0.75). Implications are discussed.
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37
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Navin MC, Kozak AT, Deem MJ. Perspectives of public health nurses on the ethics of mandated vaccine education. Nurs Outlook 2019; 68:62-72. [PMID: 31375346 DOI: 10.1016/j.outlook.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/06/2019] [Accepted: 06/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. PURPOSE To attend to the activity and dispositions of the public health staff who provide "waiver education". METHOD This study reports results of focus group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. FINDINGS Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. DISCUSSION These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, MI.
| | - Andrea T Kozak
- Department of Psychology, Oakland University, Rochester, MI
| | - Michael J Deem
- School of Nursing, Duquesne University, Pittsburgh, PA; Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA
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Stadnick NA, Brookman-Frazee L, Mandell DS, Kuelbs CL, Coleman KJ, Sahms T, Aarons GA. A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder. Pilot Feasibility Stud 2019; 5:51. [PMID: 30976456 PMCID: PMC6438023 DOI: 10.1186/s40814-019-0434-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/15/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD). Children with ASD have many service needs, including the need to access effective mental healthcare, given high rates of co-occurring psychiatric conditions. Pediatric primary care is an ongoing point of healthcare that is well positioned to identify mental health concerns and facilitate linkage to mental health services for children with ASD. However, identifying mental health problems in children with ASD by primary care providers is complex, subject to being overlooked and may significantly vary based on primary care organizational characteristics. Efforts targeting integrated primary-mental healthcare implementation require a tailored approach for children with ASD. METHODS This mixed methods, community-partnered study will apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011; Moullin et al., in press) to adapt and implement an integrated care model, "Access to Tailored Autism INtegrated Care" (ATTAIN), in pediatric practices within three diverse healthcare settings for children ages 4-18 years. Key inner context factors from the Exploration, Preparation, and Implementation phases of the EPIS framework will guide three objectives of this study: (1) to identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, (2) to adapt integrated care procedures to facilitate identification of mental health problems and linkage to evidence-based care for children with ASD, and (3) to examine feasibility, acceptability, and uptake of the adapted integrated mental healthcare model through a pilot study in pediatric primary care. DISCUSSION Improving integrated mental healthcare for children with ASD could have a significant public health impact on mental healthcare access, child clinical outcomes, and reduction in healthcare costs. Results from this mixed methods study will inform selection of implementation strategies to conduct larger-scale implementation of tailored integrated mental healthcare for children with ASD that will ultimately help to address the high unmet mental health needs for these children.
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Affiliation(s)
- Nicole A. Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
- Rady Children’s Hospital, San Diego, USA
| | - David S. Mandell
- Department of Psychiatry, Center for Mental Health, University of Pennsylvania, Philadelphia, USA
| | - Cynthia L. Kuelbs
- Department of Pediatrics, University of California, San Diego, La Jolla USA
- Rady Children’s Hospital, San Diego, USA
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - Timothy Sahms
- Department of Pediatrics, University of California, San Diego, La Jolla USA
- San Ysidro Health Center, San Ysidro, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
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Hackley B, Elyachar-Stahl E, Savage AK, Stange M, Hoffman A, Kavanaugh M, Aviles MM, Arévalo S, Machuca H, Shapiro A. A Qualitative Study of Women's Recall of Content and Skills Developed in Group Prenatal and Well-Baby Care 2 Years Later. J Midwifery Womens Health 2018; 64:209-216. [PMID: 30407720 DOI: 10.1111/jmwh.12899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Group prenatal and well-baby care is a system of health care visits that occur in a group setting. Each individual session lasts approximately 2 hours, allowing more time for education and support than can occur in an individual visit. Compared with individual care, research suggests that group care is associated with similar or better short-term outcomes, but no studies have yet examined potential long-term benefits beyond one year postpartum. The purpose of this qualitative descriptive study was to elicit women's recall about content covered in group prenatal and well-baby care and whether they were or were not continuing to use skills discussed during group prenatal and well-baby care 2 or more years after their group ended. METHODS Eligible women participated in group prenatal and/or well-baby care between 2008 and 2012, were aged at least 18 years, and were English-speaking. Of the 127 eligible women, 32 were reached and 17 agreed to participate. Women were interviewed on average 3 years after group prenatal or well-baby care ended using a semistructured interview guide. Transcripts were reviewed and coded by each team member. Final codes and themes were identified using an iterative review process among the research team. RESULTS Three themes were identified: sustained change, transferable skills, and group as a safe haven. All women were still using strategies discussed during group and had made sustained improvements in nutrition, stress management, and/or in the quality of their interactions with their children, partner, or families. The group environment was described as a safe haven: a respectful, nonjudgmental space that allowed women to share and support each other while learning new skills. DISCUSSION This is the first study to document that group prenatal and well-baby care is associated with long-term benefits in areas not yet reported in the literature: nutrition, family communication, and parenting.
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Garg P, Eastwood J, Liaw ST, Jalaludin B, Grace R. A case study of well child care visits at general practices in a region of disadvantage in Sydney. PLoS One 2018; 13:e0205235. [PMID: 30307993 PMCID: PMC6181326 DOI: 10.1371/journal.pone.0205235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 09/22/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Well-Child Care (WCC) is the provision of preventive health care services for children and their families. Prior research has highlighted that several barriers exist for the provision of WCC services. OBJECTIVES To study "real life" visits of parents and children with health professionals in order to enhance the theoretical understanding of factors affecting WCC. METHODS Participant observations of a cross-sectional sample of 71 visits at three general practices were analysed using a mixed-methods approach. RESULTS The median age of the children was 18 months (IQR, 6-36 months), and the duration of visits was 13 mins (IQR, 9-18 mins). The reasons for the visits were immunisation in 13 (18.5%), general check-up in 10 (13.8%), viral illness in 33 (49.2%) and miscellaneous reasons in 15 (18.5%). Two clusters with low and high WCC emerged; WCC was associated with higher GP patient-centeredness scores, younger age of the child, fewer previous visits, immunisation and general check-up visits, and the solo general practitioner setting. Mothers born overseas received less WCC advice, while longer duration of visit increased WCC. GPs often made observations on physical growth and development and negotiated mothers concerns to provide reassurance to them. The working style of the GP which encouraged informal conversations with the parents enhanced WCC. There was a lack of systematic use of developmental screening measures. CONCLUSIONS GPs and practice nurses are providing parent/child centered WCC in many visits, particularly when parents present for immunisation and general check-ups. Providing funding and practice nurse support to GPs, and aligning WCC activities with all immunisation visits, rather than just a one-off screening approach, appears to be the best way forward. A cluster randomised trial for doing structured WCC activities with immunisation visits would provide further evidence for cost-effectiveness studies to inform policy change.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, New South Wales, Australia
- Specialist Disability Health Team, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Griffith University, Gold Coast, Queensland, Australia
- Department of Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - Siaw-Teng Liaw
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
- Academic General Practice Unit, Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - Rebekah Grace
- Faculty of Human Sciences Department: Department of Educational Studies, Macquarie University, Sydney, Australia
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Jones KA, Do S, Porras-Javier L, Contreras S, Chung PJ, Coker TR. Feasibility and Acceptability in a Community-Partnered Implementation of CenteringParenting for Group Well-Child Care. Acad Pediatr 2018; 18:642-649. [PMID: 29890229 PMCID: PMC10937253 DOI: 10.1016/j.acap.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/29/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND In a community-academic partnership, we implemented a group-based model for well-child care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC). METHODS The FQHC implemented CenteringParenting for all WCC visits in the first year of life, starting at the 2-week visit. Over a 14-month time period, parents from each new CenteringParenting group were enrolled into the study. Baseline data were collected at enrollment (infant age < 31 days) and again at a 6-month follow-up survey. Main outcomes were feasibility and acceptability of CenteringParenting; we also collected exploratory measures (parent experiences of care, utilization, self-efficacy, and social support). RESULTS Of the 40 parent-infant dyads enrolled in the pilot, 28 CenteringParenting participants completed the 6-month follow-up assessment. The majority of infants were Latino, black, or "other" race/ethnicity; over 90% were Medicaid insured. Of the 28 CenteringParenting participants who completed the 6-month follow-up, 25 completed all visits between ages 2 weeks and 6 months in the CenteringParenting group. Of the CenteringParenting participants, 97% to 100% reported having adequate time with their provider and sufficient patient education and having their needs met at visits; most reported feeling comfortable at the group visit, and all reported wanting to continue CenteringParenting for their WCC. CenteringParenting participants' mean scores on exploratory measures demonstrated positive experiences of care, overall satisfaction of care, confidence in parenting, and parental social support. CONCLUSIONS A community-academic partnership implemented CenteringParenting; the intervention was acceptable and feasible for a minority, low-income population. We highlight key challenges of implementation.
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Affiliation(s)
- Kai A Jones
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Paul J Chung
- Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA; UCLA Fielding School of Public Health, Los Angeles, Calif
| | - Tumaini R Coker
- University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Wash.
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Wurster Ovalle VM, Pomerantz WJ, Gittelman MA. Severe Unintentional Injuries to Ohio Children: What We Should Be Addressing at Well-Child Visits. Clin Pediatr (Phila) 2018; 57:1092-1099. [PMID: 29400077 DOI: 10.1177/0009922818756350] [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: 11/15/2022]
Abstract
This was a retrospective study examining severe injuries to Ohio children in order to provide pediatricians with targeted injury talking points at well visits. We included children ≤14 years old from the Ohio Trauma Acute Care Registry with severe unintentional injuries from January 1, 2003, to December 31, 2012. There were 45 347 patients; 611 died, and the mean age was 6.8 years. Fractures/dislocations were common (46.6%), and many injuries occurred at home (49.1%). In children ≤2 years old, the leading causes of injury were falls and burns/fire; falls and motor vehicle collisions (MVCs) predominated above this age. Leading causes of death were MVCs, drowning, and suffocation. We concluded that national data may not always reflect state-specific injury patterns. In Ohio, though falls and MVCs were the most common mechanisms, fire and drowning also caused significant injury. Given limited time to discuss injury prevention, pediatricians should concentrate on statewide injuries.
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Affiliation(s)
- Victoria M Wurster Ovalle
- 1 Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Wendy J Pomerantz
- 1 Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael A Gittelman
- 1 Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Qualitative Evaluation of Individual and Group Well-Child Care. Acad Pediatr 2018; 18:516-524. [PMID: 29355778 DOI: 10.1016/j.acap.2018.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/02/2018] [Accepted: 01/06/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Individual well care (IWC) is the standard delivery model for well-child care in the United States. Alternative models, such as group well care (GWC), may create opportunities to enhance care for babies. The purpose of this study was to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC. METHODS Since 2014, we have provided both IWC and GWC at an urban academic practice serving a low-income minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n = 32 parents; 7 GWC groups, n = 33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t tests; focus groups were digitally recorded, transcribed, and analyzed to identify themes. RESULTS Both groups had similar demographics: parents were mostly female (91%) and black (>80%); about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment, or stress. IWC parents' themes highlighted ways to improve care delivery, while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits, such as garnering social support and learning from other parents. CONCLUSIONS Parents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.
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Drouin O, Winickoff JP. Screening for Behavioral Risk Factors Is Not Enough to Improve Preventive Services Delivery. Acad Pediatr 2018; 18:460-467. [PMID: 29367020 DOI: 10.1016/j.acap.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Unhealthy behaviors are a major cause of chronic disease. Preappointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounter will lead to higher counseling rate and service delivery by clinicians. METHODS We used a pre/post design in one practice with a control practice to evaluate the effects of preappointment screening for 3 behavioral risk factors (tobacco smoke exposure, no recent dental care visit, and consumption of sugar-sweetened beverages). After their clinic visit, we asked English-speaking parents whose child had one or more risk factor whether they had received counseling or services from their pediatrician to address them. RESULTS We recruited 264 parents in the pre phase and 242 in the post phase. Among 215 parents whose child had one or more risk factors, parents in the post phase were as likely to report receiving counseling than parents in the pre phase for each of the risk factors: smoking odds ratio 6.75 (95% confidence interval, 0.51, 88.88), dental health odds ratio 1.44 (95% confidence interval, 0.47, 4.41), and sugar-sweetened beverage consumption odds ratio 0.34 (95% confidence interval, 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases. CONCLUSIONS Counseling rates for tobacco, dental health, or sugar-sweetened beverage consumption were low in pediatric primary care, and preappointment screening did not significantly affect clinician counseling. Future efforts will require a more robust approach to effect change in counseling, provision of service, and family behavior.
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Affiliation(s)
- Olivier Drouin
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass; Harvard-wide Pediatric Health Services Research Fellowship, Boston, Mass.
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass; Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Ill
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Niccolai LM, North AL, Footman A, Hansen CE. Lack of school requirements and clinician recommendations for human papillomavirus vaccination. J Public Health Res 2018; 7:1324. [PMID: 29780768 PMCID: PMC5941259 DOI: 10.4081/jphr.2018.1324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians' recommendations. DESIGN AND METHODS Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. RESULTS Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. CONCLUSIONS The current lack of school entry requirements for HPV vaccination is an important influence on clinicians' recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians' recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.
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Affiliation(s)
- Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Anna L. North
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Alison Footman
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Caitlin E. Hansen
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Management of an Early Detection Program: Supporting Helpful Features. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017. [DOI: 10.1007/s40474-017-0123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Autism Diagnosis: The Local Context Matters. J Dev Behav Pediatr 2017; 38:663-664. [PMID: 28937448 DOI: 10.1097/dbp.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bauer NS, Azer N, Sullivan PD, Szczepaniak D, Stelzner SM, Downs SM, Carroll AE. Acceptability of Group Visits for Attention-Deficit Hyperactivity Disorder in Pediatric Clinics. J Dev Behav Pediatr 2017; 38:565-572. [PMID: 28816910 PMCID: PMC5657442 DOI: 10.1097/dbp.0000000000000492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with attention-deficit hyperactivity disorder (ADHD) have ongoing needs that impair home and school functioning. Group visit models are a promising way to deliver timely parenting support but family and provider acceptance has not previously been examined. The objective was to describe the acceptability of ADHD group visits in busy pediatric clinics based on caregivers, child participants and facilitators. METHODS Data were analyzed from school-age children and caregivers who participated in one of two 12-month long randomized controlled studies of the ADHD group visit model from 2012 to 2013 or 2014 to 2015. Feedback was obtained using semi-structured questions at each study end, by telephone or at the last group visit. Sessions were audio-recorded, transcribed and themes were extracted by participant type. RESULTS A total of 34 caregivers, 41 children and 9 facilitators offered feedback. Caregivers enjoyed the "support group" aspect and learning new things from others. Caregivers reported improved understanding of ADHD and positive changes in the relationship with their child. Children were able to recall specific skills learned including how skills helped at home or school. Facilitators acknowledged systems-level challenges to offering group visits but felt the group format helped increase understanding of families' needs, improved overall care, and provided innovative ways to engage with families. CONCLUSION The majority of comments from families and facilitators highlighted a variety of benefits of the use of a group visit model for ADHD chronic care. Despite systems-level barriers to implementation, families and facilitators felt the benefits outweighed the challenges.
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Affiliation(s)
- Nerissa S. Bauer
- Department of Pediatrics, Indiana University School of Medicine, Section of Children’s Health Services Research, Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute Inc., Indianapolis, IN
| | - Nina Azer
- Department of Pediatrics, University of Kentucky, Lexington, KY
| | - Paula D. Sullivan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Dorota Szczepaniak
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Stephen M. Downs
- Department of Pediatrics, Indiana University School of Medicine, Section of Children’s Health Services Research, Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute Inc., Indianapolis, IN
| | - Aaron E. Carroll
- Center for Health Services Research, Regenstrief Institute Inc., Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, IN
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Diaz A, Peake K, Nucci-Sack A, Shankar V. Comparison of Modes of Administration of Screens to Identify a History of Childhood Physical Abuse in an Adolescent and Young Adult Population. Ann Glob Health 2017; 83:726-734. [PMID: 29248088 PMCID: PMC5739060 DOI: 10.1016/j.aogh.2017.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Childhood physical abuse is a major public health issue with negative consequences to health and well-being manifested in childhood and adolescence, and persisting into adulthood. Yet much childhood physical abuse is not identified when it occurs and little is known about how to screen for it. METHODS To address this gap, the effectiveness of 4 modes of administration of screens to identify childhood physical abuse were compared in a sample of 506 adolescents and young adults aged 12-24 years seeking general health services at a primary care clinic. Comparisons were made between paper and pencil screen, audio computer-assisted self-interview screen, face-to-face structured screen (all 3 using the same measure), and face-to-face unstructured interview. FINDINGS Overall, 44.5% of the sample disclosed that they had been physically abused. Compared to paper and pencil screen, the odds of reporting physical abuse were 1.5 (95% confidence interval [CI]: 0.92, 2.58) and 4.3 (95% CI: 2.49, 7.43) higher among participants using face-to-face structured screen and face-to-face unstructured interview methods, respectively. The face-to-face unstructured interview identified significantly more reports than the paper and pencil screen. CONCLUSIONS Although the unstructured interview was the most effective mode for screening for childhood physical abuse, additional research is needed to confirm whether this holds true in other health care settings. Further research should examine how a health provider's training, experience, and comfort level might influence the identification of physical abuse disclosure in primary care settings using face-to-face unstructured interview.
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Affiliation(s)
- Angela Diaz
- Department of Pediatrics and Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Ken Peake
- Icahn School of Medicine at Mount Sinai, New York, NY
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Mantha A, Beckworth KL, Ansiaux JA, Chen CC, Hoffman B, Shenoi RP. Comparison of the effectiveness of hands-on versus online education in child passenger safety. Inj Prev 2017; 24:365-371. [PMID: 28848056 DOI: 10.1136/injuryprev-2017-042430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/24/2017] [Accepted: 07/28/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Community paediatricians' knowledge of appropriate child safety seat (CSS) use in vehicles may be inadequate. We compared the effectiveness of hands-on and online education in improving and retaining child passenger safety (CPS) knowledge and skills among paediatric trainees. METHODS Paediatric trainees were randomised to receive hands-on skills training versus a 1-hour online module in CPS. CSS knowledge and installation skills were assessed using a validated 10-item/point questionnaire and an assessment tool respectively at baseline and after 6 months. Preintervention and postintervention knowledge improvement and CSS installation skills between groups were assessed using paired t-tests and effect size (d). RESULTS Forty-eight students agreed to participate and were randomised. Thirty-nine completed training (hands-on: 23 and online: 15). At entry, no significant differences in learners' demographics and prior CPS education existed. Baseline CPS knowledge scores did not differ significantly between groups (p=0.26). Postintervention, both groups demonstrated a significant increase in knowledge scores (hands-on=3.1 (95% CI 2.4 to 3.7), p<0.0001; online=2.6 (95% CI 1.9 to 3.3), p<0.0001), though the pre-post gain in knowledge scores were not significantly different between groups (p=0.35). At follow-up, both groups demonstrated a significant increase in knowledge scores (hands-on=1.8 (95% CI 1.2 to 2.4), p<0.0001; online=1.1 (95% CI 0.7 to 1.6), p<0.0001) with the hands-on group scores significantly better than the online group (p<0.02). The long-term gain in knowledge scores was not significantly different between groups (p=0.12).Baseline CSS installation skill scores did not significantly differ between groups for forward-facing seats (p=0.16) and rear-facing seats (p=0.51). At follow-up, mean CSS installation skill scores significantly increased for the hands-on group (forward-facing seat: 0.8 (95% CI 0.16 to 1.44), p<0.02; rear-facing seat: 1.2 (95% CI 0.6 to 1.7), p<0.001) but not for the online group (forward-facing seat: 0.9 (95% CI -0.08 to 1.9), p=0.07); rear-facing seat: -0.2 (95% CI -1.1 to 0.7), p=0.6). CONCLUSIONS Among paediatric trainees, hands-on and online CPS education are both effective in improving long-term CPS knowledge. Long-term installation skills for forward-facing and rear-facing CSS persist for hands-on education but are inconclusive for online education.
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Affiliation(s)
- Anita Mantha
- Department of Pediatrics, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Fairfax, Virginia, USA
| | - Kristen L Beckworth
- Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, Texas, USA
| | - John A Ansiaux
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Carol C Chen
- Department of Emergency Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Benjamin Hoffman
- Doernbecher Children's Hospital Oregon Health and Science University, Portland, Oregon, USA
| | - Rohit P Shenoi
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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