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Saulnier KG, Browne J, Merrill S, Philibert AL, Grau PP, Szymanski BR, Bowersox NW. Rapid transition to virtual care during the COVID-19 pandemic for VHA patients with serious mental illness. Gen Hosp Psychiatry 2024:S0163-8343(24)00173-7. [PMID: 39174366 DOI: 10.1016/j.genhosppsych.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Kevin G Saulnier
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Stephanie Merrill
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Anna L Philibert
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Peter P Grau
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
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2
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Tabet M, Kirby RS, Boyd R, Xaverius P. Family-Centered Care and Delayed or Missed Pediatric Preventive Care due to the COVID-19 Pandemic. Acad Pediatr 2024; 24:848-855. [PMID: 38432513 DOI: 10.1016/j.acap.2024.02.014] [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: 12/18/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To examine the association between family-centered care and its components with delayed or missed preventive care due to the COVID-9 pandemic among US children. METHODS This is a cross-sectional study using nationally representative data from the 2021 National Survey of Children's Health (NSCH). Children were eligible if they received health care services in the past 12 months (n = 42,649; 79.3%). We excluded children with missing data, for a final sample of 40,511 (93.7% of the eligible sample). Children were deemed to have received family-centered care if caregivers responded "always" or "usually" to all five measures of family-centered care. Poisson regression was used to ascertain weighted prevalence ratios (PRs) and 95% confidence intervals (CIs). Predisposing, enabling, and need factors of health care services use were evaluated as potential confounders. RESULTS Approximately 86.7% of children received family-centered care during the pandemic, with significant racial and ethnic differences, findings consistent with pre-pandemic data. In multivariable analyses adjusted for the child's race and age, family-centered care was associated with a 30% reduced likelihood of delayed or missed preventive care (95% CI: 0.64-0.78). Individual components of family-centered care were associated with a 26%-43% reduced likelihood of delayed or missed preventive care. CONCLUSIONS Family-centered care and its components were associated with a reduced likelihood of delayed or missed pediatric preventive care. Our findings highlight the important role of health care providers in curbing the negative effects of the COVID-19 pandemic on pediatric preventive care utilization and emphasize the need to expand family-centered care among racial and ethnic minority groups.
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Affiliation(s)
- Maya Tabet
- College of Global Population Health (M Tabet and R Boyd), University of Health Sciences and Pharmacy in St. Louis, St. Louis, Mo.
| | - Russell S Kirby
- Chiles Center (RS Kirby), College of Public Health, University of South Florida, Tampa, Fla
| | - Ri'enna Boyd
- College of Global Population Health (M Tabet and R Boyd), University of Health Sciences and Pharmacy in St. Louis, St. Louis, Mo
| | - Pamela Xaverius
- Parkinson's School of Health Sciences and Public Health (P Xaverius), Loyola University Chicago, Maywood, Ill
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3
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Lin A, Chung S. Understanding Pediatric Surge in the United States. Pediatr Clin North Am 2024; 71:395-411. [PMID: 38754932 DOI: 10.1016/j.pcl.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
The concepts of pediatric surge in the United States continue to evolve from a theoretic framework to practical implementation. As disasters become more frequent, ranging from natural to human-caused, children remain a vulnerable population. The coronavirus disease 2019 pandemic and the 2022 to 2023 tripledemic respiratory surge revealed advances and continued challenges in our ability to care for a large influx of pediatric patients. Understanding pediatric surge through the framework of the 4 S's (space, staff, stuff, and systems/structures) can identify gaps at multiple levels.
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Affiliation(s)
- Anna Lin
- Pediatric Hospital Medicine, Stanford Medicine Children's Health; Department of Pediatrics, Stanford School of Medicine.
| | - Sarita Chung
- Disaster Preparedness, Division of Emergency Medicine, Boston Children's Hospital; Pediatric and Emergency Medicine, Harvard Medical School
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4
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Johnson SB, Kuehn M, Lambert JO, Spin JP, Klein LM, Howard B, Sturner R, Perrin EM. Developmental Milestone Attainment in US Children Before and During the COVID-19 Pandemic. JAMA Pediatr 2024; 178:586-594. [PMID: 38648043 PMCID: PMC11036311 DOI: 10.1001/jamapediatrics.2024.0683] [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: 11/01/2023] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
Importance Restrictions related to the COVID-19 pandemic disrupted the lives of young children, but the association between the pandemic and any changes in early childhood developmental milestone achievement in the US remains unclear. Objectives To determine the association between the COVID-19 pandemic and changes in developmental screening scores among US children aged 0 to 5 years and to investigate whether caregivers self-reported more worries about their children or concerns about children's behavior during the pandemic, regardless of milestone achievement. Design, Setting, and Participants This was a cohort study using an interrupted time series analysis comparing prepandemic (March 1, 2018, to February 29, 2020), interruption (March 1 to May 31, 2020), and intrapandemic (June 1, 2020, to May 30, 2022) periods among 50 205 children (randomly sampled from a population of 502 052 children) aged 0 to 5 years whose parents or caregivers completed developmental screening at pediatric visits at US pediatric primary care practices participating in a web-based clinical process support system. Exposure COVID-19 pandemic period. Main Outcomes and Measures Age-standardized Ages and Stages Questionnaire, Third Edition (ASQ) domain scores (communication, personal-social, problem-solving, gross motor, fine motor), and rate of caregivers' concerns about the child's behavior or worries about the child as measured on the ASQ. Results A total of 50 205 children (25 852 [51.5%] male; mean [SD] age, 18.6 [16.0] months) and 134 342 ASQ observations were included. In adjusted models, significant age-specific mean score decreases from prepandemic to intrapandemic were observed in communication (-0.029; 95% CI, -0.041 to -0.017), problem-solving (-0.018; 95% CI, -0.030 to -0.006), and personal-social (-0.016; 95% CI, -0.028 to -0.004) domains. There were no changes in fine or gross motor domains prepandemic to intrapandemic. For infants aged 0 to 12 months, similar effect sizes were observed but only for communication (-0.027; 95% CI, -0.044 to -0.011) and problem-solving (-0.018; 95% CI, -0.035 to -0.001). After accounting for age-standardized ASQ scores, caregiver worries about the child increased slightly in the intrapandemic period compared with the prepandemic period (rate ratio, 1.088; 95% CI, 1.036-1.143), but there were no changes in caregiver concerns about the child's behavior. While changes in developmental screening scores were modest (2%-3%), nationwide, this could translate to more than 1500 additional recommended developmental referrals over baseline each month. Conclusions and Relevance Modest changes in developmental screening scores are reassuring in the short term but may tax an already overburdened developmental behavioral pediatrics infrastructure. Continued attention to developmental surveillance is critical since the long-term population- and individual-level implications of these changes are unclear.
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Affiliation(s)
- Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Molly Kuehn
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer O. Lambert
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Lauren M. Klein
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara Howard
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- CHADIS, Inc, Baltimore, Maryland
| | - Raymond Sturner
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Center for Promotion of Child Development Through Primary Care, Baltimore, Maryland
| | - Eliana M. Perrin
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins School of Nursing, Baltimore, Maryland
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5
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Loper OR, Schultz JM, Kintigh BF, Callaghan DJ. Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System. J Rural Health 2024. [PMID: 38683043 DOI: 10.1111/jrh.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake. METHODS A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter. FINDINGS Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity. CONCLUSION This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.
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Affiliation(s)
- Ona R Loper
- Iowa Department of Health and Human Services, Des Moines, Iowa, USA
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6
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Jiter N, Dykstra A, Loper O, Kuramoto S, Schultz J. Tri-State Evaluation of the Effects of the COVID-19 Pandemic on Routine Vaccine Uptake in Iowa, Minnesota, and North Dakota, 2017-2021. J Community Health 2024:10.1007/s10900-024-01355-4. [PMID: 38581625 DOI: 10.1007/s10900-024-01355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
The objective of this analysis was to evaluate and compare the effects of the COVID-19 pandemic on routine and annual influenza vaccination in Iowa, Minnesota, and North Dakota. Routine and annual influenza vaccination uptake and coverage between 2017 and 2021 was collected from each state's immunization information system (IIS) by age group and stratified by provider and vaccine type. Data from 2017 to 2019 were averaged to obtain a pre-pandemic baseline and compared to 2020 and 2021 data. Percent changes were calculated to evaluate differences in uptake and coverage. Changes in coverage and administration varied by state, but each state had some level of decreased administration across the different age groups and vaccine types. The most consistent decreases in vaccine administration occurred in the 15-year-old cohort with each state finding decreased administrations in 2020 and 2021. The 12-year-old age group had decreased administration of hepatitis B, measles, mumps, and rubella, and varicella vaccine while the 2-year-old age group had the most consistent decrease in coverage across all vaccines analyzed. Trends by provider type were also noted in all three states, with local public health (LPH) experiencing the largest and most consistent declines in vaccine administrations by age group. Adult influenza coverage improved to varying degrees in 2020 (+ 14.1% IA, + 2.1% MN, + 1.5% ND), but either decreased or approached the 2017-19 average in 2021. All three states saw some level of decreased vaccine administration across the age groups, vaccines, and provider types assessed. The COVID-19 pandemic affected how many children and adults received recommended immunizations, leaving communities vulnerable to vaccine-preventable diseases.
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Affiliation(s)
- Naomi Jiter
- Minnesota Department of Health, 625 Robert St N, PO Box 64975, St. Paul, MN, 55164, USA
| | - Allison Dykstra
- North Dakota Department of Health and Human Services, Public Health Division, 600 E Boulevard Ave, Bismarck, ND, 58505, USA
| | - Ona Loper
- Iowa Department of Health and Human Services, Public Health Division, 321 E 12th St, Des Moines, IA, 50319, USA.
| | - Sydney Kuramoto
- Minnesota Department of Health, 625 Robert St N, PO Box 64975, St. Paul, MN, 55164, USA
| | - Jessica Schultz
- Iowa Department of Health and Human Services, Public Health Division, 321 E 12th St, Des Moines, IA, 50319, USA
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7
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Castillo-Rodenas M, Vicente Gómez JÁ, Fuster-Casanovas A, Miró Catalina Q, Vidal-Alaball J, López Seguí F. Impact of COVID-19 on the Pediatric Primary Care Model in Catalonia: Analysis of Changes in the Number and Type of Face-to-Face and Remote Visits. JMIR Pediatr Parent 2024; 7:e49943. [PMID: 38532544 PMCID: PMC11004613 DOI: 10.2196/49943] [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: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 03/28/2024] Open
Abstract
Background The outbreak of COVID-19 has turned the care model of health systems around the world upside down. The health care crisis has led to opportunities for digital health to deliver quality care, and the system has been redirected toward telemedicine. In Catalonia, Spain, as of March 2020, the pattern of visits in primary care pediatric consultations changed, such that face-to-face visits decreased in favor of non-face-to-face visits. Objective This study aimed to analyze variations in the types of pediatric visits in primary care centers in Catalonia before and after the onset of COVID-19. Methods This was a descriptive observational study based on administrative data. The number and type of visits to primary care pediatric services in Catalonia between January 2019 and December 2022 were studied. Results A drop of more than 80% in face-to-face visits and an increase of up to 15 times in remote visits were observed as of March 2020 compared to the previous year. Subsequently, the face-to-face attendance rate began to recover, although it did not reach the same rate as before COVID-19. Non-face-to-face visits were maintained, representing more than 20% of the total after more than 2 years of the pandemic. Conclusions COVID-19 has been the trigger for a transition in the types of visits to primary care pediatric services. The COVID-19 pandemic was a clear catalyst for the integration of telemedicine in Catalan pediatric health care. In this context, although face-to-face consultations have recovered in absolute numbers, after the pandemic period, the weight of telemedicine has increased.
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària Cardona, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | | | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Francesc López Seguí
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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8
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Thakkar PV, Scott Z, Hoffman M, Delarosa J, Hickerson J, Boutzoukas AE, Benjamin DK, Brookhart MA, Zimmerman KO, Moorthy GS. Impact of the COVID-19 Pandemic on Pediatric Preventive Health Care Among North Carolina Children Enrolled in Medicaid. J Pediatric Infect Dis Soc 2023; 12:S14-S19. [PMID: 38146859 PMCID: PMC10750309 DOI: 10.1093/jpids/piad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Children enrolled in private insurance had reduced preventive health care during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on children enrolled in Medicaid has been minimally described. METHODS We used an administrative claims database from North Carolina Medicaid to evaluate the rates of well-child visits and immunization administration for children ≤14 months of age, and used a quasi-Poisson regression model to estimate the rate ratio (RR) of each outcome during the pandemic period (3/15/2020 through 3/15/2021) compared with the pre-pandemic period (3/15/2019 through 3/14/2020). RESULTS We included 83 442 children during the pre-pandemic period and 96 634 children during the pandemic period. During the pre-pandemic period, 405 295 well-child visits and 715 100 immunization administrations were billed; during the pandemic period, 287 285 well-child visits and 457 144 immunization administrations were billed. The rates of well-child visits (RR 0.64; 95% CI, 0.64-0.64) and vaccine administration (RR 0.55; 95% CI, 0.55-0.55) were lower during the pandemic compared with the pre-pandemic period. CONCLUSIONS The rates of well-child visits and immunization administrations among North Carolina children enrolled in public insurance substantially decreased during the first year of the COVID-19 pandemic.
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Affiliation(s)
- Pavan V Thakkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zeni Scott
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Molly Hoffman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jesse Delarosa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jesse Hickerson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelique E Boutzoukas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - M Alan Brookhart
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ganga S Moorthy
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Takeda A, Ando Y, Tomio J. Long- and Short-Term Trends in Outpatient Attendance by Speciality in Japan: A Joinpoint Regression Analysis in the Context of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7133. [PMID: 38063563 PMCID: PMC10705918 DOI: 10.3390/ijerph20237133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
The COVID-19 pandemic resulted in a decline in outpatient attendance. Therefore, this study aimed to clarify long- and short-term clinic attendance trends by speciality in Japan between 2009 and 2021. A retrospective observational study of Japan's claims between 2009 and 2021 was conducted using the Estimated Medical Expenses Database. The number of monthly outpatient claims in clinics was used as a proxy indicator for monthly outpatient attendance, and specialities were categorised into internal medicine, paediatrics, surgery, orthopaedics, dermatology, obstetrics and gynaecology, ophthalmology, otolaryngology, and dentistry. The annually summarised age-standardised proportions and the percentage of change were calculated. Joinpoint regression analysis was used to evaluate long-term secular trends. The data set included 4,975,464,894 outpatient claims. A long-term statistically significant decrease was observed in outpatient attendance in internal medicine, paediatrics, surgery, ophthalmology, and otolaryngology during the pandemic. From March 2020 to December 2021, which includes the COVID-19 pandemic period, outpatient attendance in paediatrics, surgery, and otolaryngology decreased in all months compared with that of the corresponding months in 2019. For some specialities, the impact of the pandemic was substantial, even in the context of long-term trends. Speciality-specific preparedness is required to ensure essential outpatient services in future public health emergencies.
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Affiliation(s)
- Asuka Takeda
- Department of Health Crisis Management, National Institute of Public Health, Wako-shi, Saitama 3510197, Japan
| | - Yuichi Ando
- Department of Health Promotion, National Institute of Public Health, Wako-shi, Saitama 3510197, Japan
| | - Jun Tomio
- Department of Health Crisis Management, National Institute of Public Health, Wako-shi, Saitama 3510197, Japan
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10
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Patel NS, Waibel BH, Berning BJ, Terzian WTH, Evans CH, Hanna AM, Hamill ME. Kids gone wild - Alcohol use and patient characteristics in pediatric trauma during the coronavirus disease 2019 pandemic. Pediatr Investig 2023; 7:225-232. [PMID: 38050539 PMCID: PMC10693660 DOI: 10.1002/ped4.12388] [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: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 12/06/2023] Open
Abstract
Importance Reported coronavirus disease 2019 (COVID-19) pandemic effects on pediatric trauma have been variable. Objective We investigated the characteristics of pediatric trauma including alcohol use during the pandemic at our urban trauma center. Methods The trauma database of our adult level 1 trauma center was queried for all pediatric (age ≤ 18 years) patients presenting between March 1, 2020, and October 30, 2020. Data from 2017 to 2019 served as a control. Variables analyzed included demographics, mechanisms, injury severity, hospitalization characteristics, and positive blood alcohol. Results Pandemic pediatric trauma volumes increased by 67.5% (330/year vs. 197/year). Pandemic patients were younger (median age 13 vs. 14 years, P = 0.011), but similar in gender, ethnicity, severity, hospital length of stay, mortality, and rates of penetrating injury. Falls doubled (79/year vs. 34/year) and shifted away from high falls >6 meters (0% vs. 7.9%) to moderate falls 1-6 meters (58.2% vs. 51.5%) (P = 0.028). Transportation injury rates were similar however mechanisms shifted from motor vehicle crashes (-13.5%) towards recreational vehicles including motorcycles (+2.1%), all-terrain vehicles (+8.6%), and bicycles (+3.8%) (P = 0.018). Pediatric-positive blood alcohol was significantly higher (11.2% vs. 5.1%, P < 0.001), especially for ages 14-18 years (21.7% vs. 9.5%, P < 0.001). Interpretation Pediatric trauma volumes during the COVID-19 pandemic increased. Pandemic patients had more recreational vehicle injuries and higher rates of positive blood alcohol. This suggests an increased need for alcohol assessment and targeted interventions in the pediatric population during pandemics or periods of school closures.
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Affiliation(s)
- Neesha S Patel
- Department of Surgery, Division of Acute Care SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Brett H Waibel
- Department of Surgery, Division of Acute Care SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Bennett J Berning
- Department of Surgery, Division of Acute Care SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - WT Hillman Terzian
- Department of Surgery, Division of Acute Care SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Charity H Evans
- Department of Surgery, Division of Acute Care SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Angela M Hanna
- Department of SurgeryDivision of General and Thoracic Pediatric SugeryChildren's Hospital and Medical CenterOmahaNebraskaUSA
| | - Mark E Hamill
- Department of Surgery, Division of Acute Care SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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11
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Hong G, Less J, Masoudian B, Cruz A, Sifuentes S, Vue J, Yanamandra A, Sattler A, Lin S. Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic: Opportunity to Address Adolescent Behavioral Health Through Telemedicine. Fam Med 2023; 55:620-624. [PMID: 37540534 PMCID: PMC10622128 DOI: 10.22454/fammed.2023.755040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic impacted the volume and nature of pediatric primary care visits nationwide. This study aimed to identify trends in pediatric visits at our institution during the pandemic to reveal opportunities to improve care of children and adolescents. METHODS We performed a retrospective chart review of all pediatric visits conducted at a single family medicine clinic within a large academic medical center in Northern California from January 1, 2019, through September 30, 2021. Data collected for each visit included age, sex, type of visit (preventive or problem-focused), reason for visit (if problem-focused), and mode of visit (in-person or telehealth). We analyzed data using descriptive statistics and χ2 tests. RESULTS A total of 4,844 pediatric visits occurred during the study period. Visit volume dropped 9% from 2019 to 2020 and recovered to prepandemic levels in 2021. During the study period from 2019 to 2021, the percentage of problem-focused visits increased from 30% to 37% (P=.008) among adolescents, driven largely by an increase in the percentage of behavioral health visits from 14% to 29% (P<.001). We found no significant changes in the age or sex of patients seen. Telemedicine visit volume decreased from 2020 to 2021 in all age categories except for adolescents, which remained stable at 43% of all visits. CONCLUSIONS A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for adolescents in the postpandemic era.
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Affiliation(s)
- Grace Hong
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of MedicineStanford, CA
| | - Justin Less
- Stanford University School of MedicineStanford, CA
| | | | - Amy Cruz
- Stanford University School of MedicineStanford, CA
| | | | - Jileen Vue
- Stanford University School of MedicineStanford, CA
| | | | - Amelia Sattler
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of MedicineStanford, CA
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of MedicineStanford, CA
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12
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McIntyre T, Sarah S, Benjamin R, Balikcioglu PG. Disrupted Pediatric Diabetes Trends in the Second Year of the COVID-19 Pandemic. J Endocr Soc 2023; 7:bvad092. [PMID: 37457848 PMCID: PMC10349346 DOI: 10.1210/jendso/bvad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 07/18/2023] Open
Abstract
Context Increases in incident cases of pediatric type 1 (T1D) and type 2 diabetes (T2D) were observed during the first year of the COVID-19 pandemic. Objective This work aimed to identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the second year of the COVID-19 pandemic. Methods A retrospective chart review was conducted. Demographics, anthropometrics, and initial laboratory results from patients aged 0 to 21 years who presented with new-onset diabetes to a pediatric tertiary care center were recorded. Results The incident cases of T1D (n = 46) and T2D (n = 46) in 2021-2022 (second year of the pandemic) were consistent with the incident cases of T1D (n = 46) and T2D (n = 53) in 2020 to 2021 (first year of the pandemic). Compared to the incident cases of diabetes in the prepandemic years, in the second year, the incident cases of T1D increased 48%, and the incident cases of T2D increased 188%. In the second year of the pandemic, incident cases of T2D represented half (50%) of all newly diagnosed pediatric diabetes cases. Patients with T2D were more likely to present in diabetic ketoacidosis, though this was not statistically significant (P = .08). Conclusion The increase in incident cases of pediatric T1D and T2D observed during the first year of the COVID-19 pandemic persisted during the second pandemic year. This suggests that despite pediatric vaccination efforts and return to social in-person activities, we may continue to see effects of the pandemic on pediatric diabetes trends.
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Affiliation(s)
- Tatiana McIntyre
- Correspondence: Tatiana McIntyre, MD, Department of Pediatrics, Duke University Medical Center, 2301 Erwin Rd, Box 3127 DUMC, Durham, NC 27710, USA.
| | | | - Robert Benjamin
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27705, USA
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27705, USA
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27701, USA
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13
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Phan TLT, Enlow PT, Lewis AM, Arasteh K, Hildenbrand AK, Price J, Schultz CL, Reynolds V, Kazak AE, Alderfer MA. Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic. Public Health Rep 2023; 138:633-644. [PMID: 37013845 PMCID: PMC10076159 DOI: 10.1177/00333549231163527] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement. METHODS Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality). RESULTS We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased. CONCLUSIONS Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.
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Affiliation(s)
- Thao-Ly T. Phan
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul T. Enlow
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda M. Lewis
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
| | - Kamyar Arasteh
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
| | - Aimee K. Hildenbrand
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia Price
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Corinna L. Schultz
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anne E. Kazak
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa A. Alderfer
- Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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14
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Pitch N, Verma R, Davidson L, Robertson T, Anagnostopoulos G, Sunkonkit K, Qazi A, Ambreen M, Mekhuri S, Miller MR, Orkin J, Amin R. Screening for psychosocial risk in caregivers of children with medical complexity during the COVID-19 pandemic: a cross-sectional study. BMJ Open 2023; 13:e068867. [PMID: 37185638 PMCID: PMC10151246 DOI: 10.1136/bmjopen-2022-068867] [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] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The primary objective was to quantify psychosocial risk in family caregivers (FCs) of children with medical complexity (CMC) during the COVID-19 pandemic using the Psychosocial Assessment Tool (PAT). The secondary objectives were to compare this finding with the average PAT score of this population before the COVID-19 pandemic and to examine potential clinical predictors of psychosocial risk in FCs of CMC. DESIGN Cross-sectional study. PARTICIPANTS FCs of CMC were recruited from the Long-Term Ventilation Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada. A total of 91 completed the demographic and PAT questionnaires online from 10 June 2021 through 13 December 2021. MAIN OUTCOME MEASURES Mean PAT scores in FCs were categorised as 'Universal' low risk, 'Targeted' intermediate risk or 'Clinical' high risk. The effect of sociodemographic and clinical variables on overall PAT scores was assessed using multiple linear regression analysis. Comparisons with a previous study were made using Mann-Whitney tests and χ2 analysis. RESULTS Mean (SD) PAT score was 1.34 (0.69). Thirty-one (34%) caregivers were classified as Universal, 43 (47%) as Targeted and 17 (19%) as Clinical. The mean PAT score (1.34) was significantly higher compared with the mean PAT score (1.17) found prior to the COVID-19 pandemic. Multiple linear regression analysis demonstrated an overall significant model, with the number of hospital admissions since the onset of COVID-19 being the only variable associated with the overall PAT score. CONCLUSION FCs of CMC are experiencing significant psychosocial stress during the COVID-19 pandemic. Timely and effective interventions are warranted to ensure these individuals receive the appropriate support.
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Affiliation(s)
- Natalie Pitch
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Verma
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Davidson
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Taylor Robertson
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kanokkarn Sunkonkit
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pulmonary and Critical Care, Department of Pediatrics, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Adam Qazi
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Munazzah Ambreen
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Mekhuri
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael R Miller
- Children's Health Research Institute, London, Ontario, Canada
- Department of Paediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Julia Orkin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences SickKids Research Institute, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences SickKids Research Institute, Toronto, Ontario, Canada
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15
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McGowan EC, McGrath M, Law A, O’Shea TM, Aschner JL, Blackwell CK, Fry RC, Ganiban JM, Higgins R, Margolis A, Sathyanarayana S, Taylor G, Alshawabkeh AN, Cordero JF, Spillane NT, Hudak ML, Camargo CA, Dabelea D, Dunlop AL, Elliott AJ, Ferrara AM, Talavera-Barber M, Singh AM, Karagas MR, Karr C, O’Connor TG, Paneth N, Wright RJ, Wright RO, Cowell W, Stanford JB, Bendixsen C, Lester BM. Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm. JAMA Netw Open 2023; 6:e2310696. [PMID: 37115545 PMCID: PMC10148204 DOI: 10.1001/jamanetworkopen.2023.10696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Importance Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. Objective To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. Design, Setting, and Participants In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Exposures Premature birth (<37 weeks' gestation). Main Outcomes and Measures The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks' gestation) and differences among preterm subgroups of individuals (<28 weeks', 28-36 weeks' vs ≥37 weeks' gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Results Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks' gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks' gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). Conclusions and Relevance These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19-related health care use may facilitate refinement of care models.
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Affiliation(s)
- Elisabeth C. McGowan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Monica McGrath
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew Law
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Judy L. Aschner
- Albert Einstein College of Medicine, New York, New York
- Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | - Rebecca C. Fry
- The University of North Carolina at Chapel Hill, Chapel Hill
| | - Jody M. Ganiban
- George Washington University, Washington, District of Columbia
| | - Rosemary Higgins
- Department of Global and Community Health, College of Health and Human Sciences, George Mason University, Fort Myers, Florida
- Marieb College of Health and Human Services, Florida Gulf Coast University, Fort Myers
| | - Amy Margolis
- Columbia University Irving Medical Center, New York, New York
| | - Sheela Sathyanarayana
- University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
| | | | | | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens
| | - Nicole T. Spillane
- Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Mark L. Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | | | - Maria Talavera-Barber
- Avera McKennan Hospital, Sioux Falls, South Dakota
- University Health Center, Avera Research Institute, Sioux Falls, South Dakota
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Catherine Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
| | | | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing
| | - Rosalind J. Wright
- Institute for Exposomic Research, Icahn School of Medicine Mount Sinai, New York, New York
| | - Robert O. Wright
- Institute for Exposomic Research, Icahn School of Medicine Mount Sinai, New York, New York
| | - Whitney Cowell
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | | | - Casper Bendixsen
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Barry M. Lester
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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16
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Grefe A, Chen SH, Ip EH, Kirkendall E, Nageswaran S. Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children. J Child Neurol 2023; 38:263-269. [PMID: 37186764 PMCID: PMC10524612 DOI: 10.1177/08830738231172633] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND Children of minority race/ethnicity face barriers to accessing specialty services. During the COVID pandemic, health insurance companies reimbursed telehealth services. Our objective was to evaluate the effect of audio versus video visits on children's access to outpatient neurology services, particularly for Black children. METHODS Using Electronic Health Record data, we collected information about children who had outpatient neurology appointments in a tertiary care children's hospital in North Carolina from March 10, 2020, to March 9, 2021. We used multivariable models to compare appointment outcomes (canceled vs completed, and missed vs completed) by visit type. We then conducted similar evaluation for the subgroup of Black children. RESULTS A total of 1250 children accounted for 3829 scheduled appointments. Audio users were more likely to be Black and Hispanic, and to have public health insurance than video users. Adjusted odds ratio (aOR) for appointments completed versus canceled was 10 for audio and 6 for video, compared to in-person appointments. Audio visits were twice as likely as in-person visits to be completed versus missed; video visits were not different. For the subgroup of Black children, aOR for appointments completed versus canceled for audio was 9 and video was 5, compared to in-person appointments. For Black children, audio visits were 3 times as likely as in-person visits to be completed versus missed; video visits were not different. CONCLUSIONS Audio visits improved access to pediatric neurology services, especially for Black children. Reversal of policies to reimburse audio visits could deepen the socioeconomic divide for children's access to neurology services.
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Affiliation(s)
- Annette Grefe
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward H. Ip
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eric Kirkendall
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC
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Abstract
This cross-sectional study uses National Survey of Children’s Health data to assess demographic disparities in medical and childcare disruptions during the COVID-19 pandemic.
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Affiliation(s)
- Kelsi Batioja
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, Oklahoma
| | - Covenant Elenwo
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, Oklahoma
| | - Micah Hartwell
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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18
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Kukafka R, Eysenbach G, Burns S, Doan TT, Schweiberger KA, Yabes JG, Hanmer J, Krishnamurti T. Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study. J Med Internet Res 2023; 25:e42892. [PMID: 36757763 PMCID: PMC9951070 DOI: 10.2196/42892] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/18/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Telemedicine delivered from primary care practices became widely available for children during the COVID-19 pandemic. OBJECTIVE Focusing on children with a usual source of care, we aimed to examine factors associated with use of primary care telemedicine. METHODS In February 2022, we surveyed parents of children aged ≤17 years on the AmeriSpeak panel, a probability-based panel of representative US households, about their children's telemedicine use. We first compared sociodemographic factors among respondents who did and did not report a usual source of care for their children. Among those reporting a usual source of care, we used Rao-Scott F tests to examine factors associated with parent-reported use versus nonuse of primary care telemedicine for their children. RESULTS Of 1206 respondents, 1054 reported a usual source of care for their children. Of these respondents, 301 of 1054 (weighted percentage 28%) reported primary care telemedicine visits for their children. Factors associated with primary care telemedicine use versus nonuse included having a child with a chronic medical condition (87/301, weighted percentage 27% vs 113/753, 15%, respectively; P=.002), metropolitan residence (262/301, weighted percentage 88% vs 598/753, 78%, respectively; P=.004), greater internet connectivity concerns (60/301, weighted percentage 24% vs 116/753, 16%, respectively; P=.05), and greater health literacy (285/301, weighted percentage 96% vs 693/753, 91%, respectively; P=.005). CONCLUSIONS In a national sample of respondents with a usual source of care for their children, approximately one-quarter reported use of primary care telemedicine for their children as of 2022. Equitable access to primary care telemedicine may be enhanced by promoting access to primary care, sustaining payment for primary care telemedicine, addressing barriers in nonmetropolitan practices, and designing for lower health-literacy populations.
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Affiliation(s)
| | | | - Sarah Burns
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tran T Doan
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janel Hanmer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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19
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Vargas G, Prunier L, Borus J. Gender Differences in Routine Health Maintenance Examinations Before and During the COVID-19 Pandemic. J Adolesc Health 2023; 72:300-302. [PMID: 36473777 PMCID: PMC9721310 DOI: 10.1016/j.jadohealth.2022.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/05/2022] [Accepted: 09/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Adolescent and young adult (AYA) males historically have lower healthcare utilization than their female peers. METHODS Electronic health record data from an Adolescent/Young Adult Medicine outpatient practice were reviewed to assess gender differences in routine health maintenance examinations before and during the COVID-19 pandemic. RESULTS Routine health maintenance examinations decreased for both males and females during the pandemic. However, a two-proportion z-test demonstrated that established male patients were statistically less likely (p < .01) to have a routine health maintenance examination from December 2020 to December 2021 than their female counterparts. DISCUSSION AYA males are at a higher risk for persistent disengagement in healthcare and exacerbates future gender gaps in healthcare utilization. Primary care providers need to focus efforts on re-engaging all young people in preventive care, with specific efforts tailored to AYA males.
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Affiliation(s)
- Gabriela Vargas
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lee Prunier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Joshua Borus
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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20
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Ahat TK, Gençer TY, Baysal ŞG, Baz HM, Durak U, Canaloğlu SK, Büyükavcı MA, Doğan DG, Gumus Dogan D. The Impact of COVID-19 Pandemic on Patient Admissions to the Developmental Pediatrics Unit: An Outpatient Clinic in Eastern Turkey. Turk Arch Pediatr 2023; 58:62-67. [PMID: 36598213 PMCID: PMC9885809 DOI: 10.5152/turkarchpediatr.2022.22200] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the impact of coronavirus disease 2019 pandemic on the number and diagnosis of patients admitted to the Developmental Pediatrics Unit. Materilas and Methods: We compared the number and the diagnosis of patients admitted to the Developmental Pediatrics Unit by using International Classification of Diseases and Related Health Problems 10th revision (ICD-10) codes of our institution's electronic health data before and after 18 months from March 16 2020, when coronavirus disease 2019 pandemic was declared in Turkey. Statistical analyses were performed by using International Business Machines Statistical Package for Social Sciences for windows version 22.0 (Armonk, NY) program. RESULTS We found that the number of patients admitted to the Developmental Pediatrics Unit decreased during the pandemic period (pre-coronavirus disease 2019 n = 1107, during coronavirus disease 2019 n = 761). There was no significant difference between the ratio of the most common diagnosis (prematurity) before and during the pandemic period (32% and 30.6% respectively). It was observed that the ratio of children with speech delay (17.4%-23%, P = .003) increased during the pandemic, while there was a significant decrease in the ratio of admissions with Down syndrome (11.6%-6.6%, P < .001). CONCLUSION We found that the number of admissions to the Developmental Pediatrics Unit with developmental difficulties decreased significantly during the pandemic. The ratio of admissions of speech delay increased during the same period, while admissions with Down syndrome decreased. This increase may be due to lockdown, increase in electronic screen exposure, and lack of stimuli and the decrease may be due to the risk of severe illness from coronavirus disease 2019. The decrease in admissions of patients who require developmental follow-up reveals the need for additional efforts such as implementing tele-health to our daily practice.
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21
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Bailey-Davis L, Moore AM, Poulsen MN, Dzewaltowski DA, Cummings S, DeCriscio LR, Hosterman JF, Huston D, Kirchner HL, Lutcher S, McCabe C, Welk GJ, Savage JS. Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial. BMC Public Health 2022; 22:2429. [PMID: 36572870 PMCID: PMC9792161 DOI: 10.1186/s12889-022-14827-w] [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] [Received: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Obesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour). METHODS A total of 2,025 parents and their preschool-aged children (20-60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO-the Family Nutrition and Physical Activity (FNPA) risk assessment-from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child's electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures. DISCUSSION Study findings will inform health care systems' choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors. TRIAL REGISTRATION ClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.
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Affiliation(s)
- Lisa Bailey-Davis
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA ,Center for Obesity & Metabolic Research, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Amy M. Moore
- grid.29857.310000 0001 2097 4281Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802 USA
| | - Melissa N. Poulsen
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - David A. Dzewaltowski
- grid.266813.80000 0001 0666 4105College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198 USA
| | - Stacey Cummings
- Department of Pediatrics, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Laina R. DeCriscio
- Health and Wellness, Steele Institute, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Jennifer Franceschelli Hosterman
- Department of Pediatrics, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA ,Departments of Internal Medicine and Pediatrics, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Daniel Huston
- Health and Wellness, Steele Institute, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - H. Lester Kirchner
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Shawnee Lutcher
- Center for Obesity & Metabolic Research, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Carolyn McCabe
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA ,Center for Obesity & Metabolic Research, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Gregory J. Welk
- grid.34421.300000 0004 1936 7312Department of Kinesiology, Iowa State University, 103E Forker, 534 Wallace Rd, Ames, IA 50011 USA
| | - Jennifer S. Savage
- grid.29857.310000 0001 2097 4281Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802 USA
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22
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Rivera AS, Plank M, Davis A, Feinstein MJ, Rusie LK, Beach LB. Assessing widening disparities in HbA1c and systolic blood pressure retesting during the COVID-19 pandemic in an LGBTQ+-focused federally qualified health center in Chicago: a retrospective cohort study using electronic health records. BMJ Open Diabetes Res Care 2022; 10:10/6/e002990. [PMID: 36593660 PMCID: PMC9748509 DOI: 10.1136/bmjdrc-2022-002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To assess disparities in retesting for glycated hemoglobin (HbA1c) and systolic blood pressure (SBP) among people with diabetes mellitus (DM) and hypertension (HTN), respectively, we analyzed medical records from a lesbian, gay, bisexual, transgender, queer-specialized federally qualified health center with multiple sites in Chicago. RESEARCH DESIGN AND METHODS We identified people with DM seen in 2018 and 2019 then assessed if individuals had HbA1c retested the following year (2019 and 2020). We repeated this using SBP for people with HTN. Rates of retesting were compared across gender, sexual orientation, and race and ethnicity and across the 2 years for each categorization with adjustment for socioeconomic indicators. RESULTS Retesting rates declined from 2019 to 2020 for both HbA1c and SBP overall and across all groups. Cisgender women and transgender men with DM (vs cisgender men) and straight people (vs gay men) had significantly lower odds of HbA1c retesting for both years. There was evidence of widening of HbA1c retesting disparities in 2020 between gay men and other orientations. Cisgender women, straight people, and black people (vs white) with HTN had significantly lower odds of SBP retesting for both years. There was evidence of narrowing in the retesting gap between black and white people with HTN, but this was due to disproportionate increase in no retesting in white people rather than a decline in no retesting among black people with HTN. CONCLUSIONS Disparities in DM and HTN care according to gender, race, ethnicity, and sexual orientation persisted during the pandemic with significant widening according to sexual orientation.
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Affiliation(s)
- Adovich S Rivera
- Center for Education in Health Sciences, Institute for Public Health and Management, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Megan Plank
- Data, Evaluation, and Epidemiology, Howard Brown Health Center, Chicago, Illinois, USA
| | - Ash Davis
- Data, Evaluation, and Epidemiology, Howard Brown Health Center, Chicago, Illinois, USA
| | - Matthew J Feinstein
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura K Rusie
- Data, Evaluation, and Epidemiology, Howard Brown Health Center, Chicago, Illinois, USA
| | - Lauren B Beach
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern UniversityFeinberg School of Medicine, Chicago, IL, USA
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23
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Trends in Well-Child Visits and Routine Vaccination among Children of U.S. Military Members: An Evaluation of the COVID-19 Pandemic Effects. J Clin Med 2022; 11:jcm11226842. [PMID: 36431319 PMCID: PMC9699213 DOI: 10.3390/jcm11226842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic has drastically impacted administration of healthcare including well-child visits and routine vaccinations. The purpose of this study was to determine the impact of COVID-19 pandemic disruption on childhood health maintenance: well-child visits and scheduled vaccinations. We queried the TRICARE Management Activity's Military Health System (MHS) database for outpatient well-child visits and vaccinations for all children 0 to 23 months of age eligible for TRICARE healthcare. The median rate of well-child visits, during the COVID-19 period (March 2020-July 2021), was significantly declined for all demographic groups: all ages, parental military ranks, sex, and regions as compared to the pre-COVID-19 period (February 2019-February 2020). Similar to rates of well-child visits, the rate of vaccinations declined during the COVID-19 period as compared to the pre-COVID-19 period for all demographic groups, except children 12-23 months. Rates of well-child visits for military dependent children under 2 years of age were decreased during the 16 month COVID-19 period, with large increases seen in the first 2 months of the pandemic; the consequences of missed well-child visits and vaccination are unknown.
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24
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Wallis KE, Nekrasova E, Bennett AE, Fiks AG, Gerdes M, Jenssen BP, Miller JS, Shu D, Guthrie W. Autism Spectrum Disorder Screening During the COVID-19 Pandemic in a Large Primary Care Network. Acad Pediatr 2022; 22:1384-1389. [PMID: 35460894 PMCID: PMC9020644 DOI: 10.1016/j.acap.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on screening for autism spectrum disorder (ASD) and screening equity among eligible children presenting for well-child care in a large primary care pediatric network, we compared rates of ASD screening completion and positivity during the pandemic to the year prior, stratified by sociodemographic factors. METHODS Patients who presented for in-person well-child care at 16 to 26 months between March 1, 2020 and February 28, 2021 (COVID-19 cohort, n = 24,549) were compared to those who presented between March 1, 2019 and February 29, 2020 (pre-COVID-19 cohort, n = 26,779). Demographics and rates of completion and positivity of the Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT/F) were calculated from the electronic health record and compared by cohort using logistic regression models. RESULTS Total eligible visits decreased by 8.3% between cohorts, with a greater decline in Black and publicly insured children. In the pre-COVID-19 cohort, 89.0% of eligible children were screened at least once, compared to 86.4% during the pandemic (P < 0.001). Significant declines in screening completion were observed across all sociodemographic groups except among Asian children, with the sharpest declines among non-Hispanic White children. Sociodemographic differences were not observed in screen-positive rates by cohort. CONCLUSIONS Well-child visits and ASD screenings declined across groups, but with different patterns by race and ethnicity during the COVID-19 pandemic. Findings regarding screen-completion rates should not be interpreted as a decline in screening disparities, given differences in who presented for care. Strategies for catch-up screening for all children should be considered.
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Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Ekaterina Nekrasova
- Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; The Possibilities Project (E Nekrasova, AG Fiks, BP Jenssen), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Amanda E Bennett
- Division of Developmental and Behavioral Pediatrics (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Alexander G Fiks
- Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; The Possibilities Project (E Nekrasova, AG Fiks, BP Jenssen), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Marsha Gerdes
- Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Brian P Jenssen
- Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; The Possibilities Project (E Nekrasova, AG Fiks, BP Jenssen), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Judith S Miller
- Division of Developmental and Behavioral Pediatrics (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Child and Adolescent Psychiatry and Behavioral Sciences (JS Miller and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry, Perelman School of Medicine (JS Miller and W Guthrie), University of Pennsylvania, Philadelphia, Pa
| | - Di Shu
- Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Biostatistics, Epidemiology and Informatics (D Shu), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Child and Adolescent Psychiatry and Behavioral Sciences (JS Miller and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry, Perelman School of Medicine (JS Miller and W Guthrie), University of Pennsylvania, Philadelphia, Pa
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25
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Mandelbaum J, Harrison SE. Primary Care Clinicians' Perceived Role in Addressing Childhood Obesity in the Southern United States. South Med J 2022; 115:824-830. [PMID: 36318948 DOI: 10.14423/smj.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Primary care is an opportune setting to promote healthy behaviors for children and families. In 2007, an expert committee recommended that pediatric primary care clinicians assess nutrition and physical activity at wellness visits and offer recommendations; however, little is known about what pediatric primary care clinicians perceive their role as in childhood weight management. This qualitative study aimed to describe the perceived role of pediatric primary care clinicians in the prevention and treatment of childhood obesity in South Carolina, a state in the southern United States with high rates of childhood obesity. METHODS Pediatric primary care clinicians (n = 23) from South Carolina were recruited for two focus groups. Participants were asked semistructured, open-ended questions, and audio recordings were transcribed verbatim. Themes and subthemes were identified through an iterative coding and consensus-building process with two coders. Excerpts coded under the parent code of "clinician role" centered on three themes: conducting assessments, making referrals, and providing education. RESULTS Pediatric primary care clinicians in South Carolina coalesced around the important role of addressing childhood obesity within primary care. Notably, clinicians primarily discussed treatment rather than prevention strategies and described changes in the scope of their practice over time as a result of the increasing numbers of pediatric patients with obesity. CONCLUSIONS Addressing childhood obesity within primary care is a critical component of obesity prevention and treatment in the southern United States. Effective, sustainable prevention and treatment within primary care will depend on the involvement of pediatric clinicians, thus emphasizing the importance of understanding how they perceive their role within this setting.
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Affiliation(s)
- Jennifer Mandelbaum
- From the Departments of Health Promotion, Education, and Behavior and Psychology, University of South Carolina, Columbia
| | - Sayward E Harrison
- From the Departments of Health Promotion, Education, and Behavior and Psychology, University of South Carolina, Columbia
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26
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Herrman A, Ruisinger JF, Moore EE, Melton BL. Assessing the impact of a pharmacy-provided personalized vaccination recommendation on immunization rates of adolescents. J Am Pharm Assoc (2003) 2022:S1544-3191(22)00362-4. [PMID: 36424294 PMCID: PMC9595482 DOI: 10.1016/j.japh.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescents should receive timely doses of recommended vaccinations. The coronavirus disease 2019 (COVID-19) vaccination approval for adolescents presented an opportunity for community pharmacists to address gaps in adolescent immunization schedules. OBJECTIVES The objectives of this research were to (1) identify adolescent immunization gaps, (2) identify number of patients receiving recommended vaccination(s) at the community pharmacy, and (3) determine how many vaccinations were administered after the intervention. METHODS Three pharmacies conducted the prospective intervention. Adolescents aged 11-17 years initiating the Pfizer-BioNTech COVID-19 vaccination series were eligible to receive a personalized vaccination recommendation (PVR), which included up to 3 other vaccinations. State immunization information systems were assessed after dose 1 of the COVID-19 vaccine to create the recommendation(s) and reassessed 6 months after providing the PVR for accepted recommendations. Patient demographics and number of vaccinations administered were assessed using descriptive statistics. RESULTS Of the 225 adolescents who received COVID-19 vaccine dose 1, 74.7%, 75.1%, and 83.1% were indicated to receive tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal conjugate (MenACWY), or human papillomavirus (HPV) vaccine, respectively. Thirty-three (14.7%) adolescents were up to date on all 3 vaccinations assessed. Of the 225 adolescents, 180 returned to the same location for COVID-19 vaccine dose 2 and received a PVR. Forty-two caregivers reported that their adolescent previously received 1 or more of the recommended vaccinations, indicating that state immunization information systems were inaccurate. Six months after the PVRs were given, 24 vaccinations had been administered. CONCLUSIONS Most adolescents presenting for a COVID-19 vaccine were indicated, according to state immunization information systems, to receive at least 1 additional vaccination. After pharmacist-provided PVR and education, vaccine uptake occurred. Considering caregiver-reported inaccuracies, pharmacists should be cognizant of potential discrepancies when providing PVRs. In addition, this study highlights the value of a state immunization information system.
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Affiliation(s)
- Adrianna Herrman
- Correspondence: Adrianna Herrman, PharmD, PGY1 Pharmacy Resident, 5300 Speaker Rd, Kansas City, KS 66106
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27
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Negriff S, Huang BZ, Sharp AL, DiGangi M. The impact of stay-at-home orders on the rate of emergency department child maltreatment diagnoses. CHILD ABUSE & NEGLECT 2022; 132:105821. [PMID: 35939889 PMCID: PMC9355635 DOI: 10.1016/j.chiabu.2022.105821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND There is limited data regarding the rates and severity of child maltreatment in medical settings during the COVID-19 pandemic, and the reports are somewhat contradictory. OBJECTIVE To examine the rates of emergency department (ED) child maltreatment (CM) diagnosis before and after the California statewide stay-at-home order, as well as potential disparities by age, gender, race/ethnicity, and Medicaid status. METHODS A retrospective pre-post interrupted time series was conducted using data from the electronic health records of children (<18 years) with at least one emergency department visit between January 1, 2019 and September 30, 2021. Enactment of the stay-at-home order in California, March 2020 was used to determine a change in trend of rates of diagnosis of CM in the ED. RESULTS Overall the study included 407,228 pediatric ED visits. There was a significant change in the percentage of CM visits immediately after the stay-at-home order, followed by small month to month decreases returning to near pre-stay-at-home order levels. This significant increase was driven by higher risk for children <4 years old. The increased rate of CM in the first month after the stay-at-home order was also elevated for female, Black, and Hispanic children. CONCLUSIONS Our results indicated the rates of CM diagnoses in the ED doubled after the March 2020 stay-at-home order in California. Additionally, our findings suggest that some children may be at higher risk than others, which supports the importance of social safety nets for children in times of national emergency.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States of America.
| | - Brian Z Huang
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America
| | - Adam L Sharp
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States of America
| | - Mercie DiGangi
- Kaiser Permanente Southern California, Department of Pediatrics, Bellflower, CA, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States of America
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New Parent Support Needs and Experiences with Pediatric Care During the COVID-19 Pandemic. Matern Child Health J 2022; 26:2060-2069. [PMID: 35934725 PMCID: PMC9358093 DOI: 10.1007/s10995-022-03496-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022]
Abstract
Objectives Despite evidence for heightened psychiatric risk and unique parenting challenges during the COVID-19 pandemic, no research exists on the specific needs of parents of infants and responsiveness of pediatric care to their needs. We aimed to describe the support needs of new parents and explore their experiences with pediatric care. Methods In late 2020 we conducted semi-structured interviews with 30 mothers of babies born or due that year. Interviews addressed perinatal experiences during the pandemic, with an emphasis on experiences related to social support. In an iterative, inductive process, thematic analysis was used to analyze the data. Results This study identifies a set of support needs specific to the context of parenting an infant during the COVID-19 crisis: coping with the compound psychological impacts of the postpartum period and a pandemic; parenting in the absence of expected social support; risk assessment to keep infant and family safe. This study finds that policies implemented by health care providers to reduce risk of COVID-19 transmission came at a cost to new parents and parent-provider relationships. Participants reported mixed experiences with in-person and telehealth pediatric care, including inadequate and/or uncomfortable postpartum mental health screening and breastfeeding support, and identified specific features that constituted responsive care during the pandemic. Conclusions Normative changes associated with the postpartum period combined with complex adaptations necessitated by the COVID-19 pandemic presented substantial challenges for families with infants, even relatively privileged families. Providers can incorporate these findings to enhance support for families and promote maternal and child health.
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Raffa LH, Balbaid NT, Ageel MM. "Smart Optometry" phone-based application as a visual acuity testing tool among pediatric population. Saudi Med J 2022; 43:946-953. [PMID: 35964961 PMCID: PMC9749677 DOI: 10.15537/smj.2022.43.8.20220374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the validity of a smartphone-based application for visual acuity (VA) testing in children and to compare parent and clinician-performed VA to standard VA assessment. METHODS A cohort of 100 children aged <18 years old was recruited. Subjects were randomly assigned to either start with conventional distance VA chart screening or the smartphone VA assessment twice by both the clinician and the caregiver if applicable. Near VA scores were assessed using the near vision E chart. Accuracy and reliability values were analyzed. RESULTS One hundred patients with an average age of 9.92 ± 3.0 years old were enrolled. The difference between conventional distance and application logMAR values was -0.023, and the difference between near vision and application logMAR values was -0.004. "Smart Optometry" had a sensitivity of 89.3% in detecting subnormal VA compared with conventional vision testing methods. Sensitivity in detecting subnormal VA was found to be higher in younger age groups up to 91.7% in comparison with the older age groups. The interclass correlation of application-measured VA scores by the caregivers and the clinician were 0.77 (95% CI; 0.67-0.83) using single measures and 0.87 (95%CI; 0.8-0.9) using average measures. CONCLUSION "Smart Optometry" phone application was found to be an acceptable home-based VA testing tool with good inter-rater reliability for young children showing good sensitivity in detecting subnormal VA, but lower sensitivity in detecting amblyopia.
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Affiliation(s)
- Lina H. Raffa
- From the Department of Ophthalmology (Raffa, Balbaid), King Abdulaziz University Hospital; and from Department of Ophthalmology (Ageel), Jeddah Eye Hospital, Jeddah, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Lina Raffa, Associate Professor & Consultant Pediatric Ophthalmologist, Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8211-2353
| | - Nasser T. Balbaid
- From the Department of Ophthalmology (Raffa, Balbaid), King Abdulaziz University Hospital; and from Department of Ophthalmology (Ageel), Jeddah Eye Hospital, Jeddah, Kingdom of Saudi Arabia.
| | - Mariam M. Ageel
- From the Department of Ophthalmology (Raffa, Balbaid), King Abdulaziz University Hospital; and from Department of Ophthalmology (Ageel), Jeddah Eye Hospital, Jeddah, Kingdom of Saudi Arabia.
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30
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Wattles BA, Jawad KS, Feygin YF, Stahl JD, Vidwan NK, Stevenson MD, Kong M, Smith MJ. Quality of antibiotic prescribing to children through the coronavirus disease 2019 (COVID-19) pandemic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e94. [PMID: 36483376 PMCID: PMC9726595 DOI: 10.1017/ash.2022.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To describe pediatric outpatient visits and antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN An observational, retrospective control study from January 2019 to October 2021. SETTING Outpatient clinics, including 27 family medicine clinics, 27 pediatric clinics, and 26 urgent or prompt care clinics. PATIENTS Children aged 0-19 years receiving care in an outpatient setting. METHODS Data were extracted from the electronic health record. The COVID-19 era was defined as April 1, 2020, to October 31, 2021. Virtual visits were identified by coded encounter or visit type variables. Visit diagnoses were assigned using a 3-tier classification system based on appropriateness of antibiotic prescribing and a subanalysis of respiratory visits was performed to compare changes in the COVID-19 era compared to baseline. RESULTS Through October 2021, we detected an overall sustained reduction of 18.2% in antibiotic prescribing to children. Disproportionate changes occurred in the percentages of antibiotic visits in respiratory visits for children by age, race or ethnicity, practice setting, and prescriber type. Virtual visits were minimal during the study period but did not result in higher rates of antibiotic visits or in-person follow-up visits. CONCLUSIONS These findings suggest that reductions in antibiotic prescribing have been sustained despite increases in outpatient visits. However, additional studies are warranted to better understand disproportionate rates of antibiotic visits.
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Affiliation(s)
- Bethany A. Wattles
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kahir S. Jawad
- Norton Children’s Research Institute Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yana F. Feygin
- Norton Children’s Research Institute Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - J. Drew Stahl
- Department of Pharmacy, Norton Children’s Hospital, Louisville, Kentucky
| | - Navjyot K. Vidwan
- Norton Children’s and University of Louisville School of Medicine, Department of Pediatrics, Louisville, Kentucky
| | - Michelle D. Stevenson
- Norton Children’s and University of Louisville School of Medicine, Department of Pediatrics, Louisville, Kentucky
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville School for Public Health and Information Sciences, Louisville, Kentucky
| | - Michael J. Smith
- Department of Pediatrics and Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
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Abstract
The coronavirus disease 2019 pandemic has vastly disrupted the lives of youth. Stressors related to the pandemic and related lockdown measures have increased the prevalence of adolescent depression, suicidal ideation, and suicide attempts, with their mental and psychosocial development making them highly vulnerable to isolating restrictions. Research has demonstrated increased loneliness and decreased social support among adolescents during the pandemic. Increased social media usage has further affected depression among adolescents. Pandemic-related stressors such as fear of illness or life changes have negatively affected adolescent mental well-being. Health care use during the pandemic has involved disruption in primary care suicide screening, patterns of suicide-related presentations in emergency departments, and access to mental health services. Health care providers can support adolescent mental health through consistent screening, effectively coordinating referral for mental health evaluation, and providing family guidance on resiliency, pandemic-related mental health risks, and suicide prevention. [Pediatr Ann. 2022;51(4):e144-e149.].
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Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: a retrospective cohort study. BMC Health Serv Res 2022; 22:328. [PMID: 35277169 PMCID: PMC8916698 DOI: 10.1186/s12913-022-07719-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Adult well visits declined during COVID-19, but literature is inconsistent in regard to whether childhood well visits declined. We determined if the COVID-19 pandemic was associated with a change in well visits among infants, children, adolescents and adults before, compared to during the COVID-19 pandemic, including through the emergence of the Delta variant. Methods De-identified electronic health care data came from a multi-state Midwest health care system. Eligible patients (n = 798,571) had ≥ 1 well visit between 7/1/2018 and 6/30/2021. Trends in well visits per month for children (< 1, 1–4, 5–11, 12–17 years) and adults (18–39, 40–64, ≥ 65 years) over 3-years were assessed using Joinpoint regression models and monthly percent change (MPC). Results Well visits remained stable for infants (< 1 year of age) (MPC = -0.1; 95% CI = -0.3, 0.1). For children 1–4 years and all adults, visits were stable prior to 2020, decreased from 1/2020 to 4/2020 (MPC range -20 to -40), increased from 4/2020–7/2020 (MPC range 30 to 72), and remained stable after 7/2020. Children 5–17 had seasonal variation in visits where low points occurred in Jan/Feb 2019 and high points in Aug 2019 (start of school year); however, the low point in 2020 occurred in April 2020 and the seasonal variation normalized after this. Conclusions In a large Mid-western health care system, infant well visits did not decline at the onset (3/1/2020) of the COVID-19 pandemic. Although well visits for all other ages decreased to a low point in 4/2020, a rapid return to pre-pandemic utilization rates occurred by 7/2020. The brief decrease in preventive care may have had little impact on health. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07719-7.
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Cahan EM, Maturi J, Bailey P, Fernandes S, Addala A, Kibrom S, Krissberg JR, Smith SM, Shah S, Wang E, Saynina O, Wise PH, Chamberlain LJ. The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization. Acad Pediatr 2022; 22:1375-1383. [PMID: 35318159 PMCID: PMC8933868 DOI: 10.1016/j.acap.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic. METHODS Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March-June 2019 and March-June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses. RESULTS Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (P < .0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments. CONCLUSIONS Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.
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Affiliation(s)
- Eli M. Cahan
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,New York University School of Medicine (EM Cahan), New York, NY,Address correspondence to Eli M. Cahan, MS, Department of Pediatrics, Stanford School of Medicine, 770 Welch Road, #100, Stanford, CA 94305
| | - Jay Maturi
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paige Bailey
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Susan Fernandes
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Medicine (S Fernandes), Stanford School of Medicine, Stanford, Calif
| | - Ananta Addala
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sara Kibrom
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Jill R. Krissberg
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Stephanie M. Smith
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sejal Shah
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Ewen Wang
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Emergency Medicine (E Wang), Stanford School of Medicine, Stanford, Calif
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paul H. Wise
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Lisa J. Chamberlain
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
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David P, Fracci S, Wojtowicz J, McCune E, Sullivan K, Sigman G, O'Keefe J, Qureshi NK. Ethnicity, Social Determinants of Health, and Pediatric Primary Care During the COVID-19 Pandemic. J Prim Care Community Health 2022; 13:21501319221112248. [PMID: 35822762 PMCID: PMC9284195 DOI: 10.1177/21501319221112248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study assessed the relationship between ethnicity, social determinants of
health (SDH), and measures of health outcomes for children during the COVID-19
pandemic. This retrospective study reviewed electronic medical records of 1234
in-person well child visits (WCVs for age <18 years) at a single academic
primary care clinic in a Chicago suburb for the results of SDH screening in the
domains of food, financial, and transportation insecurity. The association
between ethnicity, unmet SDH domains, routine medical care delay, vaccine
delays, and utilization of acute and emergency department (ED) visits were
evaluated. Patients with unmet SDH were more likely to be non-White
(P < .001), ≥3 years of age
(P < .001) and have Medicaid coverage
(P < .001). Unmet social needs were also associated with
more acute visits (P < .001), ED visits
(P < .001), and WCV delays (P < .001).
The results suggest that the COVID-19 pandemic has disproportionately affected
patients with unmet SDH in obtaining routine pediatric well child care.
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Affiliation(s)
- Pyone David
- Loyola University Medical Center, Maywood, IL, USA
| | | | | | - Erin McCune
- Stritch School of Medicine, Maywood, IL, USA
| | | | - Garry Sigman
- Loyola University Medical Center, Maywood, IL, USA
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35
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Vogel M, Geserick M, Gausche R, Beger C, Poulain T, Meigen C, Körner A, Keller E, Kiess W, Pfäffle R. Age- and weight group-specific weight gain patterns in children and adolescents during the 15 years before and during the COVID-19 pandemic. Int J Obes (Lond) 2022; 46:144-152. [PMID: 34556774 PMCID: PMC8458556 DOI: 10.1038/s41366-021-00968-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES There is a concern that measures aiming to limit a further spread of COVID-19, e.g., school closures and social distancing, cause an aggravation of the childhood obesity epidemic. Therefore, we compared BMI trends during the 15 years before and during the COVID-19 pandemic. SUBJECTS/METHODS To assess the change in weight dynamics during the first months of COVID-19, we compared the trends of 3-month change in BMI-SDS (ΔBMI-SDS) and the proportions of children showing a high positive (HPC) or high negative (HNC) weight change between 2005 and 2019 and the respective changes from 2019 (pre-pandemic) to 2020 (after the onset of anti-pandemic measures) in more than 150,000 children (9689 during the pandemic period). The period of 3 months corresponds approximately to the first lockdown period in Germany. RESULTS During the COVID-19 pandemic, we found a substantial weight gain across all weight and age groups, reflected by an increase in the 3-month change in BMI-SDS (β = 0.05, p < 0.001), an increase in the proportion of children showing HPC (OR = 1.4, p < 0.001), and a decrease in the proportion of children showing HNC (OR = 0.7, p < 0.001). Besides, we found the same trends since 2005 on a low but stable level with a yearly increase of ΔBMI-SDS by β = 0.001 (p < 0.001), the odds of HPC increased by ORhigh_pos = 1.01 (p < 0.001), and the odds of HNC decreased by ORhigh_neg = 0.99 (p < 0.001). These rather small effects accumulated to β = 0.02, ORhigh_pos = 1.14, and ORhigh_pos = 0.85 over the whole period 2005-2019. Alarmingly, both the long-term and the short-term effects were most pronounced in the obese subgroup. CONCLUSIONS There are positive dynamics in different measures of weight change, indicating a positive trend in weight gain patterns, especially within the group of children with obesity. These dynamics are likely to be escalated by COVID-19-related measures. Thus, they may lead to a significant further aggravation of the childhood obesity pandemic.
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Affiliation(s)
- Mandy Vogel
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany.
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany.
| | - Mandy Geserick
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Ruth Gausche
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Christoph Beger
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Tanja Poulain
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Christof Meigen
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Antje Körner
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Eberhard Keller
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Roland Pfäffle
- Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
- Center for Pediatric Research, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany
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