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Improving Pediatric Residents' Screening for Access to Firearms in High-Risk Patients Presenting to the Emergency Department. Acad Pediatr 2021; 21:710-715. [PMID: 33429102 DOI: 10.1016/j.acap.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/19/2020] [Accepted: 01/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND/OBJECTIVE Access to a firearm is a significant risk for completed suicide or homicide. We sought to increase the rate of screening for access to firearms in patients who presented to the emergency department with suicidal or homicidal ideation or suicide attempt through the use of quality improvement methodology. METHODS Patient records were eligible for inclusion if the child was under the age of 19 and presented to the emergency room of our tertiary medical center with a diagnosis of suicidal ideation, homicidal ideation, or suicide attempt. Records were manually reviewed for demographic information and documentation of screening for access to firearms. A baseline survey of the pediatric residents was completed to identify perceived barriers to screening for access to firearms. Subsequently, three "Plan, Do, Study, Act" (PDSA) cycles consisting of a noon conference, a dedicated grand rounds, and an electronic health record template were completed. RESULTS During the baseline and study period, 501 patients met inclusion criteria. Forty-one of sixty-six (62.1%) residents completed a baseline survey and identified barriers to screening. There was no significant increase in screening following the first or second PDSA cycles. Following the third PDSA cycle, screening rates increased from 4% to 34%. CONCLUSIONS Quality improvement methodology can be used to increase the rates of screening for access to firearms in high-risk patients. Further work is necessary to identify additional strategies to further increase screening rates.
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Gaw CE, Berthet E, Curry AE, Zonfrillo MR, Arbogast KB, Corwin DJ. Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings. Clin Pediatr (Phila) 2020; 59:1150-1160. [PMID: 32668957 PMCID: PMC10066848 DOI: 10.1177/0009922820941237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.
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Affiliation(s)
- Christopher E Gaw
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA
| | - Ellora Berthet
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA
| | - Allison E Curry
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kristy B Arbogast
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Corwin
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Huseth-Zosel AL, Sanders G, O'Connor M. Predictors of health care provider anticipatory guidance provision for older drivers. TRAFFIC INJURY PREVENTION 2016; 17:815-820. [PMID: 26940031 DOI: 10.1080/15389588.2016.1157866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 02/20/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this study was to determine the frequency of health care provider (HCP) driving safety/cessation-related anticipatory guidance provision and predictors of driving safety-related anticipatory guidance provision by HCPs. METHODS HCPs in several central/upper Midwest states were surveyed about frequency of anticipatory guidance provision (n = 265). RESULTS More than half of HCPs stated that they frequently or always provide driving safety/cessation-related anticipatory guidance to patients aged 85 or older, 38.7% provided this guidance to patients aged 75 to 84, and 13.7% to patients aged 65 to 74. Predictors of driving safety/cessation-related anticipatory guidance provision differed by patient age. For patients aged 65-74, HCP personal experience with a motor vehicle crash (either the HCP themselves or a friend/family member) was significant in predicting anticipatory guidance provision. However, for patients aged 75 and older, significant predictors included HCP rural practice, HCP age, and percentage of HCP patients who were older adults. CONCLUSION HCP counseling provision related to driving issues differs by patient age and several HCP characteristics, including HCP rurality, age, and personal experience with motor vehicle crashes. Because aging results in physical and mental changes that affect driving and can be identified by HCPs, HCPs are in a position to counsel patients on the potential impacts of aging on the act of driving. Future research should examine the reasons for the differences in anticipatory guidance provision found in this study.
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Affiliation(s)
- Andrea L Huseth-Zosel
- a Department of Public Health , North Dakota State University , Fargo , North Dakota
| | - Gregory Sanders
- b College of Human Development and Education , North Dakota State University , Fargo , North Dakota
| | - Melissa O'Connor
- c Department of Human Development and Family Science , North Dakota State University , Fargo , North Dakota
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Roszko PJD, Ameli J, Carter PM, Cunningham RM, Ranney ML. Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury. Epidemiol Rev 2016; 38:87-110. [PMID: 26905894 PMCID: PMC7297261 DOI: 10.1093/epirev/mxv005] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/14/2022] Open
Abstract
Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.
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Affiliation(s)
| | | | | | | | - Megan L. Ranney
- Correspondence to Dr. Megan L. Ranney, Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School of Brown University, 593 Eddy Street, Claverick 2, Providence, RI 02903 (e-mail:)
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Elboray S, Elawdy MY, Dewedar S, Elezz NA, El-Setouhy M, Smith GS, Hirshon JM. Knowledge, attitudes, and practices of family physicians and nurses regarding unintentional injuries among children under 15 years in Cairo, Egypt. Int J Inj Contr Saf Promot 2015; 24:24-31. [PMID: 26176681 DOI: 10.1080/17457300.2015.1056808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Unintentional injuries are a leading cause of death among children, especially in developing countries. Lack of reliable data regarding primary health care professionals' role in childhood unintentional injury prevention hinders the development of effective prevention strategies. A survey of 99 family physicians and nurses from 10 family health centres sought to develop insight into their knowledge, attitudes, and practices regarding unintentional injury prevention for children <15 in Cairo, Egypt. Approximately, 60% were familiar with the terms unintentional injuries and injury prevention. Falls and road traffic crashes were identified as primary causes of childhood injuries by 54.5%. While >90% agreed injury prevention counselling (IPC) could be effective, only 50.5% provided IPC. Lack of time and educational materials were the leading barriers to provision of IPC (91.9% and 85.9%, respectively), while thinking counselling is not part of their clinical duties was the least perceived barrier (9.1%). There is a large disconnect between providers' knowledge, attitudes and practices regarding IPC, more training and provision of counselling tools are essential for improving IPC by Egyptian medical providers.
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Affiliation(s)
- Shereen Elboray
- a Community, Environmental and Occupational Medicine Department , Ain Shams University , Cairo , Egypt
| | - Mohamed Yehia Elawdy
- a Community, Environmental and Occupational Medicine Department , Ain Shams University , Cairo , Egypt
| | - Sahar Dewedar
- a Community, Environmental and Occupational Medicine Department , Ain Shams University , Cairo , Egypt
| | - Nahla Abo Elezz
- a Community, Environmental and Occupational Medicine Department , Ain Shams University , Cairo , Egypt
| | - Maged El-Setouhy
- a Community, Environmental and Occupational Medicine Department , Ain Shams University , Cairo , Egypt.,d The Substance Abuse Research Center (SARC) , Jazan University , Jazan , Kingdom of Saudi Arabia
| | - Gordon S Smith
- b Charles "McC." Mathias, Jr., National Study Center for Trauma and Emergency Medical Systems; Shock, Trauma, and Anesthesiology (Research Centre (STAR) ; University of Maryland School of Medicine , Baltimore , MD , USA
| | - Jon Mark Hirshon
- b Charles "McC." Mathias, Jr., National Study Center for Trauma and Emergency Medical Systems; Shock, Trauma, and Anesthesiology (Research Centre (STAR) ; University of Maryland School of Medicine , Baltimore , MD , USA.,c Department of Emergency Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
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Crnica V, Mujkić A, Young T, Miškulin M, Peek-Asa C. Healthcare providers' knowledge, attitudes and counselling on injury prevention for preschool children in Croatia. Matern Child Health J 2013; 17:1718-24. [PMID: 23086152 PMCID: PMC3664128 DOI: 10.1007/s10995-012-1165-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider's knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.
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Affiliation(s)
- Vanja Crnica
- Department of Emergency Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Aida Mujkić
- School of Medicine, “Andrija Štampar” School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Tracy Young
- College of Public Health, University of Iowa, 105 River Street, S143 CPHB, Iowa City, IA 52242, USA
| | - Maja Miškulin
- School of Medicine, University of Osijek, Osijek, Croatia
| | - Corinne Peek-Asa
- College of Public Health, University of Iowa, 105 River Street, S143 CPHB, Iowa City, IA 52242, USA
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Pediatricians’ Knowledge, Perceptions, and Behaviors Regarding Car Booster Seats. J Community Health 2010; 36:166-73. [DOI: 10.1007/s10900-010-9294-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Coker TR, Chung PJ, Cowgill BO, Chen L, Rodriguez MA. Low-income parents' views on the redesign of well-child care. Pediatrics 2009; 124:194-204. [PMID: 19564300 PMCID: PMC4587564 DOI: 10.1542/peds.2008-2608] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the perspectives of low-income parents on redesigning well-child care (WCC) for children aged 0 to 3 years, focusing on possible changes in 3 major domains: providers, locations, and formats. METHODS Eight focus groups (4 English and 4 Spanish) were conducted with 56 parents of children aged 6 months to 5 years, recruited through a federally qualified health center. Discussions were recorded, transcribed, and analyzed by using the constant comparative method of qualitative analysis. RESULTS Parents were mostly mothers (91%), nonwhite (64% Latino, 16% black), and <30 years of age (66%) and had an annual household income of <$35000 (96%). Parents reported substantial problems with WCC, focusing largely on limited provider access (especially with respect to scheduling and transportation) and inadequate behavioral/developmental services. Most parents endorsed nonphysician providers and alternative locations and formats as desirable adjuncts to usual physician-provided, clinic-based WCC. Nonphysician providers were viewed as potentially more expert in behavioral/developmental issues than physicians and more attentive to parent-provider relationships. Some alternative locations for care (especially home and day care visits) were viewed as creating essential context for providers and dramatically improving family convenience. Alternative locations whose sole advantage was convenience (eg, retail-based clinics), however, were viewed more skeptically. Among alternative formats, group visits in particular were seen as empowering, turning parents into informal providers through mutual sharing of behavioral/developmental advice and experiences. CONCLUSIONS Low-income parents of young children identified major inadequacies in their WCC experiences. To address these problems, they endorsed a number of innovative reforms that merit additional investigation for feasibility and effectiveness.
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Affiliation(s)
- Tumaini R. Coker
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, California,Rand, Santa Monica, California
| | - Paul J. Chung
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, California,Rand, Santa Monica, California
| | - Burton O. Cowgill
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, California,Department of Health Services, School of Public Health, University of California, Los Angeles, California
| | - Leian Chen
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, California
| | - Michael A. Rodriguez
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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Perry CD, Kenney GM. Differences in pediatric preventive care counseling by provider type. ACTA ACUST UNITED AC 2007; 7:390-5. [PMID: 17870648 DOI: 10.1016/j.ambp.2007.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 05/16/2007] [Accepted: 06/04/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Many children in the United States do not receive advice about health behaviors and injury prevention during routine preventive care visits. We investigated the role of provider type in the probability of receiving advice. METHODS We analyzed children aged 3 to 17 in the Medical Expenditure Panel Data 2002 to 2003 surveys who had only 1 preventive clinic or office visit in the past year. We examined whether provider type affects whether the child is advised about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a helmet when riding a bicycle. RESULTS Pediatricians were more likely to advise about healthy eating (63.6% vs 46.8% for other physicians and 41.1% for nonphysicians; P < .01). They were also more likely than nonphysicians to advise about exercise (40.1% vs 22.2%), the harmful effects of parental smoking (42.4% vs 21.4%), proper safety restraints in a car (39.9% vs 20.5%), and use of a bicycle helmet (45.7% vs 20.9%). Regardless of provider type, rates of advice were low. CONCLUSION Many pediatric providers, particularly those not trained as pediatricians, are missing opportunities to advise about health behaviors and injury prevention.
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Simon TD, Phibbs S, Dickinson LM, Kempe A, Steiner JF, Davidson AJ, Hambidge SJ. Less anticipatory guidance is associated with more subsequent injury visits among infants. ACTA ACUST UNITED AC 2006; 6:318-25. [PMID: 17116604 DOI: 10.1016/j.ambp.2006.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 08/16/2006] [Accepted: 08/24/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe clinician delivery of injury prevention anticipatory guidance and injury visits in a birth cohort, and to describe the association of injury prevention anticipatory guidance with subsequent injury visits. METHODS We performed a prospective cohort study of 2610 infants born from July 1, 1998 to June 30, 1999, at an urban safety-net hospital and seen subsequently for well child care (WCC, visits = 10558) and/or injury by 16 months of age. Injury guidance was defined as the proportion of recommended injury prevention anticipatory guidance items delivered to those expected, given the WCC visits the child attended. The outcome was a first injury visit to a clinic, emergency department, or hospital. RESULTS The injury prevention items most discussed were car seats (84%-95% of all WCC visits) and rolling over at the 2-month WCC visit (80%). Other items were addressed at 36%-69% of visits. A total of 1931 (74%) of children received > or = 50% expected injury guidance. A total of 277 children (11%) had an injury visit, primarily for minor injuries. In unadjusted analysis, children receiving < 25% expected injury guidance were more likely to have a subsequent injury visit (unadjusted odds ratio 6.2; 95% confidence interval [95% CI] 3.2-9.7). In adjusted analysis, children who received < 25% and 25%-49% expected injury guidance were more likely to have a subsequent injury visits (adjusted odds ratio [AOR] 6.6; 95% CI 3.8-11.2; and AOR 2.9, 95% CI 2.0-4.3, respectively). CONCLUSIONS Disadvantaged children whose families received less injury guidance than other children in their cohort were more likely to have a subsequent injury visit. Further studies are needed to determine whether increased injury prevention counseling reduces injury visits.
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Affiliation(s)
- Tamara D Simon
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
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Woods AJ. The role of health professionals in childhood injury prevention: a systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2006; 64:35-42. [PMID: 17011153 DOI: 10.1016/j.pec.2005.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 12/08/2005] [Accepted: 12/15/2005] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To systematically review the literature to explore health professionals' knowledge, attitudes and practices and their role in childhood injury prevention. METHODS MEDLINE (1966-September Week 1 2005), EMBASE (1980-2005 Week 37), CINAHL (1982-September Week 1 2005), BRITISH NURSING INDEX (1985-September 2005) and PsychINFO (1967-August Week 5 2005) were searched using relevant 'medical subheadings' (for MEDLINE, EMBASE and CINAHL) and 'thesaurus terms' (for PsychINFO). RESULTS Twenty-five primary studies were retrieved, the majority of which were surveys. Health professionals' knowledge was reported to be variable, although generally they have a positive attitude towards childhood injury prevention. Even with adequate knowledge and positive attitudes there appear to be barriers in prevention practice. CONCLUSION There continues to be a need for high quality research specifically looking at how to change practice. Nevertheless, although training may be effective at increasing health professionals' knowledge and changing their attitudes, legislative and engineering measures may ultimately more effective at reducing the burden of childhood injuries. PRACTICE IMPLICATIONS Barriers to practice for health professionals need to be taken into account. No matter how knowledgeable nor how positive their attitudes to childhood injury prevention if barriers to practice are not addressed we will move no closer to reducing the burden of injuries in childhood. Those health professionals who are positive about their role may be best suited to continue to raise the issue campaigning for legislative and engineering changes which can reduce childhood injuries.
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Affiliation(s)
- Amanda J Woods
- School of Nursing, University of Nottingham, Room B62, Medical School, Queens Medical Centre, NG7 2UH Nottingham, UK.
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Chung PJ, Lee TC, Morrison JL, Schuster MA. Preventive care for children in the United States: quality and barriers. Annu Rev Public Health 2006; 27:491-515. [PMID: 16533127 DOI: 10.1146/annurev.publhealth.27.021405.102155] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our objective was to examine the academic literature covering quality of childhood preventive care in the United States and to identify barriers that contribute to poor or disparate quality. We systematically reviewed articles related to childhood preventive care published from 1994 through 2003, focusing on 58 large observational studies and interventions addressing well-child visit frequency, developmental and psychosocial surveillance, disease screening, and anticipatory guidance. Although many children attend recommended well-child visits and receive comprehensive preventive care at those visits, many do not attend such visits. Estimates of children who attend all recommended visits range widely (from 37%-81%). In most studies, less than half is the proportion of children who receive developmental or psychosocial surveillance, adolescents who are asked about various health risks, children at risk for lead exposure who are screened, adolescents at risk for Chlamydia who are tested, or children and adolescents who receive anticipatory guidance on various topics. Major barriers include lack of insurance, lack of continuity with a clinician or place of care, lack of privacy for adolescents, lack of clinician awareness or skill, racial/ethnic barriers, language-related barriers, clinician and patient gender-related barriers, and lack of time. In summary, childhood preventive care quality is mixed, with large disparities among populations. Recent research has identified barriers that might be overcome through practice and policy interventions.
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Affiliation(s)
- Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA.
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Abstract
Unintentional and intentional injuries cause a great deal of human suffering throughout the world. They exact a huge toll on societies in terms of mortality, years of potential life lost, disability, and health care costs. The good news is that great strides have been made in understanding the causes of injuries and how to prevent them. Using seat belts and car seats, installing air bags in cars, replacing dangerous playground equipment, enforcing drinking and driving laws are but a few examples of modifying behavior, products, and environments to reduce injury risk. This paper provides an overview of the science of injury control and selected examples of how professionals in the field of patient education and counseling can contribute to enhancing the safety of the public.
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Affiliation(s)
- Andrea Carlson Gielen
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA.
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Bethell C, Peck C, Schor E. Assessing health system provision of well-child care: The Promoting Healthy Development Survey. Pediatrics 2001; 107:1084-94. [PMID: 11331691 DOI: 10.1542/peds.107.5.1084] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preventive care guidelines for children include parent education and counseling, developmental assessment, and screening for psychosocial and safety risks. Health care providers are in a unique position to identify and follow up on potential problems and to influence parenting knowledge, attitudes, and behavior to ensure the healthy development of young children. Few quality measures are available to assess health care system performance in this important area. OBJECTIVE To develop a feasible, valid, and reliable methodology for evaluating health care system performance in providing family-centered anticipatory guidance and child and family assessment services on behalf of children from birth through 48 months old. Methods. The Promoting Healthy Development Survey (PHDS) was developed and tested with a diverse group of families in 3 managed care organizations (n = 1478). A standard mail administration protocol was used, including an informed consent with a waiver of documentation, 2 mailings, a postcard reminder, and telephone reminders. The 36-item parent survey assesses whether health care providers(1) talk with parents about topics recommended in Bright Futures and the American Academy of Pediatrics Guidelines for Health Supervision,(2) provide follow-up for children who may be at risk for developmental problems,(3) and address psychosocial well-being and safety within the family. The PHDS also assesses the degree to which parent's interactions with providers are family-centered, helpful, and facilitate parental confidence. Psychometric, bivariate, and multivariate analyses were conducted to assess the reliability, validity, and patterns of variation in the seven quality measures derived from the PHDS. RESULTS Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity (mean factor loading: 0.69) and internal consistency (mean Cronbach's alpha: 0.80). Parents reporting positive parenting behaviors had significantly higher scores on the anticipatory guidance quality measure compared with parents not reporting positive behaviors. Parents who reported that their questions on specific anticipatory guidance topics were answered were more likely to report higher confidence in related parenting activities (odds ratio [OR]: 5.9, 95% confidence interval [CI]: 3.4-10.2; OR: 8.3, 95% CI: 5-13.8)and were less likely to report concerns about their child's development in related areas compared with parents who reported they wished they had talked more with their child's doctor about these topics (OR: 0.46, 95% CI: 0.29-0.72; OR: 0.58, 95% CI: 0.37-0.89). The 7 PHDS quality measure scores for health plans ranged from 17 to 67 (on a 0-100 scale; where 100 is the best score possible) and varied significantly across health plans. Performance was highest for provision of anticipatory guidance information from health plans and lowest for family psychosocial assessment. Scores for families with Medicaid coverage were significantly higher on 2 of the PHDS measures and significantly lower for 3 measures compared with scores for families with commercial insurance. Age of child, whether child is first- born, parental marital status, education, income, and race were significant predictors for 1 or more of the PHDS quality measures (average R(2) = 0.05). CONCLUSIONS The PHDS provides a comprehensive, psychometrically valid and reliable assessment of how well health plans and the health care providers working within these plans promote the healthy development of young children. The PHDS seems to differentiate among health care plans and among the different aspects of preventive care provided within a health plan. For the population studied here, there is significant room for improvement in ensuring families and children receive appropriate and family-centered care to promote the healthy development of children between 3 and 48 months old. Because the PHDS is conceptually based on national recommendations for child health supervision, improved performance on the PHDS would indicate greater adherence to these national recommendations and progress toward the achievement of Healthy People 2010 goals. The generalizability of the findings presented in this report are being examined using data collected in 5 statewide Medicaid samples (N = 11 696) and data from the National Survey of Early Childhood Health, which has incorporated most of the PHDS items.
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Affiliation(s)
- C Bethell
- FACCT-The, Portland, Oregon 97204, USA.
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