Confidence In Healthcare Providers Research Articles

Child Sexual Exploitation: A Survey of Knowledge and Confidence of Healthcare Providers in Saskatchewan, Canada

Key Practitioner Messages Many human trafficking victims access healthcare, but most are not identified. Healthcare providers' overall knowledge in identifying commercially sexually exploited children was strong. Healthcare providers lack confidence in identifying and managing sexually exploited children.

Patient satisfaction with healthcare services: Bangladesh perspective

<p>Patient satisfaction is a useful measure for providing a quality benchmark for healthcare services. Concern about the quality of healthcare services in Bangladesh has led to a loss of confidence in healthcare providers, low use of public health facilities and increased outflows of patients from Bangladesh to hospitals abroad. The key obstacles to access to health services are insufficient infrastructure and poor quality of existing facilities, lack of medical equipment, scarcity of doctors due to high patient load, long distance to the facilities and long waiting times until facilities have been reached, very short appointment hours, lack of empathy of health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns-all of these service failures are reported frequently in the print media. Such failures can play a powerful role in shaping patients’ negative attitudes and dissatisfaction with healthcare service providers and healthcare itself.</p>

Knowledge and attitudes of permanent chemotherapy-induced alopecia among health care providers.

142 Background: Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties. Methods: An electronic survey was distributed to HCPs (resident physicians, attending physicians, and nurse practitioners) in the departments of dermatology, oncology, and general internal medicine (GIM) within one Midwestern hospital system. Results: Of the 62 participants (response rate: 13%), there were 19 from dermatology, 20 from oncology, and 23 from GIM. Responses were analyzed with descriptive statistics, and chi-square and ANOVA tests. There was a significant difference in the number of subjects that had heard of PCIA prior to starting the survey (Derm: 79%, Onc: 30%, GIM: 22%, p<0.05). A larger percentage of dermatology and oncology HCPs knew the correct definition of the condition (alopecia persisting >6 months) than GIM (42% and 45% vs. 17%) and significantly more had encountered patients with the condition (47% and 45% vs. 17%). More providers in dermatology and GIM knew how to diagnose PCIA compared to oncology (84% and 83% vs. 70%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA. Most providers across the three specialties believed that patients would accept PCIA treatment that was topical, oral, injectable, and required frequent administration or monitoring, but not treatment that was expensive or high risk. A majority of HCPs surveyed (94%) agreed that the diagnosis of PCIA is important. However, there was a significant difference in the confidence of HCPs in diagnosing and managing PCIA. A minority of dermatology providers (2/19) specified that they would refer to an alopecia or oncodermatology specialist, while the majority of oncology and GIM providers would refer to dermatology. Conclusions: The results of this survey identify knowledge gaps about PCIA amongst health care providers. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA as part of survivorship care.

179-LB: Confidence of Healthcare Providers to Prescribe Antihyperglycemic Agents with Cardiovascular Benefit

Several antihyperglycemic agents have recently been demonstrated to provide additional glucose lowering and CVD risk reduction benefits in people living with type 2 diabetes (T2D). However, little is known about confidence of healthcare providers (HCPs) to utilize these agents in clinical practice. A national sample of 905 physicians and nurse practitioners (NPs) from primary care, cardiology, and endocrinology completed an online survey and were asked: “How confident are you that you can effectively prescribe and manage type 2 diabetes with the following medications?” Answer options included a 5-point Likert-type scale ranging from “Not at All Confident” to “Extremely Confident.” Results were weighted for representation by U.S. specialty-specific distributions of gender, race/ethnicity, years in practice, region, and employment. When compared to other HCPs, endocrinologists reported higher confidence in prescribing antihyperglycemic agents for people living with T2D (Table 1). Large proportions of HCPs in cardiology and primary care expressed low confidence prescribing many antihyperglycemic agents, particularly novel agents with CVD risk reduction benefit. Guideline-based professional education efforts may improve confidence of HCPs to utilize antihyperglycemic agents to optimize glycemic control and cardiovascular risk reduction when treating people living with T2D. Disclosure C.M. Shay: None. K.J. Robb: None. M.T. Martin: None. M.P. Petersen: None. E. Sanchez: None.

Knowledge and attitudes of permanent chemotherapy-induced alopecia among health care providers.

e23074 Background: Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties. Methods: An electronic survey was distributed to HCPs (resident physicians, attending physicians, and nurse practitioners) in the departments of dermatology, oncology, and general internal medicine (GIM) within one Midwestern hospital system. Results: Of the 60 participants (response rate: 12%), there were 19 from dermatology, 18 from oncology, and 23 from GIM. Responses were analyzed with descriptive statistics and chi-square tests. There was a significant difference in the number of subjects that had heard of PCIA prior to starting the survey (Derm: 79%, Onc: 28%, GIM: 26%, p < 0.05). A larger percentage of Dermatology and Oncology HCPs knew the correct definition of the condition (alopecia persisting > 6 months) than GIM (42% and 44% vs. 17%) and had encountered patients with the condition (47% and 44% vs. 22%). More providers in Dermatology and GIM knew how to diagnose PCIA compared to Oncology (84% and 83% vs. 67%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA. HCPs across the three specialties believed that patients would accept PCIA treatment that was topical, oral, injectable, and required frequent administration or monitoring, but not treatment that was expensive or high risk. A majority of HCPs surveyed (93%) agreed that the diagnosis of PCIA is important. However, there was a significant difference in the confidence of HCPs in diagnosing and managing PCIA. A minority of dermatology HCPs (2/19) specified that they would refer to an alopecia or oncodermatology specialist, while a majority of oncology and GIM HCPs would refer to dermatology. Conclusions: The results of this survey identify significant knowledge gaps about PCIA amongst HCPs. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA in the survivorship care of cancer patients.

Perceptual and Contextual Sources of Athletic Training Confidence: The Transition to Professional Entry Level Master’s Programs

The shift of athletic training education from undergraduate degrees to professional master’s degrees and the prominence of computer-based credentialing may impact the hands-on experiences beneficial for developing confidence in athletic training competency domains. Health care provider confidence is critical for clinical skill development, performance and enhancing patient care. Purpose: To examine domain specific efficacy, its sources, learning contexts (i.e., classroom, laboratory, clinical settings) and clinical characteristics by program types. Method: Descriptive, cross-sectional design where 178 Athletic Trainers (AT; age 24.25 + 3.76, n = 72 male, n = 106 female) participated in the study (Master’s Program (MP) = 38; Undergraduate Program (UG) = 140). A questionnaire examining athletic training confidence was administered throughout multiple universities with accredited athletic training programs. Background characteristics, certification exam attempts, and programmatic characteristics were also ascertained. Results: Clinical settings were similar in both program types and there were few differences in domain-specific efficacy. Imaginal experiences, verbal persuasion and emotional states sources of efficacy differentiated master’s from undergraduate students. Conclusions: Sources of efficacy (e.g. vicarious experiences) occur naturally in athletic training educational settings; however, these sources need to be utilized. Educators should be informed about efficacy sources and devise strategies targeting each source for implementation across evolving learning contexts.

Impact of Allergist-Facilitated Education on Public Healthcare Provider Confidence in Counseling about Early Peanut Introduction

Impact of Allergist-Facilitated Education on Public Healthcare Provider Confidence in Counseling about Early Peanut Introduction

Breast is BEST: Increasing Health-Care Provider Knowledge and Confidence.

Breastfeeding is recognized as the ideal source of nutrition for infants. However, several barriers to successful breastfeeding have been identified. Possibly one of the most significant barriers is the lack of health-care provider-related support and promotion of breastfeeding. The purpose of this study was to recognize the barriers to breastfeeding, ways health-care providers can assist patients in overcoming those barriers, and increase breastfeeding knowledge and confidence of health-care providers to better promote and manage breastfeeding clients. Study participants included: physicians, advanced practice nurses, and nurses. The American Academy of Pediatrics (AAP) Breastfeeding Residency Curriculum was utilized in the study, and participants were also educated on and encouraged to apply ACOG's Perinatal Practice Guidelines. There was an overall increase of 19.2% in health-care provider knowledge scores and a 23% increase in confidence scores. There was also a 15.6% increase in documentation of early prenatal breastfeeding counseling. The results and significance of the study provide evidence that once health-care providers are knowledgeable and confident in promoting breastfeeding, clients will be better equipped to successfully breastfeed. Breastfeeding success rates among mothers can be greatly improved through active support from health-care providers.

Controlling pertussis: how can we do it? A focus on immunization

ABSTRACTIntroduction: Pertussis is a highly contagious disease of the respiratory tract which is caused by the bacterium Bordetella pertussis and is most severe in those <1 year of age. A vaccine against pertussis, introduced in the 1950’s, led to a significant decrease in incidence of the disease, but recent increases in outbreaks have been attributed to insufficient vaccine uptake, suboptimal protection conferred by vaccines, and waning immunity after immunization.Areas covered: In this review we discuss the major challenges for controlling pertussis, and what we believe the best strategies are to overcome these challenges, focusing on immunization against pertussis in Europe, but with recommendations that are relevant worldwide.Expert commentary: To provide maximum vaccine coverage we propose a schedule that incorporates immunization of infants, preschoolers, adolescents, adults, and pregnant women. Uptake of vaccines may also vary between populations due to a variety of causes, including hesitancy to vaccinate, so any national strategy to control pertussis should also include sustaining public and healthcare provider confidence in vaccination. Addressing and improving regional variations in surveillance will also help better monitor annual incidence and outbreaks. Looking towards the future, the development of new pertussis vaccines with longer duration of protection would be advantageous.

Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi.

Background & Objective:Considering high burden of violence against healthcare workers in Pakistan APPNA Institute of Public Health developed a training to prevent reactive violence among healthcare providers. The purpose of this training was to equip healthcare providers with skills essential to control aggressive behaviors and prevent verbal and non-verbal violence in workplace settings. This study assesses the effectiveness of training in prevention, de-escalation and management of violence in healthcare settings.Methods:A quasi-experimental study was conducted in October, 2016 using mixed method concurrent embedded design. The study assessed effectiveness of de-escalation trainings among health care providers working in emergency and gynecology and obstetrics departments of two teaching hospitals in Karachi. Quantitative assessment was done through structured interviews and qualitative through Focus Group Discussions. Healthcare providers` confidence in coping with patient aggression was also measured using a standard validated tool”.Results:The overall self-perceived mean score of Confidence in Coping with Patient Aggression Instrument “(CCPAI)” scale was significantly higher in intervention group (Mean= 27.49, SD=3.53) as compared to control group (Mean= 23.92, SD=4.52) (p<0.001). No statistically significant difference was observed between intervention and control groups with regard to frequency of violence faced by HCPs post training and major perpetrators of violence..Conclusion:De-escalation of violence training was effective in improving confidence of healthcare providers in coping with patient aggression.

Educating Providers in Return-to-Play Suggested Guidelines Postconcussion.

As the awareness of concussions increases, it is imperative to be able to evaluate, diagnose, and treat concussed individuals properly to prevent further complications or death. The primary purpose of this study was to compare a provider's current awareness and comfort level as it relates to the return-to-play guidelines for concussions. A secondary aim was to evaluate current protocols that are in use and determine whether they coincide with the suggested guidelines. An educational intervention was implemented to assess the knowledge and confidence of health care providers. The study design was a quantitative, convenient sample, pretest/posttest questionnaire. The questionnaire was administered to participants who were nurse practitioners prior to an educational PowerPoint presentation. At 8 weeks, the posttest was administered. Approximately 19% of individuals were not aware of a graded return-to-play protocols. The findings suggest that the educational intervention increased their confidence levels in making a diagnosis of a concussion, in assessing danger signs, and in understanding when to refer to a specialist. Additional supporting evidence from this study indicates that the educational intervention allowed the participants to achieve a greater comfort level in finding appropriate resources for them and their patients.

Vaccine hesitancy and healthcare providers

While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others.The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English.A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported.In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents’ questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.

Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana: a methodological approach.

BackgroundNearly four decades after the Alma-Ata declaration of 1978 on the need for active client/community participation in healthcare, not much has been achieved in this regard particularly in resource constrained countries like Ghana, where over 70 % of communities in rural areas access basic healthcare from primary health facilities. Systematic Community Engagement (SCE) in healthcare quality assessment remains a grey area in many health systems in Africa, albeit the increasing importance in promoting universal access to quality basic healthcare services.Purpose/objectiveDesign and implement SCE interventions that involve existing community groups engaged in healthcare quality assessment in 32 intervention primary health facilities.MethodsThe SCE interventions form part of a four year randomized controlled trial (RCT) in the Greater Accra and Western regions of Ghana. Community groups (n = 52) were purposively recruited and engaged to assess non-technical components of healthcare quality, recommend quality improvement plans and reward best performing facilities. The interventions comprised of five cyclical implementation steps executed for nearly a year. Wilcoxon sign rank test was used to ascertain differences in group perceptions of service quality during the first and second assessments, and ordered logistic regression analysis performed to determine factors associated with groups’ perception of healthcare quality.ResultsHealthcare quality was perceived to be lowest in non-technical areas such as: information provision to clients, directional signs in clinics, drug availability, fairness in queuing, waiting times, and information provision on use of suggestion boxes and feedback on clients’ complaints. Overall, services in private health facilities were perceived to be better than public facilities (p < 0.05). Community groups dominated by artisans and elderly members (60+ years) had better perspectives on healthcare quality than youthful groups (Coef. =1.78; 95 % CI = [−0.16 3.72]) and other categories of community groups (Coef. = 0.98; 95 % CI = [−0.10 2.06]).ConclusionsNon-technical components of healthcare quality remain critical to clients and communities served by primary healthcare providers. The SCE concept is a potential innovative and complementary quality improvement strategy that could help enhance client experiences, trust and confidence in healthcare providers. SCE interventions are more cost effective, community-focused and could easily be scaled-up and sustained by local health authorities.

Trust, Satisfaction, and Confidence in Health Care Providers Among Student and Professional Dancers in France.

Patients who trust their physicians are more likely to communicate about medical problems, adhere to medical advice, and be satisfied with care. Dancers have demonstrated low utilization of physician services for both preventive care and dance injuries. The purpose of this cross-sectional study was to examine trust in physicians as a variable influencing dancers' health care-seeking behavior. The validated Trust in Physician Scale was administered to 45 professional and 34 student ballet/contemporary dancers in France (36.7% male, 63.3% female) to evaluate their trust in medical doctors (MDs) vs physical therapists (PTs). Dancers were also asked about satisfaction and confidence in medical treatment for dance injuries. Dancers indicated greater trust in PTs than MDs (70.61±10.57 vs 65.38±10.79, t=-3.499, p=0.001). Students exhibited significantly less trust in MDs than professional dancers (62.04±9.96 vs 67.65±10.42, t=-2.381, p=0.020). Trust scale scores for PTs did not differ between students and professionals (69.53±8.30 vs 71.68±12.09, t=-0.866, p=0.389). Students were less confident than professional dancers in their physician's ability to treat their most severe injury (6.7% of students vs 35.7% of professionals "very confident, " X2=9.402, p=0.052). Dancer patients exhibit lower trust in physicians compared to previously studied non-dancer populations. Our results suggest that reduced trust in physicians and factors related to professional status may influence dancers' health care-seeking behavior. Student dancers may comprise a unique subpopulation of dancers with distinctive health care needs.

E-Cigarette Use and Perceived Harm Among Women of Childbearing Age Who Reported Tobacco Use During the Past Year.

The prevalence of electronic cigarette use grows. Amid increased e-cigarette use nationwide, this paper attempts to identify underlying risk factors for the most vulnerable populations. The purpose of the study was to assess predictors of e-cigarette use among female current and former tobacco users of childbearing age-specifically to determine whether demographic factors, pregnancy status, conventional cigarette smoking, and perceived e-cigarette harm are associated with e-cigarette use. Reasons for using e-cigarettes were also measured. A cross-sectional, correlational design was used; 194 current and former female tobacco users, 18-45 years of age, from two university-affiliated prenatal clinics and one women's health clinic in Kentucky took part. Slightly more than half were pregnant. Age, race/ethnicity, education, pregnancy status, use history for cigarettes and e-cigarettes, and perception of health hazard from e-cigarettes were measured, and associations with e-cigarette use were made with Mann-Whitney U-tests or Spearman's rank correlations. Predictors of e-cigarette use were determined using proportional odds modeling. Most current e-cigarette users were also current cigarette smokers (88%). Nearly half of current and former e-cigarette users were pregnant. Most women perceived e-cigarettes as a minor (38%) or moderate (31%) health hazard. In the proportional odds model, younger women were at greater risk for e-cigarette use, whereas minority women and those who were pregnant were less likely to be e-cigarette users. Pregnant women were less likely to be more recent e-cigarette users, compared with nonpregnant women. However, nearly all current e-cigarette users were dual tobacco users, including pregnant women. It is both imperative and timely to determine the impact of e-cigarette use on maternal and infant health, thus improving healthcare provider confidence to discuss the health implications of e-cigarette use with their patients.

Adverse Effects of Tattoos and Piercing on Parent/Patient Confidence in Health Care Providers.

First impressions based on practitioner appearance often form the basis for preliminary assumptions regarding trust, confidence, and competence, especially in situations where patients or family members do not have an established relationship with the physician. Given their growing prevalence, we strove to further investigate whether visible tattoos or piercings on a medical provider affects a patient's perception of the provider's capabilities and their trust in the care that would be provided. A survey using photographs of simulated practitioners was administered to 314 participants split between rural and urban locations. Study volunteers rated tattooed practitioners with lower confidence ratings when compared with nontattooed practitioners and reported greater degrees of discomfort with greater degrees of facial piercing. We concluded that these factors adversely affect the clinical confidence ratings of practitioners, regardless of the gender, age group, or location of participants.

The family journey-to-diagnosis with systemic juvenile idiopathic arthritis: a cross-sectional study of the changing social media presence.

BackgroundChildren with systemic juvenile idiopathic arthritis (SJIA) often encounter a delay between symptom onset and disease diagnosis, partly due to the broad differential of fever and lack of symptom recognition by providers. Families often seek multiple medical opinions and post on social media about their frustrations. This linguistic analysis observed the changing language patterns and social media posting behaviors of parents in the time leading to, during, and after SJIA diagnosis.MethodsPublic social media sites were manually reviewed by a linguistic team to evaluate posts about SJIA from US-based parents.ResultsA total of 3,979 posts between July 2001 and January 2015 were reviewed from 108 sites. Pre-SJIA diagnosis parents sought answers and shared status updates on social media, focusing primarily on the following three site types: alternative/natural lifestyle forums (39%), Facebook (27%), and disease-specific forums (17%). Posts during early prediagnosis phases were characterized by expressive language showing confidence in health care providers and trust in parental instincts. At later prediagnosis stages, parents continued to use social media, but the posts demonstrated increased frustration with delays in diagnosis and gaps in communication with providers. More objective symptom descriptions and a greatly reduced child-centered emotional focus were observed as parents shifted into caregiving roles. Once the diagnosis of SJIA was confirmed, parents used straightforward, less expressive language, and Facebook (47%) to make “announcement” posts and increased their use of SJIA websites (30%). With treatment initiation, the posts demonstrated a slow return of expressive language and an increased parental understanding of the “new normal”.ConclusionParents use different language styles, frames of reference, and websites before and after SJIA diagnosis. Gaps in parent–provider communication, especially before diagnosis, and their new roles as caregivers lead to parental use of social media to express frustration with the health care process. Providers should tailor their discussions with parents to address these issues.

Bringing person-centered care to practice with CCO’s guideline for person-centred care in adult oncology services.

65 Background: CCO ensures quality cancer care for 16 million residents in Ontario. CCO has identified person-centered care (PCC) as a top strategy in driving the quality agenda. CCO, in collaboration with the Program in Evidence-Based Care, developed a PCC Guideline to set the standard of care for people experiencing cancer in Ontario. A PCC video was developed as a tool for translating this knowledge to support healthcare providers to integrate Guideline recommendations into their practice. Methods: A Guideline Working Group (GWG), including patients and health care providers, conducted a literature review and assessed the quality, relevance and utility of available evidence. An Expert Panel reviewed the decisions of the GWG and an External Review was conducted to validate the final guideline. The PCC video was developed as a tool for knowledge translation by defining fundamental concepts of PCC with the objective of promoting uptake of the guideline. A 4-question survey based on the Kirkpatrick Model was embedded to evaluate the video’s effectiveness. Results: Of 110 articles, only one guideline was found and was therefore reviewed exclusively. The GWG reviewed 68 recommendations, modifying 48, accepting 13 and rejecting 4; for a final set of 65 recommendations. External Review returned 73 responses. A total of 196 health care providers, 134 administrators, 53 patients and 103 others stakeholders participated in the video survey. The results in the table below compare the educational state of PCC before and after the video. Conclusions: CCO has adapted and endorsed 65 recommendations to create a PCC Guideline for adult oncology in Ontario. The results of the video showed that baseline PCC knowledge is poor, and that the PCC Video initiated significant (p = 0.972) growth in this knowledge. Anecdotal evidence also suggests that the video positively affected health care provider's confidence in adopting PCC. Future work is required to promote uptake and utilization of PCC Guideline at system-level. [Table: see text]

Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy.

BackgroundMany patients treated for tuberculosis (TB) in low and middle income countries are treated based on clinical suspicion without bacteriological confirmation. This is often due to lack of rapid simple accurate diagnostics and low healthcare provider confidence in the predictive value of current tests. We previously reported in an animal TB model that levels of host markers rapidly change in response to treatment initiation.MethodsWe assessed the potential of host biomarker kinetics of TB patients during the first two weeks of therapy to identify patients responding to treatment. Adult patients clinically diagnosed with and treated for TB, 29 in Nigeria and 24 in Nepal, were analyzed.ResultsChanges in concentrations of non-specific host biomarkers, particularly IP-10, in response to the first week of anti-TB therapy were strongly associated with bacteriological confirmation of TB. A decrease in IP-10 level of >300pg/ml between 0 and 7 days of treatment identified 75% of both smear-positive and smear-negative culture positive patients and correctly excluded TB in all nine culture negative patients.ConclusionsMonitoring of early IP-10 responses to treatment could form the basis of a simplified assay and could help identify patients who were erroneously clinically diagnosed with TB or those infected with drug resistant strains on inappropriate treatment. We believe this approach may be particularly appropriate for difficult to diagnose patients, e.g. smear-negative HIV-positive, or those with extra-pulmonary TB, often treated without bacterial confirmation.

No Visible Dental Staining in Children Treated with Doxycycline for Suspected Rocky Mountain Spotted Fever

To evaluate whether cosmetically relevant dental effects occurred among children who had received doxycycline for treatment of suspected Rocky Mountain spotted fever (RMSF). Children who lived on an American Indian reservation with high incidence of RMSF were classified as exposed or unexposed to doxycycline, based on medical and pharmacy record abstraction. Licensed, trained dentists examined each child's teeth and evaluated visible staining patterns and enamel hypoplasia. Objective tooth color was evaluated with a spectrophotometer. Fifty-eight children who received an average of 1.8 courses of doxycycline before 8 years of age and who now had exposed permanent teeth erupted were compared with 213 children who had never received doxycycline. No tetracycline-like staining was observed in any of the exposed children's teeth (0/58, 95% CI 0%-5%), and no significant difference in tooth shade (P=.20) or hypoplasia (P=1.0) was found between the 2 groups. This study failed to demonstrate dental staining, enamel hypoplasia, or tooth color differences among children who received short-term courses of doxycycline at <8 years of age. Healthcare provider confidence in use of doxycycline for suspected RMSF in children may be improved by modifying the drug's label.