Outpatient Care For Children Research Articles

Telehealth in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic: A scoping review protocol.

Outpatient care for children and adolescents with chronic conditions needs to be continuous and programmed, encompassing comprehensive care, with periodically scheduled consultations, exams, and procedures, to promote quality of life and reduce mortality. In the context of the new coronavirus pandemic, however, outpatient care for children and adolescents with chronic conditions, in person, was hampered in favor of social isolation, a necessary sanitary measure to reduce and prevent the spread of Coronavirus Disease 2019. In response to this need, studies suggest telehealth in pediatrics as a fertile and expanding field especially in times of pandemics. Here, we aimed to map the evidence related to telehealth in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic, to identify which strategies were implemented and their impacts on the continuity of care. A scoping review protocol is reported and guided by the Scoping Reviews Manual of the Joanna Briggs Institute. The search for evidence will cover the following databases: MEDLINE/PubMed, Cochrane Libary; Embase; Web of Science; Scopus; Cinahl and PsycINFO, plus additional sources, such as The British Library, Google Scholar, and Preprints [medRXiv]. No date or language restrictions will be employed in this scoping review. Two independent researchers will conduct the search strategy, study selection, data charting, and data synthesis. The findings will be presented through tables, charts, narrative summaries, and assessed based on the type of data charted as well as outcomes. Additionally, the meaning of these findings will be considered as they relate to the guiding question, the characterization and measurement of the impact of different telehealth modalities used in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic, and the implications for practice and further research. To the best of our knowledge, this will be the first scoping review to look specifically at the telehealth modalities to be used in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic. We expect that our results will be of interest to practitioners as well as researchers concerned with this particular emerging issue in the pandemic context. Also, the plans for the dissemination of this study comprise peer-reviewed publication and conference presentations. Open Science Framework Registration: osf.io/5pqgu.

Gender differences between adolescents with autism in emergency psychiatry.

Among adolescents seen for psychiatric emergency consultation, the percentage of adolescents with autism is increasing over the years. This applies even more to girls than to boys. We collected data of 1378 adolescents aged 12-18 years who were seen for urgent consultation by mobile psychiatric emergency services in the Netherlands. Among these, there were 64 autistic girls and 125 autistic boys. We wanted to know more about differences in problems between autistic and typical developing adolescents in crisis, both to prevent crisis and to improve services. The percentage of adolescents with autism increased over the years studied. Autistic adolescents experienced more severe impairment in functioning compared to typically developing adolescents. Compared to other adolescents, both boys and girls on the autism spectrum were diagnosed less frequently with mood disorders, behavioral disorders, relational problems, and abuse. Autistic girls had a higher suicide risk and suffered more often from anxiety disorders than autistic boys, while autistic boys had a longer history of problems. Outpatient care for children with autism should include easy access to specialized professionals who aim to reduce anxiety and help young people with autism to cope with the challenges of adolescence. Because possibly signs were missed during the emergency consultation, we recommend that as part of the routine procedure in crisis situations adolescents with autism are asked about mood and behavioral problems explicitly, as well as about negative life events.

Pemanfaatan Pelayanan Kesehatan pada Anak Indonesia: Pengaruh Kemiskinan dan Karakteristik Ibu

Pemanfaatan pelayanan kesehatan merupakan salah satu upaya untuk meningkatkan status kesehatan, khususnya pada anak. Namun, kemiskinan dan karakteristik orang tua khususnya ibu sering kali menjadi faktor utama yang memengaruhi pemanfaatan pelayanan kesehatan pada anak. Penelitian ini menggunakan data Susenas 2017 dan Podes 2018 untuk melihat pengaruh kemiskinan dan karakteristik ibu terhadap pemanfaatan pelayanan kesehatan untuk rawat jalan pada anak. Unit analisis dalam penelitian ini adalah 50.437 anak yang memiliki keluhan kesehatan, terganggu aktifitas dalam sebulan terakhir dan tinggal bersama ibu kandung. Analisis data dilakukan secara deskriptif dan menggunakan regresi logistik. Hasil menunjukkan jika sekitar satu dari tiga anak tidak memanfaatkan pelayanan kesehatan untuk rawat jalan ketika sakit. Selanjutnya, dengan metode regresi logistik, terbukti jika kemiskinan keluarga berpengaruh signifikan dan negatif terhadap pemanfaatan pelayanan kesehatan untuk rawat jalan pada anak di Indonesia (OR=0,79). Sedangkan pendidikan dan status bekerja ibu berpengaruh positif dan signifikan. Penelitian ini menunjukkan perlunya memberikan kemudahan akses terhadap pelayanan kesehatan pada anak yang ada pada rumah tangga miskin, disamping perlunya meningkatkan pemberdayaan perem-puan, khususnya ibu untuk dapat meningkatkan pemanfaatan pelayanan kesehatan khususnya rawat jalan pada anak.

Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Jackowska T, Peregud-Pogorzelski J, Marczyńska M, Czajka H. Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2. Pediatria Polska - Polish Journal of Paediatrics. 2020;95(2):61-64. doi:10.5114/polp.2020.97170. APA Jackowska, T., Peregud-Pogorzelski, J., Marczyńska, M., & Czajka, H. (2020). Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2. Pediatria Polska - Polish Journal of Paediatrics, 95(2), 61-64. https://doi.org/10.5114/polp.2020.97170 Chicago Jackowska, Teresa, Jarosław Peregud-Pogorzelski, Magda Marczyńska, and Hanna Czajka. 2020. "Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2". Pediatria Polska - Polish Journal of Paediatrics 95 (2): 61-64. doi:10.5114/polp.2020.97170. Harvard Jackowska, T., Peregud-Pogorzelski, J., Marczyńska, M., and Czajka, H. (2020). Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2. Pediatria Polska - Polish Journal of Paediatrics, 95(2), pp.61-64. https://doi.org/10.5114/polp.2020.97170 MLA Jackowska, Teresa et al. "Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2." Pediatria Polska - Polish Journal of Paediatrics, vol. 95, no. 2, 2020, pp. 61-64. doi:10.5114/polp.2020.97170. Vancouver Jackowska T, Peregud-Pogorzelski J, Marczyńska M, Czajka H. Recommendations of the Polish Paediatric Society and the National Consultant in the field of paediatrics regarding outpatient care for children during the COVID-19 pandemic caused by SARS-CoV-2. Pediatria Polska - Polish Journal of Paediatrics. 2020;95(2):61-64. doi:10.5114/polp.2020.97170.

Some results of the organization assessment of outpatient aid to children’s population in a municipal area

Primary health care for children is the mainstay of the system of medical care for children and includes measures for the prevention, diagnosis, treatment of diseases, medical rehabilitation, the development of healthy lifestyles and sanitary and hygienic education for the children. Medical organizations located in rural areas have particularities in the system of providing medical care to the population. This concerns the type, capacity, disposition of medical organizations, their provision with qualified medical personnel, and the possibility of obtaining qualified medical care. In order to assess the state of outpatient care for children under the conditions of municipal health care, data was taken out of the federal statistical reporting “Information on medical organization” form 30 “Information about the number of diseases registered in patients living in the area of service of the medical organization” form 12 for 2015-2017. The research was based on the Toksovo District Hospital, a state budgetary health care institution in the Leningrad Region. In the course of the study, pediatric staff were evaluated for pediatric staff, indicators of outpatient care for the children, indicators of the burden of pediatricians and morbidity rates for the treatment of children. It was found that in the years under study there was a high level of provision of pediatricians with an attached pediatric population, an increase in the number of district pediatricians and a decrease in the part-time ratio. The increase in the workload of pediatricians conducting outpatient admissions, including district pediatricians, associated with an increase in visits for diseases in 2015-2017, indicates a deterioration in the health of the children’s population, as evidenced by an increase in the overall morbidity rate for outpatient using the child population.

The satisfaction of parents with ambulatory polyclinic care of children in conditions of the region

To identify the most effective areas of out-patient care of children, an in-depth sociological study was carried out in the Kabardino-Balkaria Republic. The questionnaire allowed to get answers on satisfaction of parents with the quality, volume and availability of out-patient care, as well as to study the social status of respondents. The survey included 495 mothers aged of 18-45 years. Out of them, 70.0% had 1-2 children, 30.0% had 3 or more children. The orientation of the majority of families to the birth of 1-2 children formed one of the lowest in the republics of the North Caucasus total fertility rate of 1.61. The results of the study of parental satisfaction with the level of medical care of children in out-patient settings established that the main problem is sufficiently correlated with the data of similar studies in different regions of Russia. According to the data obtained, 61.0% of the respondents were satisfied with the overall health care in the clinic, and only 12.0% of the respondents were fully satisfied. At the same time, a quarter of the respondents expressed their dissatisfaction with various aspects of medical care. The main reasons for dissatisfaction are the low level of examination, organizational issues that need to be addressed, a significant workload of doctors, often the lack of doctors of narrow specialties. According to parents opinion, the clinic is lacking continuity in the work and dynamic monitoring of a sick child, as well as awareness of patients about the ongoing therapeutic and preventive measures. The low efficiency of preventive work is established. The dissatisfaction with the availability and quality of medical care of children is the basis for the necessary measures to improve functioning of the children's clinic, including introduction of new and effective organizational and medical technologies, improvement of material and technical equipment, improvement of the professionalism of medical personnel. The prerequisite for the success of the clinic is also compliance with ethical principles in Pediatrics. The results obtained on the basis of the analysis of the parents' opinion are valuable for development of the perspective programs of development and improvement of primary health care of children in the Republic of Kabardino-Balkaria.

Paediatric Optometry Alignment Project: towards interprofessionalilty between paediatric eye care providers

The Paediatric Optometry Alignment Project (POAP) was established in response to unsustainable demand for paediatric ophthalmology services in Queensland. In June 2015, 1700 children waited for an ophthalmology appointment at the Lady Cilento Children’s Hospital (LCCH), many longer than clinically recommended. Multiple factors contributed to this, including large numbers of children with stable, treated conditions returning for monitoring. It was apparent that collaboration with community optometrists reviewing these patients would improve access. However, a long history of mistrust exists between ophthalmology and optometry, creating a barrier to implementation. Change implemented : LCCH held a workshop on evidence-based paediatric eye care for community optometrists. Optometrists paid to attend the course, consisting of lectures and case discussions. They received referral guidelines, templates and access to online education. Following the workshop, optometrists could become ‘aligned’ with LCCH. Alignment was conditional upon having current registration/insurance, agreeing to follow clinical pathways, and having no affiliation with the Australasian College of Behavioural Optometry (ACBO). Communication channels were established to facilitate discussion and re-referral if necessary. The department began discharging to these optometrists in May 2016. Aim : To develop a shared model of outpatient care for children with specific chronic eye conditions; to manage tertiary hospital demand, improve access to specialist care and improve interprofessionality between ophthalmologists and optometrists. Targeted population/stakeholders : Children over 8yrs with stable, treated strabismus and amblyopia. Stakeholders include: patients/ families, community optometrists, Optometry Australia, Optometry Queensland Northern Territory, Royal Australian and New Zealand College of Ophthalmologists, Children’s Health Queensland and Queensland Department of Health. Timeline : • September 2015 – funding received • October 2015 - project officer recruited • March 2016 – workshop held • May 2016 – 42 optometrists aligned • May 2016 - discharge commenced • June 2016 - interim evaluation Highlights : First Australian project demonstrating collaboration between paediatric ophthalmologists and community optometrists. First international project demonstrating shared management of children with strabismus and amblyopia. Sustainability : Low ongoing costs: • optometrists pay to attend course; bill under Medicare • project officer cost offset by fewer travel subsidies for patients attending LCCH • future workshops planned in regional centres Transferability : The range of conditions discharged should expand over time as ophthalmologists’ trust in the model grows. Training of community providers to align with specialist management has been based on the success of antenatal shared-care programs. The model can be replicated in other specialties. Conclusions : POAP addressed a gap in optometry education, improved family-centredness of care, enhanced access to services and improved collaborative working arrangements between ophthalmologists and optometrists. Lessons learned : We failed to address the potential reputational and clinical risks involved in aligning with behavioural optometrists – a subset of ‘conventional optometrists’ before commencement of the project. Following legal advice, stricter inclusion and exclusion criteria were developed. Discussions : Formal evaluation will occur 12 months post-implementation, including clinical outcomes, wait list analysis and family and clinician satisfaction surveys. Final evaluation should demonstrate cost-effective, family-centred care for children with stable eye disease has been delivered, with excellent clinical outcomes and high family and clinician satisfaction.

Outpatient management of pediatric oncology patients with low-risk fever and neutropenia: Implementation of new clinical practice guideline at Texas Children's Hospital.

26 Background: Traditionally, pediatric oncology patients with fever and severe neutropenia (absolute neutrophil count [ANC] <500) are admitted on empiric intravenous (IV) antibiotics pending blood cultures, fever resolution, and a rising ANC. Based on significant evidence that risk-stratification of these patients with fever and neutropenia (FN) and outpatient management of “low-risk” FN (LRFN) patients with oral antibiotics can be safe and effective, we implemented an institutional clinical practice guideline (CPG) to provide outpatient care for children with LRFN. Methods: A validated “Alexander” clinical decision rule was adopted to risk stratify pediatric oncology patients with FN. A new CPG was formulated for the outpatient management of LRFN patients, with either discharge on presentation or at 24-48 hours after admission, with levofloxacin and close follow-up. All stakeholders were educated regarding the new guidelines and process prior to implementation, and the guidelines were approved by the institutional Evidence Based Outcomes Center. Results: In 9 months since guideline implementation, 10/11 (91%) of the eligible patients have been managed outpatient for LRFN (mean ANC 160, range 0 - 480). Seven patients were discharged home from the ER or oncology clinic. Three patients were discharged early at 24 – 48 hours after admission. Outpatient management was safe, and all but one patient had resolution of fever within 48 hours and negative blood cultures. One patient had a positive blood culture with Staphylococcus epidermidis and was admitted for IV antibiotics with no complications. Parents of 9/10 patients responded to surveys. All 9 families found outpatient management to be a good experience, follow-up easy, and reported no adverse effects with levofloxacin. One family preferred inpatient care due to anxiety, while importantly 8/9 (89%) parents said they preferred outpatient care compared to inpatient observation. Conclusions: Pediatric oncology patients with low-risk fever and neutropenia were successfully idenitified and managed in the outpatient setting without adverse events with a high level of parent satisfaction.

Slow cortical potential neurofeedback and self-management training in outpatient care for children with ADHD: study protocol and first preliminary results of a randomized controlled trial

Background: Treatment for children with attention deficit/hyperactivity disorder (ADHD) today is predominantly pharmacological. While it is the most common treatment, it might not always be the most appropriate one. Moreover, long term effects remain unclear. Behavior therapy (BT) and non-pharmacological treatments such as neurofeedback (NF) are promising alternatives, though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication.Methods/design: This paper presents the protocol of a randomized controlled trial to compare the effectiveness of a Slow Cortical Potential (SCP) NF protocol with self-management (SM) in a high frequent outpatient care setting. Both groups (NF/SM) receive a total of 30 high frequent therapy sessions. Additionally, 6 sessions are reserved for comorbid problems. The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings.Preliminary Results: Untill now 58 children were included in the study (48 males), with a mean age of 8.42 (1.34) years, and a mean IQ of 110 (13.37). Conners-3 parent and teacher ratings were used to estimate core symptom change. Since the study is still ongoing, and children are in different study stages, pre-post and follow-up results are not yet available for all children included. Preliminary results suggest overall good pre-post effects, though. For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects (η2 0.175–0.513). Differences between groups (NF vs. SM) could not yet be established (p = 0.81).Discussion: This is the first randomized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication. First preliminary results show positive effects. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.Trial registration: This trial is registered in www.clinicaltrials.gov as NCT01879644.

A mixed logit model of health care provider choice: analysis of NSS data for rural India

In order to address the persistent problems of access to and delivery of health care in rural India, a better understanding of the individual provider choice decision is required. This paper is an attempt in this direction as it investigates the determinants of outpatient health care provider choice in rural India in the mixed multinomial logit (MMNL) framework. This is the first application of the mixed logit to the modeling of health care utilization. We also use the multiple imputation technique to impute the missing prices of providers that an individual did not visit when she was ill. Using data from National Sample Survey Organization of India, we find the following: price and distance to a health facility play significant roles in health care provider choice decision; when health status is poor, distance plays a less significant role in an adult's provider choice decision; price elasticity of demand for outpatient care varies with income, with low-income groups being more price-sensitive than high-income ones. Furthermore, outpatient care for children is more price-elastic than that for adults, which reflects the socio-economic structure of a typical household in rural India where an adult's health is more important than that of a child for the household's economic sustenance.

Burden of Illness for Children and Where We Stand in Measuring the Quality of This Health Care

Measures of health care quality for children are not as well developed as those for adults. It is also unclear the extent to which the current pool of measures address common causes of illness and health care utilization for children. The goal of this study was to create lists of high-priority conditions for children based on different vantage points for defining burden relative to both inpatient and outpatient care for children. These high-priority conditions were then cross-tabulated with all known existing quality measures for pediatric health care. High-prevalence conditions for children were identified by using the 2000 National Ambulatory Medical Care Survey, 2000 National Hospital Ambulatory Medical Care Survey, 1999 Medical Expenditure Panel Survey, 2000 Healthcare Cost and Utilization Project's State Inpatient Databases, and 2000 Healthcare Cost and Utilization Project's State Ambulatory Surgery Databases. Burden assessments were done using frequencies of visits, charges, in-hospital deaths. Existing quality measures for children were identified from a recent compendium of such measures and a search of the National Quality Measures Clearinghouse. There are numerous and large gaps in existing quality-of-care measures for children relative to high-burden conditions in both the inpatient and outpatient setting. With the ever increasing efforts to measure and even publicly report on health care, efforts for children need to include focus on building a representative repertoire of quality measures for the high-burden conditions children experience.

Generalist-subspecialist communication for children with chronic conditions: a regional physician survey.

To identify target areas for interventions to improve communication between pediatric generalists (PCPs) and pediatric subspecialists (SPs) in the outpatient care of children with chronic conditions. We constructed a 4-page mailed questionnaire probing communication practices, opinions about the role of communication in care, and perceived barriers and facilitators to PCP-SP communication in the care of children with chronic conditions. In the spring of 2001, we surveyed all 495 New England SPs who were members of the American Academy of Pediatrics (AAP) and/or SP societies and a random sample of 495 generalist AAP members in New England. Eligible were those actively providing outpatient care. Most items were rated on a 5-point scale. Of those eligible, 48% (412/860) completed the questionnaire. Although 98% of respondents agreed that communication was important for good care, reported practices reflected large gaps in this area. Frequent receipt (>60% of the time) of communication about an initial referral was reported by only 28% of SPs. Barriers reported as most important involved inefficiencies in telephone contact, transcription delay, and failure to keep all providers informed when >1 specialist is involved. Important facilitators included letters or phone calls at or before the time of consultation, and clear and specific referral questions from PCPs. PCPs saw communication as more of a problem than did SPs (40% vs 28%), and reported several barriers as more important. Although 86% of respondents had access to e-mail in their practices, <20% used it often. PCPs and SPs sharing care for children with chronic conditions are troubled by their frequent failure or inability to contact their colleagues by phone and letter. PCPs communicate less frequently than SPs yet perceive more problems with communication. Interventions to promote efficient contact between providers at or before the time of subspecialty visits can lead to improved coordination of care, which in turn may better meet the needs of families.

Financing Pediatric Education in Community Settings

Increasingly, hospital-based pediatric outpatient departments are recognized as settings that attempt to combine two critical, but not always compatible, mandates: (1) education of medical students and pediatric residents in outpatient pediatrics, and (2) service, often with inadequate resources, to a socially highrisk population with a disproportionately high prevalence of social, family, and psychological dysfunction. Coexistence of these two mandates has raised a number of concerns, because pediatric ambulatory care education and training have historically been based almost exclusively in a hospital setting. Trainees often get a false impression of the types of problems they will be dealing with in pediatric primary care and of how an efficient pediatric practice is managed. In addition, they often are supervised by full-time faculty who have little if any experience in community settings and who practice only part time or not at all. These problems have led to a widespread desire to train pediatric residents outside the hospital, in settings that more closely approximate the places in which they will practice in the future. Residency programs that address this issue also provide residents with the opportunity to be trained by seasoned practitioners whose primary professional responsibility is the outpatient care of children. To date, little has been written about the cost or the financing of such educational efforts. This article summarizes what is known about the costs. We also attempt to specify the costs that should be anticipated for the various components and steps involved in devising and implementing pediatric community-based educational programs and to describe potential sources of funding for such programs.