Pediatric Primary Care Physicians Research Articles

Home extubation by a pediatric critical care team: Providing a compassionate death outside the pediatric intensive care unit*

Our objective is to present a case report of home extubation by a pediatric intensive care team in a terminally ill pediatric patient. Literature relevant to home extubation will be reviewed. The design is a case report. Home extubation of critically ill children may offer significant benefits and an alternative end-of-life option for families. Allowing a child to die at home creates an opportunity for families to maintain privacy and to better address their spiritual and cultural needs at the time of death. Before offering home extubation to families, hospitals should prepare families for the experience and address the availability of staff to comfort parents and provide bereavement support. Medicolegal as well as cost issues for the hospital related to home extubation should be explored before the implementation of a program of this nature. This case illustrates that home extubation is a creative, compassionate, and culturally sensitive alternative to hospital-based end-of-life care involving the pediatric intensivist, transport teams, and primary care physicians.

Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison Of Patients’ Visits

In this study we compared the demographics of and reasons for visits in national samples of visits to retail clinics, primary care physicians (PCPs), and emergency departments (EDs). We found that retail clinics appear to be serving a patient population that is underserved by PCPs. Ten clinical problems such as sinusitis and immunizations encompass more than 90 percent of retail clinic visits. These same ten clinical problems make up 13 percent of adult PCP visits, 30 percent of pediatric PCP visits, and 12 percent of ED visits. Whether there will be a future shift of care from EDs or PCPs to retail clinics is unknown.

Interactions between parents and pediatric primary care physicians about children's mental health.

Interaction patterns between parents and pediatricians were examined during 1,378 well-child visits to four public and private pediatric clinics. During 327 visits, parents listed at least one psychosocial concern related to their child's mental health. At 37 percent of these visits, parents said they did not wish to discuss the concern with the physician. Physicians failed to address concerns during approximately 35 percent of visits at which parents were willing to discuss them. Successful parent-physician interactions were three times more frequent in private practices than in a public clinic; they were more likely when fewer concerns were stated and less likely when behavior problems were the concern. Parents concerned about the parent-infant relationship were four times more likely to be referred to outside mental health services, although these cases were relatively rare. Older children and families receiving Medicaid were also more likely to be referred to such services.