Pediatric Primary Care Research Articles

"We need to talk about it, test it, prevent it, and that is our job": qualitative report on the awareness of primary care physicians regarding HIV in Ukraine.

Approximately 240,000 people in Ukraine are living with HIV. Recent changes in medical legislation have significantly strengthened the role of family doctors and primary care pediatricians in the prevention, early detection and follow-up of patients with HIV. Thus, the purpose of the study was to examine the experience of primary care physicians in testing and providing care to patients with HIV. Qualitative semi-structured in-depth interviews with typical representatives of the target audience from different regions of Ukraine were conducted. Inductive thematic content analysis was used to analyze the data upon standardized research protocols using the Theoretical Domain System. The results identify knowledge, skills, motivation, barriers, and opportunities in the context of HIV testing among family doctors in Ukraine. Primary health care providers consider HIV testing of patients to be an important part of their professional activities. In most cases, HIV testing is initiated upon detection of clinical indicators or when a person is identified as a key population. Preventive testing at the request of the patient is less common. Although most family doctors believe that they are sufficiently informed to conduct testing, there is a certain knowledge gap regarding communication with the patient and further treatment in case of a positive HIV result. The main obstacle to regular HIV testing is the reluctance and resistance of patients, as well as in some cases insufficient or non-existent tests in primary health care facilities. In order to improve the situation with HIV testing among the population, family doctors believe that it is necessary to organize regular trainings and courses to improve the skills of doctors on HIV, provide primary health care facilities with sufficient tests and establish high-quality information support. The obtained results clearly outline the main problems that concern family doctors in Ukraine regarding work with key vulnerable groups and persons living with HIV.

Nepridržavanje pedijatara primarne zdravstvene zaštite u Srbiji najnovijih upustava za lečenje akutnog i hroničnog kašlja kod dece

Introduction: Cough is the most frequent symptom in children and can indicate various pathological conditions. Several international guidelines have been published with a purpose of standardizing and improving the assessment and management of cough. Non-adherence to guidelines often leads to a suboptimal quality of patient care. Our aim was to investigate the adherence of Serbian primary care pediatricians to the latest international guidelines on cough diagnosis and management. Methods: The study included pediatricians working in primary health care centers in Serbia. They were given a questionnaire designed by a team of pediatric pulmonologists which included questions about the choice of diagnostic and therapeutic approaches in acute and chronic cough. Results: Most of primary care pediatricians assessed the value of international guidelines as fair. However, nearly 70% stated that they prescribed herbal syrup for acute cough. Chronic cough is treated mostly with ivy extract, bronchodilators and antihistamines. A majority of doctors declared positive opinion of herbal medicaments and negative opinion of alternative medicine. About 73% stated that they did not use the chest x-ray as a part of diagnostic procedure. Conclusion: Serbian pediatricians do not adhere to international guidelines in relation to diagnosis and treatment of cough. The reasons for non-adherence to guidelines should be further investigated.

Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care.

Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.

Outcome of BMI2+: Motivational Interviewing to Reduce BMI Through Primary Care AAP PROS Practices.

Pediatric obesity rates in the United States remain at an all-time high. Pediatric primary care clinicians and registered dietitians can help treat childhood obesity, and motivational interviewing (MI) has shown promising effects in prior trials. We randomized 18 pediatric primary care practices to receive the Brief Motivational Interviewing to Reduce BMI or BMI2+ intervention or continue with usual care (UC). Practices were recruited through the American Academy of Pediatrics Pediatric Research in Office Settings network. The intervention comprised 4 components1: in-person and telehealth MI counseling by pediatric clinicians; 4 recommended sessions,2 6 telephone MI counseling sessions from a registered dietitian,3 text message reminders and tailored motivational messages, and4 parent educational materials. The main outcome was the change in the percentage of the 95th percentile of BMI. The study was conducted 2017 through 2021. There was a significant treatment x time interaction (b = 0.017, 95% confidence interval: [0.0066-0.027]) for the main outcome, favoring the UC group, with youth in the intervention arm showing a greater relative increase in their percent of the 95th percentile. There was no overall benefit of the intervention and, contrary to expectations, youth in the intervention arm gained more weight, based on percent of the distance from the 95th percentile than matched youth from UC practices. The absolute excess weight gain among intervention relative to UC youth was small, approximately 0.5 BMI units and 1 kg over 2 years. We offer several potential explanations for these unexpected findings.

Adolescent, Parent, and Provider Perceptions of a Predictive Algorithm to Identify Adolescent Suicide Risk in Primary Care

ObjectiveTo understand adolescent, parent, and provider perceptions of a machine learning algorithm for detecting adolescent suicide risk prior to its implementation primary care. MethodsWe conducted semi-structured, qualitative interviews with adolescents (n = 9), parents (n = 12), and providers (n = 10; mixture of behavioral health and primary care providers) across two major health systems. Interviews were audio recorded and transcribed with analyses supported by use of NVivo. A codebook was developed combining codes derived inductively from interview transcripts and deductively from implementation science frameworks for content analysis. ResultsReactions to the algorithm were mixed. While many participants expressed privacy concerns, they believed the algorithm could be clinically useful for identifying adolescents at risk for suicide and facilitating follow-up. Parents’ past experiences with their adolescents’ suicidal thoughts and behaviors contributed to their openness to the algorithm. Results also aligned with several key Consolidated Framework for Implementation Research domains. For example, providers mentioned barriers inherent to the primary care setting such as time and resource constraints likely to impact algorithm implementation. Participants also cited a climate of mistrust of science and healthcare as potential barriers. ConclusionsFindings shed light on factors that warrant consideration to promote successful implementation of suicide predictive algorithms in pediatric primary care. By attending to perspectives of potential end users prior to the development and testing of the algorithm, we can ensure that the risk prediction methods will be well-suited to the providers who would be interacting with them and the families who could benefit.

Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network.

In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer's V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families' needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as "Food as Medicine" offerings in partnership with community organizations.

Teenage parents and their children-position paper of the European academy of paediatrics and the European confederation of primary care paediatricians.

Teenage parenthood presents multifaceted implications, affecting adolescent parents, their children, and extended families. Despite a decrease in teenage pregnancy rates across Europe, the phenomenon continues to present significant challenges, impacting not only the adolescent parents but also their offspring and extended families. A comprehensive literature review was conducted. Key factors influencing teenage pregnancies, including socioeconomic background, family structure, and access to sex education and contraception, were examined. This review was supplemented by expert opinions from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP). The triad of mother, father, and child presents individual distinct healthcare needs and vulnerabilities, highlighting the importance of specialized support and healthcare. This paper explores the psychological, social, and educational repercussions of teenage parenthood on both parents and their children, including higher risks of postpartum depression, school dropout, and repeat pregnancies. Furthermore, it underscores the critical role that paediatricians and primary care providers play in supporting these young families. The position paper advocates for comprehensive care for adolescent parents and their children. It recommends preventive measures such as proper sex education and access to contraception to reduce unplanned teenage pregnancies. Additionally, it emphasizes the need for specialized healthcare and support for teenage parents to address their unique challenges and improve outcomes for both parents and their children.

A Two-week, Hands-on Educational Program for Primary Care Pediatricians Aimed at Equalization of Pediatric Allergy Practice across Institutions and Regions

A Two-week, Hands-on Educational Program for Primary Care Pediatricians Aimed at Equalization of Pediatric Allergy Practice across Institutions and Regions

Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.

Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians. We designed a site-randomized, quality improvement trial within a large pediatric primary care network. Each practice was randomly assigned to 1 of 4 groups: education and feedback; CDS; both interventions ("combined group"); and control. We performed difference-in-differences analysis to compare the proportion of cases with short course treatment before and after intervention among the 4 groups. For all cases of CAP and SSTI, the proportion in the control group treated with the recommended duration did not change from the baseline period (26.1% [679 of 2603]) to the intervention period (25.8% [196 of 761]; P = .9). For the education and feedback group, the proportion rose from 22.3% (428 of 1925) to 45.0% (239 of 532; P < .001); for the CDS group, from 26.6% (485 of 1824) to 52.3% (228 of 436; P < .001); and for the combined group, from 26.2% (491 of 1875) to 67.8% (314 of 463; P < .001). A difference-in-differences analysis showed that all 3 intervention groups improved performance compared with the control group (P < .001); the combined group had greater improvement than the education and feedback group or the CDS group (P < .001). In this quality improvement project to encourage shorter duration treatment of CAP and SSTI, both education with performance feedback and CDS were effective in modifying clinician behavior; however, the combination of the two was substantially more effective than either strategy alone.

An analysis of interagency collaboration: Lessons learned from Colorado's early intervention program.

The purpose of this study was to describe interagency collaboration in Part C Early Intervention (EI) programs. Between 18 April and 9 May 2022, 48 EI service coordinators (SCs) from 14 programs in one state completed adapted versions of the Interagency Collaboration Activities Scale (IACAS) and Relational Coordination Survey (RCS). Assessing perceptions of shared structures (IACAS) and coordination quality (RCS), these combined measures summarized interagency collaboration with 11 organizations. Mean (SD) survey responses were estimated and ranked. Sample SCs represent a breadth of professional disciples and vary substantially in their current and desired collaborations. The quantity of SCs collaborating with organizations ranged from 0% to 98%. Nearly all (98%) reported collaborating with the school districts, few (15%) reported collaborating with insurance, and none reported collaborating with Supplemental Nutrition Assistance Program or Special Supplemental Nutrition Program for Women, Infants, and Children. The majority of SCs expressed desire to increase their collaborations with most of the listed organizations. The perceived quality of collaborations varied substantially at both individual and organizational levels. When comparing SC perceptions of shared structures and coordination quality, SCs reported more favourable collaborations with school districts (IACAS rank: first and RCS rank: first) and less favourable collaborations with insurance (IACAS rank: ninth and RCS rank: seventh). Some organizations rankings varied across both scales, including pediatric primary care (IACAS rank: third and RCS rank: eighth) and hospitals (IACAS rank: sixth and RCS rank: second). Overall, SCs reported low perceived existence of shared structures while coordination quality varied by organization. Opportunities for collaborative growth were identified. Despite its importance and required implementation in EI, perceptions of interagency collaboration varied substantially within and between EI programs. There is a suggested need to increase the quantity of SCs that collaborate and identified opportunities to increase the quality of collaborations that already exist.

Pediatric Primary Care Provider Perspectives on Universal Suicide Screening.

Given the increase in youth mental health concerns, the American Academy of Pediatrics (AAP) recommends universal suicide screening for ages 12 and older, with positive screens followed by a brief suicide risk assessment. However, it is unclear how pediatric clinicians incorporate this recommendation into practice. Therefore, the objective of this qualitative study was to identify pediatric clinicians' current practice, attitudes, and barriers to implement the updated universal suicide screening recommendation in primary care. Community-based pediatric primary care providers (PCPs) in the St. Louis Metropolitan area who by self-report provide mental health care for patients participated. Participants completed a 30-minute semi-structured interview with invitations extended through an electronic listserv in a local Pediatric PCP Learning Collaborative. Interviews were transcribed and analyzed using consensual deductive and inductive approaches until data saturation. Eighteen PCPs participated in the interviews. Interviews described themes related to acceptability of the recommendations, PCPs' current screening practices, and perceived barriers for implementing the recommendations. Overall, PCPs agreed with, but expressed hesitancy about, the recommendation. Frequently mentioned barriers to suicide screening included time, training, and inadequate access to resources for follow-up care for at-risk patients. Yet, PCPs were optimistic they could learn with support and were interested in working in this subject area through quality improvement interventions. PCPs agree with the AAP recommendation about suicide screening but need support to implement into practice. Specifically, PCPs need time sensitive strategies, resources, training, and practice change support to assist these efforts.

Learning in pediatrics primary care internship: Medical undergraduates’ point of view

Resumo Introdução: Muito se discute sobre a formação de profissionais de saúde preparados para atender às reais necessidades da população no contexto do Sistema Único de Saúde como preconizado pelas Diretrizes Curriculares Nacionais, almejando o cuidado integral. A Atenção Básica se destaca como importante cenário de prática nesse contexto, inclusive no internato, considerando a autonomia e o domínio dessa fase. Objetivo: Este estudo teve como objetivo analisar as percepções dos egressos de um curso médico em relação ao internato em pediatria na Atenção Básica. Método: Trata-se de pesquisa descritiva, exploratória com abordagem qualitativa, desenvolvida por meio de entrevistas on-line com egressos de Medicina, formados em uma instituição de ensino superior pública do interior paulista nos anos de 2018 e 2019. Os dados foram examinados por meio da análise de conteúdo temática. Resultado: Entrevistaram-se 11 egressos de 2018 e 15 egressos de 2019, com atuações profissionais diversas desde a finalização do curso. A categoria explorada neste artigo será “Oportunidade de aprendizagem durante a Atenção Básica em pediatria”. Vivenciar a Atenção Básica em pediatria oportunizou aprendizados diversos quanto ao cuidado integral da criança, compreendendo a importância de seu contexto e e de suas repercussões. Conclusão: Conhecer sobre a Rede de Atenção à Saúde desde o início do curso possibilitou entender as dificuldades vivenciadas nela e o impacto no cuidado. As situações mais prevalentes e de baixa complexidade são a realidade do egresso na atuação profissional e precisam ser abordadas durante o processo de ensino-aprendizagem do internato, favorecendo a atuação dele.

Improving Substance Use Screening among Teens utilizing S2BI in a Pediatric Primary Care Clinic

Improving Substance Use Screening among Teens utilizing S2BI in a Pediatric Primary Care Clinic

Improving Oral Health in Pediatric Primary Care

Improving Oral Health in Pediatric Primary Care

Evaluation of a Clinic-Based, Electronic Social Determinants of Health Screening and Intervention in Primary Care Pediatrics

ObjectiveSocial determinants of health (SDOH) significantly affect individuals' health outcomes, yet universal electronic SDOH screening is not standard in primary care. Our study explores the implementation of an electronic SDOH screening in the electronic health record (EHR) and follow-up intervention among primary care pediatric patients within an academic clinic. MethodsBeginning in August of 2022, patients and their families determined to have at least one SDOH need qualified for an in-clinic referral to a coordinated care team member. We assessed the overall efficacy and feasibility of the implementation. ResultsOver the 4-month pilot, 1473 of 2064 (71.4%) eligible patients were screened, with 472 (32%) patients screening positive on at least one SDOH domain. Of the 472 screened positive, 48 (10.2%) declined a referral. Two hundred and forty-seven of the 424 (58.3%) received a referral to a care coordination team member. ConclusionsThis study demonstrates the feasibility of a universal electronic SDOH screening tool within the EHR within an urban, academic-based clinic.

Parent attitudes and perceptions of integrated behavioral health care delivery for pediatric patients

Introduction: Patient access to high-quality behavioral health services has been a well-documented problem that has only been further complicated by the COVID-19 pandemic, especially within the pediatric population. Although integrated models of care have demonstrated efficacy for improving access, there is little research examining parents’ preferences for key elements of integrated practice, which now include increased utilization of virtual care. Parent/caregiver perspectives are essential to understand and enhance behavioral health service delivery within an integrated model of care because they are largely responsible for initiating, facilitating, and intimately participating in their children’s behavioral health care.&#x0D; Methods and Aims: The Parent Acceptance of Pediatric Integrated Care Survey Revised (PAPICS-R) was developed by a multidisciplinary panel of integrated care experts to evaluate caregiver perceptions of behavior health care delivery models for pediatric patients. A major component of the revised survey was a focus on virtual care, which has become ubiquitous since the beginning of the Covid-19 pandemic. Eight hundred thirty-four parents from diverse backgrounds across the United States who had children under 18-years old completed the revised survey online. Survey responses were analyzed using various statistical modeling techniques. Detailed demographic data was collected and associations of demographic variables with item responses were assessed using ANOVA and Chi-square tests.&#x0D; Results: Results indicated parent support for core components of integrated care such as co-location of medical and behavioral health care, interactive communication between providers, and shared access to health records. Parents also tended to prefer to be involved in their child’s therapy and indicated acceptability of virtual behavioral health care. Significant differences in parent responses were evident across several demographic variables such as race/ethnicity, parent age, child age, number of children and parent education. Notably, patient privacy and stigma were primary concerns for certain groups. These key findings will be shared to explore how specific demographic differences affect parent integrated care perspectives and how best to address these differences in practice.&#x0D; Conclusions: Results from the PAPICS-R provide valuable insight into parent perceptions of integrated behavioral health care. Notably, parent attitudes toward the integrated model of care (including virtual healthcare delivery methods) are largely positive. The findings have directly impacted multiple key aspects of the IBH program including future format of care delivery, trainee education, program expansion, and quality improvement. These adaptations will be discussed along with broader implications.&#x0D; Future Directions: Additional data are being gathered to examine the impact of various parent demographic variables on perspectives of an integrated primary care model. We are also currently working to disseminate results from the PAPICS-R survey to health care providers and organizations as the data are expected to provide valuable insight for those looking to establish integrated pediatric primary care clinics or improve their current model of care. Applicability of implementation within a diverse range of communities and regions will be discussed.&#x0D;

Digital child health: opportunities and obstacles. A joint statement of European Academy of Paediatrics and European Confederation of Primary Care Paediatricians.

The advancement of technology and the increasing digitisation of healthcare systems have opened new opportunities to transform the delivery of child health services. The importance of interoperable electronic health data in enhancing healthcare systems and improving child health care is evident. Interoperability ensures seamless data exchange and communication among healthcare entities, providers, institutions, household and systems. Using standardised data formats, coding systems, and terminologies is crucial in achieving interoperability and overcoming the barriers of different systems, formats, and locations. Paediatricians and other child health stakeholders can effectively address data structure, coding, and terminology inconsistencies by promoting interoperability and improving data quality and accuracy of children and youth, according to guidelines of the World Health Organisation. Thus, ensure comprehensive health assessments and screenings for children, including timely follow-up and communication of results. And implement effective vaccination schedules and strategies, ensuring timely administration of vaccines and prompt response to any concerns or adverse events. Developmental milestones can be continuously monitored. This can improve care coordination, enhance decision-making, and optimise health outcomes for children. In conclusion, using interoperable electronic child health data holds great promise in advancing international child healthcare systems and enhancing the child's care and well-being. By promoting standardised data exchange, interoperability enables timely health assessments, accurate vaccination schedules, continuous monitoring of developmental milestones, coordination of care, and collaboration among child healthcare professionals and the individual or their caregiver. Embracing interoperability is essential for creating a person-centric and data-driven healthcare ecosystem where the potential of digitalisation and innovation can be fully realized.

Improving Acne Treatment Modalities in Pediatric Primary Care

Published expert guidelines are available to promote evidence-based acne treatment by nondermatologic providers, but use is limited in pediatric primary care. This quality improvement initiative aimed to improve awareness and use of American Academy of Dermatology treatment guidelines for acne vulgaris in pediatric primary care and reduce reliance on referrals. Using the Model for Improvement, a positive practice change was achieved when clinicians probed acne treatment history and prescribed using American Academy of Dermatology evidence-based treatment guidelines.

Pediatric obesity during COVID-19: the role of neighborhood social vulnerability and collective efficacy.

Childhood obesity increased in the first year of COVID-19 with significant disparities across race, ethnicity, and socioeconomic status. Social distancing led to fewer physical activity opportunities but increased screen time and high-calorie food consumption, all co-determined by neighborhood environments. This study aimed to test the moderation effects of neighborhood socioeconomic and built environments on obesity change during COVID-19. Using electronic health records from a large pediatric primary care network in 2018-2022, we cross-sectionally examined 163,042 well visits of 2-17-year-olds living in Philadelphia County in order to examine (1) the pandemic's effect on obesity prevalence and (2) moderation by census-tract-level neighborhood socioeconomic disadvantage, crime, food and physical activity-related environments using interrupted-time-series analysis, Poisson regression, and logistic regression. Weekly obesity prevalence increased by 4.9 percent points (pp) during the pandemic (January 2021-August 2022) compared to pre-pandemic (March 2018-March 2020) levels. This increase was pronounced across all age groups, racially/ethnically minoritized groups, and insurance types (ranging from 2.0 to 6.4 pp) except the Non-Hispanic-white group. The increase in obesity among children racially/ethnically minoritized groups was significantly larger in the neighborhoods with high social vulnerability (3.3 pp difference between high and low groups), and low collective efficacy (2.0 pp difference between high and low groups) after adjusting for age, sex, and insurance type. Racially/ethnically minoritized children experienced larger obesity increases during the pandemic, especially those in socioeconomically disadvantaged neighborhoods. However, the buffering effect of community collective efficacy on the disparities underscores the importance of environments in pediatric health.

Managing sibling referrals: Ethical considerations for integrated pediatric primary care.

Managing sibling referrals: Ethical considerations for integrated pediatric primary care.