RESUMO
Nearly 20% of children in the United States have special health care needs, and they often experience disparities in health outcomes. This article reviews barriers to and facilitators of primary pediatric care for children within four defined categories of disability: (1) physical disabilities, both temporary and permanent; (2) chronic conditions requiring accommodations, including mental health conditions; (3) sensory disabilities and conditions; and (4) cognitive, educational, neurodevelopmental, and social disabilities. Primary care facilitators include interventions for both providers and patients that focus on time as a valued resource, provide psychosocial support, coordinate interdisciplinary teams of care, and provide training for providers. Barriers include exclusion of patients with disabilities from research trials and gaps in educational reform regarding ableism and hidden disabilities. Identified facilitators should be implemented on a larger scale, and barriers need to be addressed further so we may better support children with disabilities. [Pediatr Ann. 2022;51(6):e243-e253.].
Assuntos
Pessoas com Deficiência , Pediatria , Criança , Acessibilidade aos Serviços de Saúde , Humanos , Estados UnidosRESUMO
A focus on specific signs and symptoms-without imaging-may rule out community-acquired pneumonia in outpatients.
Assuntos
Assistência Ambulatorial/organização & administração , Infecções Comunitárias Adquiridas/diagnóstico , Medicina de Família e Comunidade/métodos , Relações Médico-Paciente , Padrões de Prática Médica/organização & administração , Nível de Saúde , Humanos , Pacientes Ambulatoriais/estatística & dados numéricos , Medição de RiscoRESUMO
BACKGROUND: Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions. OBJECTIVE: To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED. DESIGN: Cross-sectional study of hospital admissions at a single academic medical center. PARTICIPANTS: Non-critically ill adult patients admitted to the hospital (n = 297) and the admitting emergency medicine physicians (n = 34). MAIN MEASURES: A patient survey assessed non-medical factors, including primary care access and utilization. A physician survey assessed clinical and non-medical factors influencing the decision to admit. Based on physician responses, admissions were characterized as "strongly acuity-driven," "moderately acuity-driven," or "weakly acuity-driven." Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED. KEY RESULTS: Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission. CONCLUSIONS: Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.
Assuntos
Doença Aguda/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/tendências , Inquéritos e Questionários , Centros Médicos Acadêmicos/estatística & dados numéricos , Doença Aguda/epidemiologia , Estado Terminal , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Poor access to specialty care among uninsured adults threatens the delivery of quality health care and may contribute to the misuse and overuse of emergency departments and hospitals. INTERVENTION: We sought to improve access to specialty care through a program called Project Access-New Haven (PA-NH),which engages specialty physicians and hospitals to volunteer in a coordinated-care model for the uninsured. Patient navigators guide patients through the health-care network and help to alleviate administrative obstacles. RESULTS: Project Access-New Haven has been operational since August 2010. With >200 specialty physicians volunteering and strong commitments from local hospitals, comprehensive specialty care has been provided to 78 patients. Average wait-time for appointments is 17 days. CONCLUSION: PA-NH provides timely medical care and patient navigation foruninsured patientswith specialty-care needs. In the process, more physicians are participating in the care of vulnerable populations. Further data are needed to assess the potential cost-savings of PA-NH.
Assuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Hospitais Especializados , Pessoas sem Cobertura de Seguro de Saúde , Médicos , Especialização , Adulto , Connecticut , Humanos , Voluntários/organização & administraçãoRESUMO
This study aims to compare the use and cost of objective and subjective measures of adherence to pediatric antiretroviral treatment in a primary care facility in South Africa. In a 1-month longitudinal study of 53 caregiver-child dyads, pharmacy refill (PR), measurement of returned syrups (RS), caregiver self-report (3DR) and Visual Analogue Scale (VAS) were compared to Medication Event Monitoring System (MEMS). Adherence was 100% for both VAS and 3DR; by PR and RS 100% and 103%, respectively. MEMS showed that 92% of prescribed doses were administered, but only 66% of these within the correct 12-hourly interval. None of the four measures correlated significantly with MEMS. MEMS data suggest that timing of doses is often more deviant from prescribed than expected and should be better addressed when monitoring adherence. Of all, MEMS was by far the most expensive measure. Alternative, cheaper electronic devices need to be more accessible in resource-limited settings.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Monitoramento de Medicamentos/instrumentação , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Monitorização Ambulatorial/métodos , Fármacos Anti-HIV/normas , Cuidadores , Criança , Pré-Escolar , Monitoramento de Medicamentos/normas , Processamento Eletrônico de Dados/normas , Processamento Eletrônico de Dados/estatística & dados numéricos , Feminino , Seguimentos , Infecções por HIV/virologia , Humanos , Lactente , Estudos Longitudinais , Masculino , Medição da Dor , Farmácias , África do Sul , Inquéritos e Questionários , Carga ViralRESUMO
OBJECTIVE: To explore how a video of a patient with advanced dementia impacts the rationale for patients' decisions about future care. METHODS: Participants were read a verbal description of advanced dementia and asked their preferences for future care--either life-prolonging, limited, or comfort care--and the rationale for that choice. Participants then watched a video of a patient with advanced dementia and again stated their preferred level of care and the rationale. Thematic content analysis was utilized to develop common themes among the rationale of participants in each response category. RESULTS: We interviewed 120 participants. The rationale of those who initially chose life-prolonging or limited care (47/120) emphasized lengthening life and cited an inherent good of medical treatment. Those who initially chose comfort care (60/120) focused on avoiding suffering and quality of life. Post-video, 107/120 participants chose comfort care and the rationale focused on the experience of the patient and family rather than treatment-centered considerations. Participants found great value in the video images. CONCLUSIONS: While pre-video reasoning reflects general beliefs about extending life and the inherent good of treatment, the post-video reasoning reveals more focus on the experience of the actual patient and family. PRACTICE IMPLICATIONS: Video may serve an important role in advanced care planning by enriching the understanding of the condition and allowing one to imagine a future health state.