Biomedical subjects

Sarah J Clark

Publications and source records attributed to Sarah J Clark.

44 records · Page 3Linked to original sources

PubMedDate not supplied

Informing parents about newborn screening.

OBJECTIVE: To evaluate current rules and regulations for educating parents about newborn screening. DESIGN: Cross-sectional survey. SAMPLE: Newborn screening program coordinators in all 50 states and the District of Columbia. MEASUREMENTS: Answers to a standardized semi-structured telephone survey in January 2004. RESULTS: Fifty programs provide standardized information about screening, and 32 of these have information available in multiple languages. Most programs (n=36) believe that parents should be informed about newborn screening as a part of prenatal care; however, none has rules or regulations requiring this. Five require documented informed consent; only one provides the consent form in a language other than English. Hospitals and birthing centers are required by many programs to educate families, including providing information (n=12), obtaining informed consent (n=5), informing parents of the right to refuse screening (n=13), and documenting refusal on institutionally developed forms (n=9). We found considerable variation in policy language across the newborn screening programs. CONCLUSIONS: The complexity of current newborn screening programs and the likelihood of expansion in the number of conditions on newborn screening panels present a unique opportunity and challenge for public health nurses to ensure that these programs are effective and that care is integrated.

Adult↗

PubMedDate not supplied

Reasons hospitals give for not offering hepatitis B vaccine to low-risk newborns.

After a temporary suspension of hepatitis B vaccination (HBV) for low-risk newborns in July 1999, some hospitals still do not offer HBV to these infants. A semi-structured telephone survey of medical directors from a national random sample of 296 hospital nurseries was completed from August 2000 to April 2001 and analyzed using qualitative techniques. Directors of 201 of 290 eligible nurseries (71%) participated. Twenty-ight nurseries have never offered HBV to low-risk newborns ("Never Offered HBV") and 37 nurseries had offered HBV to low-risk newborns before July 1999, but discontinued this practice after the temporary suspension ("Discontinued HBV"). Common reasons for not offering HBV to low-risk newborns were difficulty with reimbursement and convenience of outpatient administration. In addition, directors of "Never Offered HBV" nurseries cited low disease incidence in their patient population, whereas directors of "Discontinued HBV" cited preference for the combination hepatitis B-Haemophilus influenza type b vaccine as important factors. Multi-faceted interventions may be necessary to increase HBV use in the nursery.

Hepatitis B↗

PubMedDate not supplied

Variation in pediatric asthma quality improvement programs by managed care plans.

Although asthma quality improvement (QI) programs are common, little is known about the scope and content of QI initiatives in managed care arrangements. The authors conducted a cross-sectional survey of all managed care plans in Michigan serving the pediatric Medicaid population. Using semi-structured interviews, they assessed the comprehensiveness of the asthma QI program regarding provider, allied health professional, pharmacy, and member services. Although all QI initiatives included some type of physician-directed component and patient-directed components, only half included allied health professionals and one quarter included pharmacy-directed components. Interactive physician continuing medical education was associated with plans whose members were concentrated in only 1 or 2 counties. The authors noted wide variation in content, format, inclusion of incentives, inclusion of other health professionals, and outcome goals. The variation in QI approaches by each of the managed care organizations suggests that there is a dearth of information on appropriate and cost-effective methods to improve pediatric asthma quality at the plan level.

Asthma↗

PubMedDate not supplied

Effect of state vaccine-financing strategy on hepatitis B immunization in hospital nurseries.

OBJECTIVE: Changes in recommendations for newborn hepatitis B vaccination offer an opportunity to examine the association between newborn hepatitis B vaccination in hospital nurseries and state vaccine-financing strategies, which include the Vaccines for Children (VFC) program alone, an enhanced VFC program, and universal purchase. METHODS: We conducted a cross-sectional telephone survey of nursery directors from a national random sample of 290 hospital nurseries. RESULTS: Directors at 207 (71%) of 290 eligible nurseries responded. After the end of the temporary suspension of the hepatitis B vaccine birth dose, 59 (29%) of the 207 nurseries did not return to their previous policy and adopted a less strict policy for offering this vaccination to low-risk infants. In logistic regression analysis, compared with nurseries in states with VFC-only financing, nurseries in states with universal purchase financing were more likely to return a strict policy of routinely offering hepatitis B vaccination (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.11-0.78), and nurseries in states with enhanced VFC financing were less likely to return to a strict policy of routinely offering hepatitis B vaccination (OR, 3.00; 95% CI, 1.14-7.88). The presence of residents or students in the nursery was associated with a lower likelihood of not returning to a strict policy of routinely offering hepatitis B vaccination (OR, 0.32; 95% CI, 0.10-0.97). CONCLUSIONS: State vaccine-financing strategy for the birth dose of hepatitis B vaccine is associated with nursery policy to routinely offer this vaccine in the nursery. The temporary change in national hepatitis B vaccination recommendations in 1999 served as a window of opportunity for the adoption of new hospital nursery policies and showed the effects of state vaccine financing on the adoption of newborn immunization recommendations.

Financing, Government↗

PubMedDate not supplied

Willingness of eye care practices to evaluate children and accept Medicaid.

BACKGROUND: The willingness of eye care providers to evaluate children or to accept Medicaid may be a barrier to care for those with an abnormal screen. OBJECTIVES: To determine the proportion of eye care practices that would provide diagnostic evaluation for children and accept Medicaid payment and to evaluate the influence of child age and practice characteristics on provision of care or acceptance of Medicaid. METHODS: We conducted a telephone survey of 364 eye care practices in Michigan, which were randomly selected from telephone directories of 26 rural and urban cities as defined by metropolitan statistical areas. RESULTS: The response rate was 93%. Most eye care practices, but more optometry-listed practices than ophthalmology-listed ones, would evaluate preschool-aged children (88% vs 73%; P <.01) or school-aged children only (11% vs 7%; P <.01). The proportion of practices willing to evaluate preschool-aged children was lower in urban cities compared with rural cities for optometry-listed (83% vs 96%; P <.01) and ophthalmology-listed practices (67% vs 93%; P <.01). Medicaid acceptance among practices that would evaluate children was higher among ophthalmology-listed than optometry-listed practices (74% vs 59%; P =.01) and did not vary by urban or rural status. Practice size was not associated with willingness to provide care for children. However, among practices that would provide care for children, larger practice size was associated with increased odds of Medicaid acceptance in both optometry-listed and ophthalmology-listed practices. CONCLUSIONS: These findings contradict the perception that eye care for children is unavailable. More work is needed to understand the relationship of this availability with the accessibility of eye care.

Attitude of Health Personnel↗

PubMedDate not supplied

Physician barriers to lead testing of Medicaid-enrolled children.

BACKGROUND: The rate of blood lead testing among Medicaid-enrolled children is low. OBJECTIVE: To determine barriers to lead testing perceived by pediatricians to develop future interventions to improve the rate of appropriate blood lead testing. METHODS: We developed a mail survey based on findings from 6 focus groups of primary-care providers in Michigan. We then surveyed a random sample of 520 primary-care pediatricians in Michigan. Pediatricians who did not accept Medicaid were excluded from the analysis. RESULTS: The overall response rate was 65% (257 of 396 potentially eligible respondents). Most (68%) reported that they routinely test 1-year-old Medicaid-enrolled children. Practices with onsite blood testing were more likely to report routine testing of 1-year-old children (79% vs 62%; P < .01). Most (76%) who do not routinely test were aware of the Medicaid requirements for testing. The most common reason (70%) for not testing Medicaid-enrolled children was physicians' belief that they practice in a low-risk area. However, 35% of those who do not test because they practice in a low-risk area actually have their main practice site in a high-risk area. CONCLUSIONS: To improve the rate of blood lead testing, the public health department should provide pediatricians with data regarding the local risk of lead poisoning. The public health department should also consider working with practices to facilitate onsite blood collection for lead testing.

Attitude of Health Personnel↗

PubMedDate not supplied

One-year uptake of pneumococcal conjugate vaccine: a national survey of family physicians and pediatricians.

BACKGROUND: Pneumococcal conjugate vaccine (PCV7) was recommended by June 2000 for administration to all US children </=23 months old and to children at high risk for pneumococcal disease 24 to 59 months old. We sought to identify physician characteristics associated with adoption of the recommendation within 1 year. METHODS: We conducted a cross-sectional mail survey from April to July, 2001, of 788 family physicians (FP) and 833 pediatricians (PD) in 24 states. We measured whether physicians had adopted PCV7 recommendations, their expectations of the effectiveness of PCV7, the number of vaccine injections they would consider administering at 1 visit, and barriers to administering multiple injections. RESULTS: Response rate was 60%. Overall, 87% of physicians had adopted PCV7 recommendations (68% FP; 99% PD; P <.001). FP adopters are significantly more likely than nonadopters to believe PCV7 will be effective in preventing pneumococcal sepsis and meningitis, as well as >25% of cases of otitis media. In multivariable logistic regression analyses of adoption of PCV7, FP who have higher proportions of African American patients and patients on Medicaid, see greater numbers of newborns, work in practices of >/=4 physicians, and are willing to consider administering at least 4 vaccine injections at 1 visit are significantly more likely to have adopted PCV7. Concerns about vaccine cost and reimbursement were the most commonly cited factors in physicians' decisions not to adopt PCV7 recommendations. CONCLUSIONS: One year after PCV7 was recommended, nearly all pediatricians and a majority of family physicians had incorporated this vaccine into their practices. Barriers to higher rates of uptake-especially among family physicians-must be addressed to achieve immunization goals with this new vaccine.

Attitude of Health Personnel↗

PubMedDate not supplied

Services provided for preschool-aged children with suspected amblyopia.

BACKGROUND: Little is known about the pattern and variation of care offered to preschool-aged children who have had an abnormal vision screening test. PURPOSE: To evaluate the variations in pediatric eye care services and availability of optometrists and ophthalmologists for preschool-aged patients, referral patterns, and barriers to providing care as perceived by eye care specialists. METHODS: A survey was mailed to 542 ophthalmologists and a random sample of 501 optometrists actively practicing in Michigan. RESULTS: The response rate was 65% (optometrists, 75%; ophthalmologists, 57%). More optometrists than ophthalmologists evaluated preschool-aged children (97% vs 79%; P < .001). Of these, most managed amblyopia (80% vs 77%; P = .372) and strabismus (89% vs 80%; P = .002) themselves. Fewer optometrists than ophthalmologists dilated eyes routinely during the first evaluation of a preschool-aged child (39% vs 93%; P < .001). The leading barrier to care for preschool-aged children reported by both optometrists and ophthalmologists was difficulty of the examination (25% vs 23%; P = .501). Optometrists reported that most of their patients were referred from community-based screening programs or by parent self-referral. Ophthalmologists reported that most of their preschool-aged patients were referred from primary care providers. CONCLUSIONS: There are different sources of referrals for optometrists and ophthalmologists. Although most eye care specialists treat amblyopia, the types of care offered by optometrists and ophthalmologists differ. Future studies should address the impact that these patterns have on outcomes and cost. The results of these studies should be shared with those responsible for screening.

Amblyopia↗