Posted On: June 30, 2011

Making the Transition from Pediatric to Adult Health Care

They grow up so fast, don't they? Some time between graduating middle school and graduating college, an adolescent should also graduate from pediatric to adult medical care. A new clinical report from three organizations recommends that such a transition should be planned in advance.

A successful, well-designed plan reflects the needs of the individual and involves the family and the medical providers on both ends--the ones who treated the kid, and the ones who will treat the adult--in order to develop the patient's ability to assume the responsibilities of self-care.

In preparing young people to be treated as adult patients, pediatricians should have a written policy spelling out the expectations of health-care transition, and they should bring up the subject with parents.

Doctors should develop individual plans jointly with the patients and their parents, ideally by the time the kids are 14, and earlier if they have special needs. The plan should be reviewed regularly by caregivers and parents to ensure updates are made before the transition occurs. And the pediatrician should communicate directly with the new adult health-care providers about the patient's history and needs.

The report offers six steps for parents and providers to effect a smooth transition (that is, as smooth a transition as anything adolescent-related can be).

  • 1. Ensure that all young people with special health-care needs have a health-care professional to address them.

  • 2. Identify core educational needs related to transition and integrate them into health-care professionals' training and certification requirements.

  • 3. Prepare and maintain a current medical summary that is portable.

  • 4. Create a written health-care transition plan for each patient by age 14.

  • 5. Apply the same primary and preventive-care guidelines to all adolescents and young adults.

  • 6. Ensure affordable, continuous health-care insurance for young people with special needs through adolescence and adulthood.

The report, scheduled to appear in the July 1 issue of Pediatrics, discusses a study showing that adult survivors of childhood diseases increasingly seek in-patient care at childrens' hospitals, which suggests that "systemic barriers" thwart the transition of some patients to adult care. But proactive parents in conjunction with enagaged pediatricians can overcome obstacles that would loom larger if left longer.

In comparison with the transition from puberty to sorority, transitioning your kid from pediatrician to the general practitioner is a walk in the parental park.

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Posted On: June 20, 2011

Kids on Medicaid go to the back of the health care waiting line

Children on the public Medicaid program who need to see a doctor for a serious but non-emergency health issue are shunned by many pediatricians' offices when their parents try to get appointments, according to a new study.

Two out of three get rejected entirely, and the average wait time for those who do get an appointment is three weeks longer than kids on private insurance.

This study gives scientific credence to the common hunch that children with public health insurance receive lesser care than those with private insurance.

According to an auditing study published in the New England Journal of Medicine this month, expanded eligibility for Medicaid and the Children's Health Insurance Program (CHIP) has not been accompanied by easier access.

"There's never been a study this comprehensive or this rigorous that actually measured access to specialty care, let alone children's access," said Karin V. Rhodes, M.D., an author of the study and director of emergency care policy research in the department of emergency medicine at the University of Pennsylvania.

Researchers telephoned clinics for medical appointments pretending to be the parent of a child with an urgent problem that wasn't an emergency. Problems included diabetes, seizures, asthma and broken bones. If asked, they said a primary care doctor or emergency department had referred them.

Sixty-six percent of the Medicaid-CHIP callers were denied an appointment versus 11% of privately insured callers.

Among 89 clinics that accepted both types of insurance, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children.

Researchers attributed the disparity to low and delayed Medicaid fees that also were encumbered by red tape. The study, said the New York Times, is one of only a few efforts to measure access to health care among people with Medicaid.

Medicaid supplies coverage to one in five Americans at some point in a given year, and publicly insured patients are poised to find themselves wedged even deeper between the rock of financially strapped states and the hard place of diminishing coverage. As described in another New York Times story, the Obama administration's infusion of billions of dollars into Medicaid during the depths of the recession is expiring, and benefits are being cut for millions of recipients.

In one example from the study, Medicaid paid $99.86 for an office visit for a problem of "moderate severity," compared with $160 from a private insurer. Several doctors said their practices were threatened by accepting too many Medicaid patients, Rhodes reported; specialists said they would be willing to treat more Medicaid patients but the academic medical centers with which they were affiliated pressed them to see more patients with private insurance.

As health-care experts widely acknowledge, the blowback of diminishing resources will be felt elsewhere within the health-care system. Patients whose doctors refuse to accept lower Medicaid payments often turn to hospital emergency rooms for routine as well as urgent care. Other health-care providers--individuals and institutions--often try to recover lost Medicaid revenue with increased charges to privately insured patients.

Those children who get their care through emergency rooms often are sicker than kids with more ready access to the health care system, because their harried parents wait until the child is really, really sick to go to the ER. Their care winds up being more expensive than if the illness was nipped in the bud with earlier care. Thus a vicious cycle is born.

Meantime, the harsh and impossible reality for poor families is: Don't let your kid get sick.

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Posted On: June 16, 2011

Swimming pool safety advocates say law isn’t working

A federal law designed to prevent children – and sometimes, even adults – from being sucked in and trapped by a pool or spa drain isn’t working, pool safety advocates say.

The Virginia Graeme Baker Pool and Spa Safety Act, named for the 7-year-old granddaughter of former secretary of State James Baker, who died in a hot tub in Northern Virginia in 2002 after getting trapped by the drain, was passed by Congress in 2007. But a recent recall of more than 1 million pool drain covers designed to fix the problem – just the latest of many setbacks - highlights how difficult the implementation of the law has become, the law's backers say.

Nancy Baker, the mother whose lobbying efforts helped get the law passed, says the implementation of the law has been “botched.” The law was supposed to award more than $4 million in grants for states to bring their pool safety codes up to federal standards. Not one state has done so.

Members of Congress who supported the law complain that the Consumer Product Safety Commission (CPSC) undermined it by eliminating the requirement for automatic drain shut-off switches as an added layer of protection in some pools. Industry groups argued that the switches were unnecessary.

That decision "runs counter to both the spirit and letter" of the law, say five senators led by Mark Pryor (D-Ark), who sponsored the 2007 law in the Senate. "In single drain pools, no drain cover — no matter how large or unblockable — can protect a child from entrapment if the drain cover is improperly installed or inadvertently removed," the senators wrote in a 2010 letter to the CPSC.

CPSC enforcement of the law has also been problematic. The commission could not provide precise statistics on how many inspections have been done, but estimated that since 2009, it has contracted out with 16 state and local health departments to do more than 2,800 inspections. Those contracts cover fewer than 1% of the 300,000 commercial pools in the U.S., not including residential pools and spas, which number more than 16 million, according to industry data.

In addition, a CPSC investigation found that the testing laboratories that certified drain covers as meeting safety standards applied those standards inconsistently and incorrectly, meaning many of the covers may be unsafe for the pools they're installed in.

Source: USA Today

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Posted On: June 8, 2011

Pediatricians update patient safety guidelines to reduce risk of malpractice to kids

The American Academy of Pediatrics (AAP) has revised its patient safety guidelines to reduce unintended harm to children by the healthcare system.

Noting that national awareness of patient safety risks has grown in this decade, Marlene Miller, MD, and AAP colleagues write in the June issue of Pediatrics that “the depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to uncover a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification.”

As technology evolves and medical advances become increasingly complex, the risk of causing unintentional medical harm has also increased, they write, pointing to studies that show seven failures to prevent a clinically important deterioration per 100 hospitalized children, 100 prescribing errors per 1000 children seen in an emergency room, and three preventable adverse drug events per 100 children seen in pediatric practices.

"The field of pediatric patient safety has matured much in recent years; there are now more robust epidemiology of errors for children, a deep understanding of the concept and measurement of a culture of safety, clear guidance on key elements of patient-safety solutions and introduction of successful pediatric patient-safety solutions," the article says.

"Nonetheless, continued work is needed to infuse these data and concepts into everyday pediatric practice for all clinicians, and special attention should be paid to the training of new clinicians to ensure that the future workforce can exercise all the tenets of pediatric patient safety as part of their everyday work life.

The new AAP patient safety recommendations aim to:

Expand efforts to educate clinicians, ensuring that they can all identify pediatric patient-safety issues and know how to improve them individually and within healthcare systems.

Create a safety culture by challenging all organizations, including small practices, to implement a pediatric patient safety plan that informs, supports and educates using appropriate local examples.

Develop patient-safety metrics for the ambulatory settings, where most children in the U.S. primarily interact with the healthcare system (though most patient safety work to date has been in hospitals).

Develop and support broad-scale pediatric error-reporting systems and analysis of reported events.

Comply with proven best practices for improving pediatric patient safety to enhance pediatric healthcare outcomes.

Target drug safety by advocating for the development of effective and safe pediatric medications and formulations and for withdrawal of medications with unfavorable risk/benefit ratios.

Educate clinicians on strategies to reduce medication errors by ensuring that they maintain access to and proficiency in the use of a comprehensive and current pharmaceutical knowledge base.

Source: Medscape

You can read the full text of the AAP statement here.

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