The Experts below are selected from a list of 83784 Experts worldwide ranked by ideXlab platform
Karen G Oconnor - One of the best experts on this subject based on the ideXlab platform.
-
vaccine delays refusals and patient dismissals a survey of Pediatricians
Pediatrics, 2016Co-Authors: Catherine Houghtelford, David W Kimberlin, Inmaculada Aban, William P Hitchcock, Jon R Almquist, Richard Kratz, Karen G OconnorAbstract:BACKGROUND: Parental noncompliance with the American Academy of Pediatrics and Centers for Disease Control and Prevention immunization schedule is an increasing public health concern. We examined the frequency of requests for vaccine delays and refusals and the impact on US Pediatricians’ behavior. METHODS: Using national American Academy of Pediatrics Periodic Surveys from 2006 and 2013, we describe pediatrician perceptions of prevalence of (1) vaccine refusals and delays, (2) parental reasons for refusals and/or delays, and (3) physician dismissals. Questions about vaccine delays were asked only in 2013. We examined the frequency, reasons for, and management of both vaccine refusals and delays by using bivariate and multivariable analyses, which were controlled for practice characteristics, demographics, and survey year. RESULTS: The proportion of Pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 ( P P = .002). A total of 75.0% of Pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of Pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% ( P = .004). CONCLUSIONS: Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.
-
do on site mental health professionals change Pediatricians responses to children s mental health problems
Academic Pediatrics, 2016Co-Authors: Sarah M Horwitz, Karen G Oconnor, Andrew S. Garner, Amy Storferisser, Bonnie D Kerker, Moira Szilagyi, Kimberly Hoagwood, Cori Green, Jane Meschan FoyAbstract:Abstract Objective To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to Pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems. Methods Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and Pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed. Results Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, Conclusions On-site MHPs are more frequent in settings where low-income children are served and where Pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of Pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.
-
changes in language services use by us Pediatricians
Pediatrics, 2013Co-Authors: Lisa Ross Decamp, Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:BACKGROUND AND OBJECTIVES: Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US Pediatricians in 2004 and 2010 and examined variation in use in 2010 by pediatrician, practice, and state characteristics. METHODS: We used data from 2 national surveys of Pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency Pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of Pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children’s Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS: Most Pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of Pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24–4.40). CONCLUSIONS: US Pediatricians’ use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use. * Abbreviations: AAP — : American Academy of Pediatrics CHIP — : Children’s Health Insurance Program CLAS standards — : National Standards for Culturally and Linguistically Appropriate Services LEP — : limited English proficiency
-
Pediatricians use of language services for families with limited english proficiency
Pediatrics, 2007Co-Authors: Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:OBJECTIVES. Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about Pediatricians9 use of language services. The objective of this study was to examine Pediatricians9 provision of language services to patients with limited English proficiency and the pediatrician, practice, and state characteristics associated with use of these services. METHODS. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. RESULTS. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. CONCLUSIONS. Most Pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.
-
pediatrician characteristics associated with child abuse identification and reporting results from a national survey of Pediatricians
Child Maltreatment, 2006Co-Authors: Emalee G Flaherty, Robert D Sege, Lori Lyn Price, Katherine Kaufer Christoffel, D P Norton, Karen G OconnorAbstract:Pediatrician experience with child protective services (CPS) and factors associated with identifying and reporting suspected child physical abuse were examined by a survey of members of the American Academy of Pediatrics (AAP). Respondents provided information about their demographics and experience, attitudes and practices with child abuse. They indicated their diagnosis and management of a child in a purposely ambiguous clinical vignette. Pediatricians who had received recent child abuse education were more confident in their ability to identify and manage child abuse. High confidence in ability to manage child abuse and positive attitude about domestic violence screening and value of anticipatory guidance predicted that Pediatricians would have high suspicion that the child in the vignette was abused and that they would report the child to CPS. Future efforts to improve medical intervention in child abuse should focus on physician attitudes and experience, as well as cognitive factors.
Cynthia S Minkovitz - One of the best experts on this subject based on the ideXlab platform.
-
changes in language services use by us Pediatricians
Pediatrics, 2013Co-Authors: Lisa Ross Decamp, Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:BACKGROUND AND OBJECTIVES: Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US Pediatricians in 2004 and 2010 and examined variation in use in 2010 by pediatrician, practice, and state characteristics. METHODS: We used data from 2 national surveys of Pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency Pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of Pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children’s Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS: Most Pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of Pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24–4.40). CONCLUSIONS: US Pediatricians’ use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use. * Abbreviations: AAP — : American Academy of Pediatrics CHIP — : Children’s Health Insurance Program CLAS standards — : National Standards for Culturally and Linguistically Appropriate Services LEP — : limited English proficiency
-
Pediatricians use of language services for families with limited english proficiency
Pediatrics, 2007Co-Authors: Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:OBJECTIVES. Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about Pediatricians9 use of language services. The objective of this study was to examine Pediatricians9 provision of language services to patients with limited English proficiency and the pediatrician, practice, and state characteristics associated with use of these services. METHODS. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. RESULTS. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. CONCLUSIONS. Most Pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.
Dennis Z Kuo - One of the best experts on this subject based on the ideXlab platform.
-
changes in language services use by us Pediatricians
Pediatrics, 2013Co-Authors: Lisa Ross Decamp, Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:BACKGROUND AND OBJECTIVES: Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US Pediatricians in 2004 and 2010 and examined variation in use in 2010 by pediatrician, practice, and state characteristics. METHODS: We used data from 2 national surveys of Pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency Pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of Pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children’s Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS: Most Pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of Pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24–4.40). CONCLUSIONS: US Pediatricians’ use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use. * Abbreviations: AAP — : American Academy of Pediatrics CHIP — : Children’s Health Insurance Program CLAS standards — : National Standards for Culturally and Linguistically Appropriate Services LEP — : limited English proficiency
-
Pediatricians use of language services for families with limited english proficiency
Pediatrics, 2007Co-Authors: Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:OBJECTIVES. Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about Pediatricians9 use of language services. The objective of this study was to examine Pediatricians9 provision of language services to patients with limited English proficiency and the pediatrician, practice, and state characteristics associated with use of these services. METHODS. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. RESULTS. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. CONCLUSIONS. Most Pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.
David M Krol - One of the best experts on this subject based on the ideXlab platform.
-
educating Pediatricians on children s oral health past present and future
Pediatrics, 2004Co-Authors: David M KrolAbstract:Objective. The American Academy of Pediatrics (AAP) policy Oral Health Risk Assessment Timing and Establishment of the Dental Home encourages Pediatricians to play an important role in the oral health of children. The purpose of this study was to determine how well Pediatricians are prepared to play the AAP suggested role in children9s oral health by examining the oral health content of their educational process. Methods. This article reviews current medical education guidelines, programs, surveys, and pediatrician experiences in oral health training at the undergraduate, graduate, and continuing medical education levels. Results. Although some medical schools, residency programs, and continuing medical education efforts do include oral health in their curricula, the practice is not widespread. Professional and oversight organizations such as the Association of American Medical Colleges, the Council on Medical Student Education in Pediatrics, Association of Pediatric Program Directors, AAP, and the pediatric Residency Review Committee do not include oral health in key guidelines and surveys of the medical education continuum. When surveyed, Pediatricians state that the time spent on oral health education at each level of training is inadequate. Conclusions. Overall, the level of oral health training for Pediatricians at the undergraduate, graduate, and continuing medical education levels is inadequate to provide Pediatricians with the competencies required for the provision of quality oral health care to children. Despite this inadequacy, educational efforts are under way and various tools and guidelines are available in a few locations. In addition, numerous opportunities exist for the organizations responsible for pediatrician education to ensure that curricula are designed and adopted to achieve these competencies, faculty are trained to teach these competencies, and program accreditation and certification are closely linked to acquisition of these competencies. Ensuring the success of such efforts will require cooperation between many organizations and disciplines and a genuine commitment to improve pediatric education and medical care for children.
Louis Ostrowsky - One of the best experts on this subject based on the ideXlab platform.
-
availability of outpatient mental health care by Pediatricians and child psychiatrists in five u s cities
International Journal of Health Services, 2017Co-Authors: Shireen Cama, Monica Malowney, Anna Jo Bodurtha Smith, Margaret Spottswood, Elisa Cheng, Louis OstrowskyAbstract:The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual Pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the Pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. Providers were less likely to have available appointments for children on Medicaid, which is public insurance for low-income people. The ...