The Experts below are selected from a list of 85794 Experts worldwide ranked by ideXlab platform
Virginia Schmied - One of the best experts on this subject based on the ideXlab platform.
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Australian general practitioners’ perspectives on their role in Well-Child health Care
BMC Family Practice, 2013Co-Authors: Adrian Jeyendra, Jeremy Rajadurai, Joanna Chanmugam, Alan Trieu, Suraj Nair, Radheshan Baskaran, Virginia SchmiedAbstract:Background In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health Care for the Well-Child. However, the role of the GP in Well-Child health Care is not Well understood in Australia. The aim of this study was to describe the role of the GP in providing services for Well-Children and families in Australia. Methods This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of Well-Child health Care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Results Five main themes were identified in the analysis: ‘prevention is better than cure’, ‘health promotion: the key messages’, ‘working with families’, ‘working with other health professionals’, and ‘barriers to the delivery of Well-Child health services’. Conclusions Participating GPs had a predominantly preventative focus, but in the main Well-Child Care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of Children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of Care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal Child and family health nursing services that have Well Children and families as their prime focus.
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australian general practitioners perspectives on their role in Well Child health Care
BMC Family Practice, 2013Co-Authors: Adrian Jeyendra, Jeremy Rajadurai, Joanna Chanmugam, Alan Trieu, Suraj Nair, Radheshan Baskaran, Virginia SchmiedAbstract:In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health Care for the Well-Child. However, the role of the GP in Well-Child health Care is not Well understood in Australia. The aim of this study was to describe the role of the GP in providing services for Well-Children and families in Australia. This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of Well-Child health Care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Five main themes were identified in the analysis: ‘prevention is better than cure’, ‘health promotion: the key messages’, ‘working with families’, ‘working with other health professionals’, and ‘barriers to the delivery of Well-Child health services’. Participating GPs had a predominantly preventative focus, but in the main Well-Child Care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of Children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of Care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal Child and family health nursing services that have Well Children and families as their prime focus.
Tumaini R Coker - One of the best experts on this subject based on the ideXlab platform.
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feasibility and acceptability in a community partnered implementation of centeringparenting for group Well Child Care
Academic Pediatrics, 2018Co-Authors: Kai A Jones, Sandra Contreras, Paul J Chung, Lorena Porrasjavier, Tumaini R CokerAbstract:Abstract Background In a community-academic partnership, we implemented a group-based model for Well-Child Care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC). Methods The FQHC implemented CenteringParenting for all WCC visits in the first year of life, starting at the 2-week visit. Over a 14-month time period, parents from each new CenteringParenting group were enrolled into the study. Baseline data were collected at enrollment (infant age Results Of the 40 parent-infant dyads enrolled in the pilot, 28 CenteringParenting participants completed the 6-month follow-up assessment. The majority of infants were Latino, black, or “other” race/ethnicity; over 90% were Medicaid insured. Of the 28 CenteringParenting participants who completed the 6-month follow-up, 25 completed all visits between ages 2 weeks and 6 months in the CenteringParenting group. Of the CenteringParenting participants, 97% to 100% reported having adequate time with their provider and sufficient patient education and having their needs met at visits; most reported feeling comfortable at the group visit, and all reported wanting to continue CenteringParenting for their WCC. CenteringParenting participants’ mean scores on exploratory measures demonstrated positive experiences of Care, overall satisfaction of Care, confidence in parenting, and parental social support. Conclusions A community-academic partnership implemented CenteringParenting; the intervention was acceptable and feasible for a minority, low-income population. We highlight key challenges of implementation.
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a parent coach model for Well Child Care among low income Children a randomized controlled trial
Pediatrics, 2016Co-Authors: Christina Bethell, Tumaini R Coker, Sandra Chacon, Marc N Elliott, Yovana Bruno, Toni Chavis, Christopher Biely, Sandra Contreras, Naomi A MimilaAbstract:OBJECTIVE: The goal of this study was to examine the effects of a new model for Well-Child Care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health Care utilization among low-income families. METHODS: PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each Well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey–PLUS was used to assess receipt of recommended WCC services at 12 months’ postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS: A total of 251 parents with a Child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean Child age at enrollment was 4.5 months; 64% had an annual household income less than $20 000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive Care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of Care measures (family-centeredness, helpfulness, and overall rating of Care). Fifty-two percent fewer intervention Children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent Care utilization. CONCLUSIONS: A parent coach–led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.
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Well Child Care clinical practice redesign for serving low income Children
Pediatrics, 2014Co-Authors: Tumaini R Coker, Mark A. Schuster, Candice Moreno, Paul G Shekelle, Paul J ChungAbstract:Our objective was to conduct a rigorous, structured process to create a new model of Well-Child Care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured Children. Working groups of clinicians, staff, and parents (called “Community Advisory Boards” [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for Children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non–face-to-face methods (text, phone) for parent communication with the health Care team are also critical to these new models of Care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as Well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.
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Well Child Care clinical practice redesign for young Children a systematic review of strategies and tools
Pediatrics, 2013Co-Authors: Mark A. Schuster, Tumaini R Coker, Candice Moreno, Annika Windon, Paul J ChungAbstract:BACKGROUND AND OBJECTIVE: Various proposals have been made to redesign Well-Child Care (WCC) for young Children, yet no peer-reviewed publication has examined the evidence for these. The objective of this study was to conduct a systematic review on WCC clinical practice redesign for Children aged 0 to 5 years. METHODS: PubMed was searched using criteria to identify relevant English-language articles published from January 1981 through February 2012. Observational studies, controlled trials, and systematic reviews evaluating efficiency and effectiveness of WCC for Children aged 0 to 5 were selected. Interventions were organized into 3 categories: providers, formats (how Care is provided; eg, non–face-to-face formats), and locations for Care. Data were extracted by independent article review, including study quality, of 3 investigators with consensus resolution of discrepancies. RESULTS: Of 275 articles screened, 33 met inclusion criteria. Seventeen articles focused on providers, 13 on formats, 2 on locations, and 1 miscellaneous. We found evidence that WCC provided in groups is at least as effective in providing WCC as 1-on-1 visits. There was limited evidence regarding other formats, although evidence suggested that non-face-to-face formats, particularly web-based tools, could enhance anticipatory guidance and possibly reduce parents’ need for clinical contacts for minor concerns between Well-Child visits. The addition of a non–medical professional trained as a developmental specialist may improve receipt of WCC services and enhance parenting practices. There was insufficient evidence on nonclinical locations for WCC. CONCLUSIONS: Evidence suggests that there are promising WCC redesign tools and strategies that may be ready for larger-scale testing and may have important implications for preventive Care delivery to young Children in the United States.
Janet R Serwint - One of the best experts on this subject based on the ideXlab platform.
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pediatric residents knowledge and comfort with oral health bright futures concepts a cornet study
Academic Pediatrics, 2015Co-Authors: Rani S Gereige, Janet R Serwint, Niramol Dhepyasuwan, Karla L Garcia, Rukmani Vasan, Henry H BernsteinAbstract:Abstract Objective Training residents in oral health helps eliminate disparities and improves access. The American Academy of Pediatrics Bright Futures Guidelines curriculum is used as a training guide. We assessed knowledge, confidence, and perceived barriers to incorporating Bright Futures oral health concepts into Well-Child Care for Children below 3 years in a national sample of pediatric residents. Methods A sample of postgraduate year 1 and 2 residents from CORNET sites completed demographic, Bright Futures oral health concepts confidence and knowledge cross-sectional surveys before any intervention. Measures were tested for reliability using Cronbach's alpha coefficient. Results One hundred sixty-three residents from 28 CORNET sites completed the surveys. One third reported no prior training in oral health. Time (42%) and knowledge (33%) led the perceived barriers to addressing these concepts in Well visits. Although 63% rated their confidence as excellent in identifying tooth decay risk factors, a significant percentage rated their oral health risk assessment skills as poor or neutral (64%) and identifying caries at examination (53%). Only 49% conveyed oral health messages during encounters and 80% correctly scored 75% or higher on knowledge questions. Conclusions This cross-sectional study shows that residents from a wide geographic range have high self-reported oral health knowledge but low perceived skills and competency in clinical implementation. Lack of time and knowledge in identifying caries led the perceived barriers. Barriers are addressed by implementing oral health curricula that promote competence and skill-development. This study helps programs effectively implement Bright Futures concepts to train graduates to incorporate oral health in Well visits.
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secondary sexual characteristics in boys data from the pediatric research in office settings network
Pediatrics, 2012Co-Authors: Marcia E Hermangiddens, Jennifer Steffes, Donna Harris, Michael A Hussey, Steven A Dowshen, Richard C Wasserman, Janet R Serwint, Eric J SloraAbstract:BACKGROUND: Data from racially and ethnically diverse US boys are needed to determine ages of onset of secondary sexual characteristics and examine secular trends. Current international studies suggest earlier puberty in boys than previous studies, following recent trend in girls. METHODS: Two hundred and twelve practitioners collected Tanner stage and testicular volume data on 4131 boys seen for Well-Child Care in 144 pediatric offices across the United States. Data were analyzed for prevalence and mean ages of onset of sexual maturity markers. RESULTS: Mean ages for onset of Tanner 2 genital development for non-Hispanic white, African American, and Hispanic boys were 10.14, 9.14, and 10.04 years and for stage 2 pubic hair, 11.47, 10.25, and 11.43 years respectively. Mean years for achieving testicular volumes of ≥3 mL were 9.95 for white, 9.71 for African American, and 9.63 for Hispanic boys; and for ≥4 mL were 11.46, 11.75, and 11.29 respectively. African American boys showed earlier ( P CONCLUSIONS: Observed mean ages of beginning genital and pubic hair growth and early testicular volumes were 6 months to 2 years earlier than in past studies, depending on the characteristic and race/ethnicity. The causes and public health implications of this apparent shift in US boys to a lower age of onset for the development of secondary sexual characteristics in US boys needs further exploration.
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improving the management of family psychosocial problems at low income Children s Well Child Care visits the we Care project
Pediatrics, 2007Co-Authors: Arvin Garg, Arlene Manns Butz, Paul H Dworkin, Rooti A Lewis, Richard E Thompson, Janet R SerwintAbstract:OBJECTIVE: Our goal was to evaluate the feasibility and impact of an intervention on the management of family psychosocial topics at Well-Child Care visits at a medical home for low-income Children. PATIENTS AND METHODS: A randomized, controlled trial of a 10-item self-report psychosocial screening instrument was conducted at an urban hospital-based pediatric clinic. Pediatric residents and parents were randomly assigned to either the intervention or control group. During a 12-week period, parents of Children aged 2 months to 10 years presenting for a Well-Child Care visit were enrolled. The intervention components included provider training, administration of the family psychosocial screening tool to parents before the visit, and provider access to a resource book that contained community resources. Parent outcomes were obtained from postvisit and 1-month interviews, and from medical chart review. Provider outcomes were obtained from a self-administered questionnaire collected after the study. RESULTS: Two hundred parents and 45 residents were enrolled. Compared with the control group, parents in the intervention group discussed a significantly greater number of family psychosocial topics (2.9 vs 1.8) with their resident provider and had fewer unmet desires for discussion (0.46 vs 1.41). More parents in the intervention group received at least 1 referral (51.0% vs 11.6%), most often for employment (21.9%), graduate equivalent degree programs (15.3%), and smoking-cessation classes (14.6%). After controlling for Child age, Medicaid status, race, educational status, and food stamps, intervention parents at 1 month had greater odds of having contacted a community resource. The majority of residents in the intervention group reported that the survey instrument did not slow the visit; 54% reported that it added <2 minutes to the visit. CONCLUSIONS: Brief family psychosocial screening is feasible in pediatric practice. Screening and provider training may lead to greater discussion of topics and contact of community family support resources by parents. Language: en
Adrian Jeyendra - One of the best experts on this subject based on the ideXlab platform.
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Australian general practitioners’ perspectives on their role in Well-Child health Care
BMC Family Practice, 2013Co-Authors: Adrian Jeyendra, Jeremy Rajadurai, Joanna Chanmugam, Alan Trieu, Suraj Nair, Radheshan Baskaran, Virginia SchmiedAbstract:Background In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health Care for the Well-Child. However, the role of the GP in Well-Child health Care is not Well understood in Australia. The aim of this study was to describe the role of the GP in providing services for Well-Children and families in Australia. Methods This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of Well-Child health Care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Results Five main themes were identified in the analysis: ‘prevention is better than cure’, ‘health promotion: the key messages’, ‘working with families’, ‘working with other health professionals’, and ‘barriers to the delivery of Well-Child health services’. Conclusions Participating GPs had a predominantly preventative focus, but in the main Well-Child Care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of Children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of Care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal Child and family health nursing services that have Well Children and families as their prime focus.
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australian general practitioners perspectives on their role in Well Child health Care
BMC Family Practice, 2013Co-Authors: Adrian Jeyendra, Jeremy Rajadurai, Joanna Chanmugam, Alan Trieu, Suraj Nair, Radheshan Baskaran, Virginia SchmiedAbstract:In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health Care for the Well-Child. However, the role of the GP in Well-Child health Care is not Well understood in Australia. The aim of this study was to describe the role of the GP in providing services for Well-Children and families in Australia. This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of Well-Child health Care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Five main themes were identified in the analysis: ‘prevention is better than cure’, ‘health promotion: the key messages’, ‘working with families’, ‘working with other health professionals’, and ‘barriers to the delivery of Well-Child health services’. Participating GPs had a predominantly preventative focus, but in the main Well-Child Care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of Children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of Care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal Child and family health nursing services that have Well Children and families as their prime focus.
Paul J Chung - One of the best experts on this subject based on the ideXlab platform.
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feasibility and acceptability in a community partnered implementation of centeringparenting for group Well Child Care
Academic Pediatrics, 2018Co-Authors: Kai A Jones, Sandra Contreras, Paul J Chung, Lorena Porrasjavier, Tumaini R CokerAbstract:Abstract Background In a community-academic partnership, we implemented a group-based model for Well-Child Care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC). Methods The FQHC implemented CenteringParenting for all WCC visits in the first year of life, starting at the 2-week visit. Over a 14-month time period, parents from each new CenteringParenting group were enrolled into the study. Baseline data were collected at enrollment (infant age Results Of the 40 parent-infant dyads enrolled in the pilot, 28 CenteringParenting participants completed the 6-month follow-up assessment. The majority of infants were Latino, black, or “other” race/ethnicity; over 90% were Medicaid insured. Of the 28 CenteringParenting participants who completed the 6-month follow-up, 25 completed all visits between ages 2 weeks and 6 months in the CenteringParenting group. Of the CenteringParenting participants, 97% to 100% reported having adequate time with their provider and sufficient patient education and having their needs met at visits; most reported feeling comfortable at the group visit, and all reported wanting to continue CenteringParenting for their WCC. CenteringParenting participants’ mean scores on exploratory measures demonstrated positive experiences of Care, overall satisfaction of Care, confidence in parenting, and parental social support. Conclusions A community-academic partnership implemented CenteringParenting; the intervention was acceptable and feasible for a minority, low-income population. We highlight key challenges of implementation.
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Well Child Care clinical practice redesign for serving low income Children
Pediatrics, 2014Co-Authors: Tumaini R Coker, Mark A. Schuster, Candice Moreno, Paul G Shekelle, Paul J ChungAbstract:Our objective was to conduct a rigorous, structured process to create a new model of Well-Child Care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured Children. Working groups of clinicians, staff, and parents (called “Community Advisory Boards” [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for Children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non–face-to-face methods (text, phone) for parent communication with the health Care team are also critical to these new models of Care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as Well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.
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Well Child Care clinical practice redesign for young Children a systematic review of strategies and tools
Pediatrics, 2013Co-Authors: Mark A. Schuster, Tumaini R Coker, Candice Moreno, Annika Windon, Paul J ChungAbstract:BACKGROUND AND OBJECTIVE: Various proposals have been made to redesign Well-Child Care (WCC) for young Children, yet no peer-reviewed publication has examined the evidence for these. The objective of this study was to conduct a systematic review on WCC clinical practice redesign for Children aged 0 to 5 years. METHODS: PubMed was searched using criteria to identify relevant English-language articles published from January 1981 through February 2012. Observational studies, controlled trials, and systematic reviews evaluating efficiency and effectiveness of WCC for Children aged 0 to 5 were selected. Interventions were organized into 3 categories: providers, formats (how Care is provided; eg, non–face-to-face formats), and locations for Care. Data were extracted by independent article review, including study quality, of 3 investigators with consensus resolution of discrepancies. RESULTS: Of 275 articles screened, 33 met inclusion criteria. Seventeen articles focused on providers, 13 on formats, 2 on locations, and 1 miscellaneous. We found evidence that WCC provided in groups is at least as effective in providing WCC as 1-on-1 visits. There was limited evidence regarding other formats, although evidence suggested that non-face-to-face formats, particularly web-based tools, could enhance anticipatory guidance and possibly reduce parents’ need for clinical contacts for minor concerns between Well-Child visits. The addition of a non–medical professional trained as a developmental specialist may improve receipt of WCC services and enhance parenting practices. There was insufficient evidence on nonclinical locations for WCC. CONCLUSIONS: Evidence suggests that there are promising WCC redesign tools and strategies that may be ready for larger-scale testing and may have important implications for preventive Care delivery to young Children in the United States.
