Thursday, July 25th, 2013
A growing number of retail stores are offering pediatric care services, examining kids with minor health issues and saving parents a trip to the doctor’s office. A new study published in the journal JAMA Pediatrics is taking a closer look at whether these retail clinics are as effective as they are convenient. More from Time.com:
Researchers from Washington University School of Medicine, St. Louis report that even families with well-established relationships with a pediatrician take advantage of pediatric retail clinics to take care of their children’s minor health issues, even if they are staffed with non-pediatric health care personnel.
Why? The researchers surveyed 1,484 parents from 19 Midwestern pediatric practices who said that they took their kids to the clinics out of convenience; 74% of the parents said they first considered going to their pediatrician, but 37% decided on the retail clinic because it had hours that conformed better with their schedules.
In a corresponding editorial, Dr. Edward Schor of the Lucille Packard Foundation for Children’s Health in Palo Alto, California wrote that such decisions may become more commonplace: “Retail-based clinics reflect systemic changes occurring within the health care industry to which pediatric practices must adapt.” Retail clinics, which are typically run by nurse practitioners and physician assistants, are not only convenient, but cost patients about 30% to 40% less than office practices. Most of these clinics are located in retail pharmacy stores, while others are operated by hospitals or doctors’ groups.
The lower cost and increased convenience of the clinics are putting pediatricians on the defensive, and the American Academy of Pediatrics (AAP) formally opposes them as an appropriate venue for care of infants and children. AAP officials question the quality of care patients receive, stemming from the fact that children may see different practitioners at each visit.
Image: Mother and child at pharmacy, via Shutterstock
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Wednesday, January 16th, 2013
Parents who offer their children complementary and alternative medical therapies including acupuncture, herbal supplements, and chiropractic care, are not necessarily forthcoming about those practices with their pediatricians, a new study published in the journal Pediatrics has found. Sharing more information with pediatricians would, however, benefit children, parents, and doctors alike, as CNN reports:
The most commonly used CAM therapies included massage, faith healing, chiropractic and aromatherapy, while the most popular products to treat conditions ranging from cancer to asthma and inflammatory bowel disease were vitamins and minerals, herbal remedies and homeopathic medicines.
“Whether we’re looking at the general population or at children’s hospitals, it seems that complementary medicine use is extremely common,” says Dr. Sunita Vohra, lead author of the study and a pediatrician who is chair of the section on integrated medicine for the American Academy of Pediatrics.
In the United States, a recent survey found that one in nine children had used alternative therapies to treat a health condition.
Vohra says parents’ own beliefs about and reliance on CAM therapies is a major factor behind its use in children, as is parents’ desire to provide their children with every possible health option.
“For most parents, their number one priority is the health of their children so they’re interested in exploring all options to promote their children’s health,” says Vohra. “Many parents consider all products that are available and seek out not only conventional health care but also complementary health care.”
With CAM being used by so many children, however, she and her colleagues say it’s time for pediatricians to do a better job of discussing the safety and efficacy of the therapies with parents.
“Given the rates of use, we would like to encourage all health care providers to ask about complementary therapies and we encourage all parents to tell,” says Vohra. “In many cases, it’s not discussed because parents think doctors won’t support them, but it’s far better to have an open discussion.”
Such discussions can avoid potentially harmful interactions between conventional medicines and herbal remedies, for example, or other incompatibilities that can worsen, rather than improve, symptoms. In the study, parents reported 80 adverse effects, most of which were described as minor.
Most parents, says Vohra, will deny that their children are taking alternative therapies, even if they are — and not because they want to intentionally deceive their doctors.
“They don’t think of herbs as medicine,” says Vohra. “So doctors should ask parents, ‘What are all the therapies, including complementary medicines, that your child is taking?’”
Image: Acupuncture, via Shutterstock
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Wednesday, October 10th, 2012
A growing trend in pediatric care may be in the technology devices teenagers carry with them everywhere they go: doctors are using text messaging and other communication strategies to communicate better with their patients. From The New York Times:
But using social media also raises questions about doctor-patient boundaries, privacy laws and confidentiality. Should doctors “friend” young patients on Facebook? What rules should doctors establish about texting with teenagers: content, hours and expectations of speedy replies? How should doctors take into account the reality that teenagers’ cellphones are often missing in action, only to be found — and pored over — by friends and parents?
For these reasons, many doctors stop short of texting. Because texting is not encrypted and does not comply with privacy laws, “my clinic rules forbid me,” said Dr. Wendy Sue Swanson, a pediatrician who treats teenagers at the Everett Clinic, which is outside Seattle, and at Seattle Children’s Hospital.
But teenagers follow her on Twitter and her Seattle Mama Doc blog, on which she writes commentary and posts health news and videos.
During visits, she will ask a teenager the safest way to pass along private information. For those on birth control, she’ll say, “Take out your cellphone and put in a daily alarm about when to take your pill. Call it…‘strawberry.’ ”
Dr. Swanson won’t answer individual questions on her blog. “But if they ask a question in my office that I think a lot of teens would like to know about,” she added, “I can put the content on the blog without identifying the patient.”
In New York, Mount Sinai Hospital’s Adolescent Health Center uses a program called Text in the City to send patients tips and reminders about medications and appointments. Patients can also text questions, understanding that answers may not arrive for 24 hours. Dr. Katie Malbon, who writes most of the responses, said she cautions: delete an answer after reading it….
….But many doctors cannot imagine adding social media responsibilities to an already exhausting practice. Dr. [Natasha] Burgert, 36, is a juggernaut: With two children, she has a busy practice, keeps a blog on her group’s Web site, posts Twitter messages, texts her teenage patients and still sticks to an 8-to-5 workday.
She carries a paper notebook to jot reminders, and spends 15 minutes a day sending texts and e-mails. It saves her hours of phone tag with patients.
The teenagers don’t overload her with exchanges, she said. “They understand it is a privilege, that not all physicians will do this. Actually, I have more problems with first-time parents.”
Image: Doctor texting, via Shutterstock
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Thursday, September 27th, 2012
While most parents whose low income qualifies them for health coverage through Medicaid fill prescriptions for antibiotics and other medications for acute illnesses, many fail to fill pediatricians’ orders for vitamin and mineral supplements, a new study has found. Reuters Health reports:
Antibiotics and other drugs for infections were filled 91 percent of the time, versus 65 percent of prescriptions for vitamins and minerals, for example.
“When your child has an ear infection and is in pain, you have much more of a sense of urgency,” [lead researcher Dr. Rachael] Zweigoron [of the Medical University of South Carolina in Charleston] said. But if a doctor recommends a vitamin D or iron supplement, she added, parents might not see the immediate need.
That raises the question of whether parents always know why a pediatrician has prescribed a medication or supplement. “Are we, as pediatricians, doing a good enough job of explaining the importance to parents?” Zweigoron said.
The findings, which appear in the journal Pediatrics, are based on 4,833 kids seen over two years at two clinics connected to Lurie Children’s Hospital of Chicago.
All of the children were on Medicaid, the government health insurance program for the poor. So it’s not clear if the findings would be the same for U.S. kids with private insurance.
Image: Child taking medicine, via Shutterstock
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Thursday, February 16th, 2012
A growing number of pediatricians are refusing to treat families who choose not to vaccinate their children, according to a report in the Wall Street Journal.
Medical associations such as the American Academy of Pediatrics don’t recommend that doctors “fire” families who opt out of vaccines. Instead they encourage pediatricians to bring the topic up at multiple visits but continue to work with families. Yet research shows that it’s increasingly common for practices to push these patients out.
From the Wall Street Journal:
In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.
By comparison, in 2001 and 2006 about 6% of physicians said they “routinely” stopped working with families due to parents’ continued vaccine refusal and 16% “sometimes” dismissed them, according to surveys conducted then by the American Academy of Pediatrics.
Many pediatricians see administering vaccines as one of their main duties in keeping children healthy, and say it’s difficult to work with families when parents and doctors don’t see eye-to-eye on this key issue.
Pediatrician Allan LaReaux of Kalamazoo, Mich., stopped treating non-vaccinating families in 2010, in part because he worries that children who have not been immunized could make others in the waiting room sick. From the Journal:
“You feel badly about losing a nice family from the practice,” [said] Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated.
Pamela Felice, an Atlanta mom whose family was dismissed by their pediatrician for refusing vaccines says it’s been difficult to find another doctor. One of her children has gastrointestinal problems and regressed development that she believes is related to immunizations. At least four practices have denied them a first appointment when Felice explains her opposition to vaccines.
What do you think? Do doctors have a responsibility to treat patients even if they refuse vaccines?
Image: Doctor, baby and mom via Shutterstock.
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