Pediatrician preferences, local resources, and economic factors influence referral to a subspecialty access clinic

BackgroundPediatric patients seek timely access to subspecialty care within a complex delivery system while facing barriers: distance, economics, and clinician shortages.AimWe examined stakeholder perceptions about solutions to the access challenge. We engaged over 300 referring primary care pediatricians in the evaluation of Access Clinics at an academic children’s hospital.MethodsUsing an anonymous online survey, we asked pediatricians about their and their patients’ experiences and analyzed factors that may influence referrals.FindingsReferring pediatricians reported satisfaction; they provided feedback about their patients’ experiences, physician communication, and referral influences. Distance from the Access Clinic does not correlate with differences in referral volume; living in areas with higher child populations and higher median income is associated with more referrals. Referring pediatricians have strong opinions about referrals, are attuned to patient experiences, and desire bi-directional communication. Multiple factors influence referral to and acceptance of Access Clinics, but external influences have less impact than expected.

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A Revised Model of Trust in Internet-Based Health Information and Advice: Cross-Sectional Questionnaire Study

Journal of Medical Internet Research ◽

10.2196/11125 ◽

2019 ◽

Vol 21 (11) ◽

pp. e11125

Author(s):

Elizabeth Sillence ◽

John Matthew Blythe ◽

Pam Briggs ◽

Mark Moss

Keyword(s):

Goodness Of Fit ◽

Online Survey ◽

Patient Experiences ◽

Model Fit ◽

Key Factors ◽

The United Kingdom ◽

Personal Experiences ◽

And Coping ◽

Fit Index ◽

Significant Direct Effect

Background The internet continues to offer new forms of support for health decision making. Government, charity, and commercial websites increasingly offer a platform for shared personal health experiences, and these are just some of the opportunities that have arisen in a largely unregulated arena. Understanding how people trust and act on this information has always been an important issue and remains so, particularly as the design practices of health websites continue to evolve and raise further concerns regarding their trustworthiness. Objective The aim of this study was to identify the key factors influencing US and UK citizens’ trust and intention to act on advice found on health websites and to understand the role of patient experiences. Methods A total of 1123 users took part in an online survey (625 from the United States and 498 from the United Kingdom). They were asked to recall their previous visit to a health website. The online survey consisted of an updated general Web trust questionnaire to account for personal experiences plus questions assessing key factors associated with trust in health websites (information corroboration and coping perception) and intention to act. We performed principal component analysis (PCA), then explored the relationship between the factor structure and outcomes by testing the fit to the sampled data using structural equation modeling (SEM). We also explored the model fit across US and UK populations. Results PCA of the general Web trust questionnaire revealed 4 trust factors: (1) personal experiences, (2) credibility and impartiality, (3) privacy, and (4) familiarity. In the final SEM model, trust was found to have a significant direct effect on intention to act (beta=.59; P<.001), and of the trust factors, only credibility and impartiality had a significant direct effect on trust (beta=.79; P<.001). The impact of personal experiences on trust was mediated through information corroboration (beta=.06; P=.04). Variables specific to electronic health (eHealth; information corroboration and coping) were found to substantially improve the model fit, and differences in information corroboration were found between US and UK samples. The final model accounting for all factors achieved a good fit (goodness-of-fit index [0.95], adjusted goodness-of-fit index [0.93], root mean square error of approximation [0.50], and comparative fit index [0.98]) and explained 65% of the variance in trust and 41% of the variance in intention to act. Conclusions Credibility and impartiality continue to be key predictors of trust in eHealth websites. Websites with patient experiences can positively influence trust but only if users first corroborate the information through other sources. The need for corroboration was weaker in the United Kingdom, where website familiarity reduced the need to check information elsewhere. These findings are discussed in relation to existing trust models, patient experiences, and health literacy.

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Factors that influence mothers’ prenatal decision to breastfeed in Spain

International Breastfeeding Journal ◽

10.1186/s13006-020-00341-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ana Ballesta-Castillejos ◽

Juan Gómez-Salgado ◽

Julián Rodríguez-Almagro ◽

Inmaculada Ortiz-Esquinas ◽

Antonio Hernández-Martínez

Keyword(s):

Online Survey ◽

Maternal Education ◽

Binary Logistic Regression ◽

Ethics Committee ◽

Cross Sectional ◽

Factors Associated ◽

Online Study ◽

Multiple Factors ◽

Intention To Breastfeed ◽

Significant Factors

Abstract Background Parents’ decisions about how to feed their newborns are influenced by multiple factors. Our objective was to identify the factors that can influence the decision to breastfeed. Methods Cross-sectional observational online study was conducted in Spain on women who gave birth between 2013 and 2018. The total number of participants was 5671. Data collection was after approval by the ethics committee in 2019. The data were collected retrospectively because the information was obtained from women who were mothers during the years 2013–2018. An online survey was distributed to breastfeeding associations and postpartum groups. Multivariate analysis with binary logistic regression was done to calculate the Adjusted Odds Ratios (aOR). The main result variable was “intention to breastfeed”. Results Ninety-seven percent (n = 5531) of women made the decision to breastfeed prior to giving birth. The internet played a role in deciding to breastfeed in 33.7% (n = 2047) of women, while 20.1% (n = 1110) said the same thing about their midwife. We identified five significant factors associated with the mother’s prenatal decision to breastfeed: attending maternal education (aOR 2.10; 95% CI 1.32, 3.34), having two (aOR 0.52; 95% CI 0.28, 0.99) and three children (aOR 0.24; 95% CI 0.10, 0.59), previous breastfeeding experience (aOR 6.99; 95% CI 3.46, 14.10), support from partner (aOR 1.58; 95% CI 1.09,2.28) and having a condition during pregnancy (aOR 0.62; 95% CI 0.43, 0.91). Conclusions Factors related with previous breastfeeding experience and education for mothers are decisive when it comes to making the decision to breastfeed. Given the proven influence that partners have in decision-making, it is important for them to be fully involved in the process.

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Athletic Training Services in Japan: A Comparison of the United States and Japan Based on Educational Background

Athletic Training Education Journal ◽

10.4085/1404305 ◽

2019 ◽

Vol 14 (4) ◽

pp. 305-314

Author(s):

Hideyuki “E” Izumi ◽

Yuri Hosokawa

Keyword(s):

Athletic Training ◽

Online Survey ◽

Athletic Trainers ◽

Medical Practitioner ◽

The United States ◽

Educational Background ◽

Median Income ◽

Cross Sectional ◽

Training Professionals ◽

Training Services

Context Each country has a unique history in the development of its athletic training professionals and education and credentialing systems. In Japan, the majority of athletic trainers hold a domestic credential (JSPO-AT) obtained from the Japan Sport Association (JSPO) or a US-based credential from the Board of Certification (BOC-AT). Objective To determine whether differences in demographic, professional, and educational characteristics exist between Japanese BOC-ATs and JSPO-ATs who currently practice athletic training services in Japan. Design Cross-sectional study. Setting Online survey. Patients or Other Participants Eight hundred twenty-nine Japanese athletic trainers in Japan (BOC-AT, n = 64; JSPO-AT, n = 765). Main Outcome Measure(s) Pearson's χ2 test and Fisher's exact test were used to determine differences in demographic, professional, and educational characteristics between BOC-ATs and JSPO-ATs. Results The proportion of female respondents was greater for BOC-ATs (29.7%) than for JSPO-ATs (18.7%; χ2 [1] = 4.5, P = .03). A greater proportion of BOC-ATs reported having master's degrees or higher (χ2 [3] = 81.6, P < .01). The percentage of respondents with at least 1 therapist or medical practitioner license in Japan was greater for JSPO-ATs (73.1%) than for BOC-ATs (20.3%; P < .01). The percentage of respondents with at least 1 credential in exercise, nutrition, or teaching was greater for BOC-ATs (62.5%) than for JSPO-ATs (45.2%; P < .01). A large difference was observed in the proportion of individuals who identified as therapists (JSPO-ATs = 29.8%, BOC-ATs = 6.3%; χ2 [5] = 18.9, P < .01). The median income for BOC-ATs was 401–600 million yen (US$36 500–$54 500), whereas the median income for JSPO-ATs was 0–200 million yen (US$0–$18 200). Conclusions BOC-ATs in Japan were more established than JSPO-ATs as athletic training professionals with higher educational backgrounds, while more JSPO-ATs tended to be therapists. Findings from the current study may serve as benchmark data for the athletic training profession and service characteristics in Japan.

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How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?

Clinical and Experimental Pediatrics ◽

10.3345/kjp.2019.00941 ◽

2020 ◽

Vol 63 (5) ◽

pp. 164-170 ◽

Cited By ~ 1

Author(s):

Hyo Jeong Kim

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

Neurological Examination ◽

Pediatric Patients ◽

Blood Biomarkers ◽

Neurological Outcomes ◽

Multiple Factors ◽

Response Recovery ◽

Hospital Cardiac Arrest ◽

Unmeasured Confounders

The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and counseling. A neurological examination is an important factor for prognostication, but widely used sedatives alter the neurological examination and delay the response recovery. Additional studies including electroencephalography, somatosensory-evoked potentials, brain imaging, and blood biomarkers are useful for evaluating the extent of brain injury. This review aimed to assess the usefulness of and provide practical prognostic strategy for pediatric postresuscitation patients. The principles of prognostication are that the assessment should be delayed until at least 72 hours after cardiac arrest and the assessment should be multimodal. Furthermore, multiple factors including unmeasured confounders in individual patients should be considered when applying the prognostication strategy.

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Providers and Families Weigh in on Delays to Pediatric Kidney Transplant Wait-List Activation

Progress in Transplantation ◽

10.1177/15269248211064875 ◽

2021 ◽

pp. 152692482110648

Author(s):

Cristina M. Farkas-Skiles ◽

Ashley Feinsinger ◽

Rachyl Pines ◽

Amy D. Waterman

Keyword(s):

Social Support ◽

Kidney Disease ◽

Kidney Transplant ◽

Pediatric Patients ◽

Medical Information ◽

Psychological Services ◽

Factors Affecting ◽

The Family ◽

Timely Access ◽

Mental Health Support

Introduction Timely access to kidney transplant is essential to reducing mortality of children with kidney disease. We examined factors affecting providers’ decisions to delay waitlisting, compared perceptions of important factors of providers to families, when delaying activation, and describe recommendations to improve support for pediatric patients and families to overcome waitlisting delays. Methods Using a mixed-methods design, 20 providers and 20 families of pediatric patients with kidney disease, participated in interviews and surveys. Interviews were analyzed using thematic analysis. Surveys were analyzed with descriptive statistics. Results Avoiding retransplantation, treatment nonadherence, poor psychological readiness for transplant, poor physical health, and greater need for social support were the key themes affecting providers’ decisions to delay waitlisting. At least 70% of both providers and families felt that waitlisting should be delayed until patients and families had reliable access to transportation, mental health support, and caregivers who can better understand medical information. At least 70% of families surveyed felt it was important to delay waitlisting until they had regulated blood pressure and well-managed labs. Ethical concerns emerge that waitlisting practices may contribute to disparities in access to transplant. Conclusion Providers and families agree that stabilizing the family situation and improving adherence to treatment are important reasons to delay waitlisting. However, pediatric patients facing greater disparities need easier access to psychological services, strengthened social support, access to economic resources, and stronger relationships with coordinators. Addressing patient burdens is essential for reaching more equitable listing practices.

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Cholelithiasis and cholecystitis in children and adolescents: Does this increasing diagnosis require a common guideline for pediatricians and pediatric surgeons?

BMC Gastroenterology ◽

10.1186/s12876-021-01772-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sonja Diez ◽

Hanna Müller ◽

Christel Weiss ◽

Vera Schellerer ◽

Manuel Besendörfer

Keyword(s):

Pediatric Surgery ◽

Large Scale ◽

Online Survey ◽

Pediatric Patients ◽

German Society ◽

Visceral Surgery ◽

Evidence Based ◽

Nation Wide Survey ◽

Consistent Treatment ◽

Surgery Department

Abstract Background In contrast to adults, for whom guidelines on the cholelithiasis treatment exist, there is no consistent treatment of pediatric patients with cholelithiasis throughout national and international departments, most probably due to the lack of evidence-based studies. Methods We evaluated the German management of pediatric cholelithiasis in a dual approach. Firstly, a retrospective, inter-divisional study was established, comparing diagnostics and therapy of patients of the pediatric surgery department with the management of patients aged < 25 years of the visceral surgery department in our institution over the past ten years. Secondarily, a nation-wide online survey was implemented through the German Society of Pediatric Surgery. Results Management of pediatric patients with cholelithiasis was primarily performed by pediatricians in the retrospective analysis (p < 0.001). Pediatric complicated cholelithiasis was not managed acutely in the majority of cases with a median time between diagnosis and surgery of 22 days (range 4 days–8 months vs. 3 days in visceral surgery subgroup (range 0 days–10 months), p = 0.003). However, the outcome remained comparable. The hospital’s own results triggered a nation-wide survey with a response rate of 38%. Primary pediatric medical management of patients was confirmed by 36 respondents (71%). In case of acute cholecystitis, 22% of participants perform a cholecystectomy within 24 h after diagnosis. Open questions revealed that complicated cholelithiasis is managed individually. Conclusions The management of pediatric cholelithiasis differs between various hospitals and between pediatricians and pediatric surgeons. Evidence-based large-scale population studies as well as a common guideline may represent very important tools for treating this increasing diagnosis.

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Patient and Parent Satisfaction with a Dietitian-and Nurse-Led Celiac Disease Clinic for Children at the Stollery Children’S Hospital, Edmonton, Alberta

Canadian Journal of Gastroenterology ◽

10.1155/2013/537160 ◽

2013 ◽

Vol 27 (8) ◽

pp. 463-466 ◽

Cited By ~ 18

Author(s):

Seema Rajani ◽

Jessica Sawyer-Bennett ◽

Leanne Shirton ◽

Gail DeHaan ◽

Cheryl Kluthe ◽

...

Keyword(s):

Celiac Disease ◽

Online Survey ◽

Pediatric Patients ◽

Parent Satisfaction ◽

Clinic Attendance ◽

Present Survey ◽

Disease Clinic ◽

The Mean ◽

Regular Contact

OBJECTIVE: To assess patient and parent satisfaction with a primarily nurse- and dietitian-led celiac disease clinic in a tertiary pediatric centre.METHODS: An online survey was sent to families and patients attending the Stollery Children’s Hospital’s Multidisciplinary Pediatric Celiac Clinic (Edmonton, Alberta) since 2007. The survey focused on clinic attendance, satisfaction with clinic structure, processes, and education and preference for alternatives to the current process. Respondents were asked to rank satisfaction or preference on a five-point Likert scale, with 1 being lowest and 5 being highest.RESULTS: Most satisfaction related to follow-up with serology (4.6) and with a dietitian (4.3). The most preferred changes included either meeting the entire multidisciplinary team after the biopsy (4.7), or meeting with only the dietitian and nurse after the biopsy (4.4). The preferred education resources were the Internet (4.3) and the dietitian (4.2). The mean overall satisfaction score of the Multidisciplinary Pediatric Celiac Clinic was 4.0.CONCLUSIONS: Results of the present survey suggested that patients and families value a multidisciplinary follow-up clinic for children with celiac disease. In particular, feedback based on repeat blood work and regular contact with a dietitian were highly valued. The present survey, outlining the most valued aspects of the clinic, may be useful for service delivery in other regions. In addition, it provides information on how to better support pediatric patients with celiac disease.

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Accidental Consumption of Aspartame in Phenylketonuria: Patient Experiences

Nutrients ◽

10.3390/nu13020707 ◽

2021 ◽

Vol 13 (2) ◽

pp. 707

Author(s):

Ella Newbould ◽

Alex Pinto ◽

Sharon Evans ◽

Suzanne Ford ◽

Mike O’Driscoll ◽

...

Keyword(s):

Online Survey ◽

Patient Experiences ◽

Chewing Gum ◽

Cross Sectional ◽

Policy Makers ◽

Vending Machines ◽

Sports Drinks ◽

Prescribed Medicines ◽

The Impact

Aspartame is a phenylalanine containing sweetener, added to foods and drinks, which is avoided in phenylketonuria (PKU). However, the amount of phenylalanine provided by aspartame is unidentifiable from food and drinks labels. We performed a cross-sectional online survey aiming to examine the accidental aspartame consumption in PKU. 206 questionnaires (58% female) were completed. 55% of respondents (n = 114) were adults with PKU or their parent/carers and 45% (n = 92) were parents/carers of children with PKU. 74% (n = 152/206) had consumed food/drinks containing aspartame. Repeated accidental aspartame consumption was common and more frequent in children (p < 0.0001). The aspartame containing food/drinks accidentally consumed were fizzy drinks (68%, n = 103/152), fruit squash (40%, n = 61/152), chewing gum (30%, n = 46/152), flavoured water (25%, n = 38/152), ready to drink fruit squash cartons (23%, n = 35/152) and sports drinks (21%, n = 32/152). The main reasons described for accidental consumption, were manufacturers’ changing recipes (81%, n = 123/152), inability to check the ingredients in pubs/restaurants/vending machines (59%, n = 89/152) or forgetting to check the label (32%, n = 49/152). 23% (n= 48/206) had been prescribed medicines containing aspartame and 75% (n = 36/48) said that medicines were not checked by medics when prescribed. 85% (n = 164/192) considered the sugar tax made accidental aspartame consumption more likely. Some of the difficulties for patients were aspartame identification in drinks consumed in restaurants, pubs, vending machines (77%, n = 158/206); similarities in appearance of aspartame and non-aspartame products (62%, n = 127/206); time consuming shopping/checking labels (56%, n = 115/206); and unclear labelling (55%, n = 114/206). These issues caused anxiety for the person with PKU (52%, n = 106/206), anxiety for parent/caregivers (46%, n = 95/206), guilt for parent/carers (42%, n = 87/206) and social isolation (42%, n = 87/206). It is important to understand the impact of aspartame and legislation such as the sugar tax on people with PKU. Policy makers and industry should ensure that the quality of life of people with rare conditions such as PKU is not compromised through their action.

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A Revised Model of Trust in Internet-Based Health Information and Advice: Cross-Sectional Questionnaire Study (Preprint)

10.2196/preprints.11125 ◽

2018 ◽

Author(s):

Elizabeth Sillence ◽

John Matthew Blythe ◽

Pam Briggs ◽

Mark Moss

Keyword(s):

Goodness Of Fit ◽

Online Survey ◽

Patient Experiences ◽

Model Fit ◽

Key Factors ◽

The United Kingdom ◽

Personal Experiences ◽

And Coping ◽

Fit Index ◽

Significant Direct Effect

BACKGROUND The internet continues to offer new forms of support for health decision making. Government, charity, and commercial websites increasingly offer a platform for shared personal health experiences, and these are just some of the opportunities that have arisen in a largely unregulated arena. Understanding how people trust and act on this information has always been an important issue and remains so, particularly as the design practices of health websites continue to evolve and raise further concerns regarding their trustworthiness. OBJECTIVE The aim of this study was to identify the key factors influencing US and UK citizens’ trust and intention to act on advice found on health websites and to understand the role of patient experiences. METHODS A total of 1123 users took part in an online survey (625 from the United States and 498 from the United Kingdom). They were asked to recall their previous visit to a health website. The online survey consisted of an updated general Web trust questionnaire to account for personal experiences plus questions assessing key factors associated with trust in health websites (information corroboration and coping perception) and intention to act. We performed principal component analysis (PCA), then explored the relationship between the factor structure and outcomes by testing the fit to the sampled data using structural equation modeling (SEM). We also explored the model fit across US and UK populations. RESULTS PCA of the general Web trust questionnaire revealed 4 trust factors: (1) personal experiences, (2) credibility and impartiality, (3) privacy, and (4) familiarity. In the final SEM model, trust was found to have a significant direct effect on intention to act (beta=.59; <italic>P</italic><.001), and of the trust factors, only credibility and impartiality had a significant direct effect on trust (beta=.79; <italic>P</italic><.001). The impact of personal experiences on trust was mediated through information corroboration (beta=.06; <italic>P</italic>=.04). Variables specific to electronic health (eHealth; information corroboration and coping) were found to substantially improve the model fit, and differences in information corroboration were found between US and UK samples. The final model accounting for all factors achieved a good fit (goodness-of-fit index [0.95], adjusted goodness-of-fit index [0.93], root mean square error of approximation [0.50], and comparative fit index [0.98]) and explained 65% of the variance in trust and 41% of the variance in intention to act. CONCLUSIONS Credibility and impartiality continue to be key predictors of trust in eHealth websites. Websites with patient experiences can positively influence trust but only if users first corroborate the information through other sources. The need for corroboration was weaker in the United Kingdom, where website familiarity reduced the need to check information elsewhere. These findings are discussed in relation to existing trust models, patient experiences, and health literacy.

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Kentucky Equestrians: Defining Socioeconomic Contexts for Extension Programming

Journal of Extension ◽

10.34068/joe.59.03.18 ◽

2021 ◽

Vol 59 (Summer 2021) ◽

Author(s):

Kimberly Tumlin ◽

Karin Pekarchik ◽

Steven Claas

Keyword(s):

Socioeconomic Factors ◽

Online Survey ◽

Program Design ◽

Economic Factors ◽

Financial Wellness

Understanding relationships between demographic and economic factors and equestrian participation could improve horse program design. We implemented an online survey that characterized associations of participation in equine activities, socioeconomic factors, and economic factors with age. Seventy-five percent of respondents ride, and 34% are recreational, non-competitive participants. Respondents were mostly female, and many participate in the sport throughout life. Many respondents indicated they overspent on equestrian activities. Horse programs should incorporate information and activities that address issues unique to females, should develop skills required by amateur or recreational riders, and should incorporate information on financial wellness.

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