Immunization Coverage and Its Relationship to Preventive Health Care Visits Among Inner-City Children in Baltimore

PEDIATRICS ◽  
1994 ◽  
Vol 94 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Bernard Guyer ◽  
Nancy Hughart ◽  
Elizabeth Holt ◽  
Alan Ross ◽  
Bonita Stanton ◽  
...  
Keyword(s):  
Health Care ◽  
Inner City ◽  
Immunization Coverage ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Care Providers ◽  
Rubella Vaccine ◽  
Young Infants ◽  
Age Appropriate ◽  
Preventive Health Care Visits

Objective. To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. Design and methods. We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers. Main outcome measures. Age-appropriate immunizations and preventive health care visits. Results. By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age. Conclusions. Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.

scholarly journals Methemoglobinemia Associated with Metoclopramide Therapy in a Neonate

2004 ◽  
Vol 9 (1) ◽  
pp. 49-54
Author(s):  
Kristine G. Palmer ◽  
Laura P. James
Keyword(s):  
Health Care ◽  
Gastroesophageal Reflux ◽  
Health Care Providers ◽  
Side Effect ◽  
Pediatric Patients ◽  
Care Providers ◽  
Young Infants ◽  
Age Appropriate ◽  
The U.S

With the removal of cisapride from the U.S. market, practitioners have increasingly used other medications, such as metoclopramide, to treat gastroesophageal reflux in pediatric patients. We describe the case of a neonate who developed methemoglobinemia after receiving metoclopramide at doses slightly above the recommended age-appropriate dosage. Health care providers should be aware of this potentially serious side effect in young infants who receive this medication.

Recommendations of the Workshop on Immunization and Preventive Care

PEDIATRICS ◽  
1990 ◽  
Vol 86 (6) ◽  
pp. 1067-1067
Keyword(s):  
Health Care ◽  
Information System ◽  
Private Sector ◽  
Health Care Providers ◽  
Birth Certificate ◽  
Preventive Health Care ◽  
The United States ◽  
Preventive Health ◽  
Surveillance Program ◽  
Care Providers

1. Information and outreach systems should be improved so that high levels of immunization in preschool children will be reached in the United States. Because of a vastly improved ability to set up systems and to transfer data, a modern information system should function far better than the previous Infant Immunization Surveillance Program of about 20 years ago, which had no outreach element at all. 2. No matter how care is delivered, and several configurations of public vs private sector were discussed, responsibility should be placed on an individual or an agency to ensure that each child needing immunization and other preventive health services is identified and contacted. The information system should be keyed to the birth certificate. Reminders—mailed, phoned or, better still, delivered in person—should be provided for all children. 3. In both the public sector and the private sector, vaccines should be provided free of charge. (Methods of financing were not addressed directly, but most participants believed that the federal government would take financial responsibility.) 4. Health care providers should be taught the importance of assessing immunization status and administering needed immunizations at every appropriate contact with a child. 5. Immunization should be provided not as a solitary service, but as a part of a package of comprehensive preventive services. 6. A comprehensive school health education program should be established. 7. Consideration should be given to the use of incentives, either positive or negative, to improve the priority assigned to immunization and other preventive health care services.

scholarly journals Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250800
Author(s):  
D. Allen Roberts ◽  
Seifu Abera ◽  
Guiomar Basualdo ◽  
Roxanne P. Kerani ◽  
Farah Mohamed ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Community Outreach ◽  
Preventive Health Care ◽  
Preventive Health ◽  
King County ◽  
Engagement In Care ◽  
Care Providers ◽  
African Immigrant

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

scholarly journals Preventive Health Care and Payment Systems

2003 ◽  
Vol 3 (1) ◽  
Author(s):  
Pedro P Barros ◽  
Xavier Martinez-Giralt
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Integrated Management ◽  
Care Center ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Primary Care Center ◽  
Care Providers ◽  
Referral Decisions ◽  
Payment Schemes

Abstract Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care. The analysis is performed through a series of examples combining different payment schemes at the primary care center and hospital. When hospitals are reimbursed according to costs, prevention efforts are unlikely to occur. However, under a capitation payment for the primary care center and prospective budget for the hospital, prevention efforts increase when shifting from an independent to an integrated management. Also, from a normative standpoint, optimal payment schemes are simpler under joint management.

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