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1.
Pediatrics ; 149(3)2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35224638

RESUMO

The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.


Assuntos
Custos de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Pediatria/métodos , Pediatria/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração , Adolescente , Criança , Pré-Escolar , Disparidades em Assistência à Saúde , Humanos , Lactente , Recém-Nascido , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/organização & administração , Pediatria/economia , Pediatria/normas , Telemedicina/economia , Telemedicina/normas , Estados Unidos
2.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34462339

RESUMO

All children and adolescents deserve access to quality health care regardless of their race/ethnicity, health conditions, financial resources, or geographic location. Despite improvements over the past decades, severe disparities in the availability and access to high-quality health care for children and adolescents continue to exist throughout the United States. Economic and racial factors, geographic maldistribution of primary care pediatricians, and limited availability of pediatric medical subspecialists and pediatric surgical specialists all contribute to inequitable access to pediatric care. Robust, comprehensive telehealth coverage is critical to improving pediatric access and quality of care and services, particularly for under-resourced populations.


Assuntos
Acessibilidade aos Serviços de Saúde , Qualidade da Assistência à Saúde , Telemedicina , Adolescente , Criança , Serviços de Saúde da Criança , Etnicidade , Humanos , Pediatras , Fatores Raciais , Especialização , Estados Unidos
3.
Otolaryngol Head Neck Surg ; 152(1 Suppl): S1-43, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25644617

RESUMO

OBJECTIVE: Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. PURPOSE: The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. ACTION STATEMENTS: The development group made a strong recommendation that clinicians recommend intranasal steroids for patients with a clinical diagnosis of AR whose symptoms affect their quality of life. The development group also made a strong recommendation that clinicians recommend oral second-generation/less sedating antihistamines for patients with AR and primary complaints of sneezing and itching. The panel made the following recommendations: (1) Clinicians should make the clinical diagnosis of AR when patients present with a history and physical examination consistent with an allergic cause and 1 or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. Findings of AR consistent with an allergic cause include, but are not limited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, and red and watery eyes. (2) Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy. (3) Clinicians should assess patients with a clinical diagnosis of AR for, and document in the medical record, the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media. (4) Clinicians should offer, or refer to a clinician who can offer, immunotherapy (sublingual or subcutaneous) for patients with AR who have inadequate response to symptoms with pharmacologic therapy with or without environmental controls. The panel recommended against (1) clinicians routinely performing sinonasal imaging in patients presenting with symptoms consistent with a diagnosis of AR and (2) clinicians offering oral leukotriene receptor antagonists as primary therapy for patients with AR. The panel group made the following options: (1) Clinicians may advise avoidance of known allergens or may advise environmental controls (ie, removal of pets; the use of air filtration systems, bed covers, and acaricides [chemical agents formulated to kill dust mites]) in patients with AR who have identified allergens that correlate with clinical symptoms. (2) Clinicians may offer intranasal antihistamines for patients with seasonal, perennial, or episodic AR. (3) Clinicians may offer combination pharmacologic therapy in patients with AR who have inadequate response to pharmacologic monotherapy. (4) Clinicians may offer, or refer to a surgeon who can offer, inferior turbinate reduction in patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management. (5) Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy. The development group provided no recommendation regarding the use of herbal therapy for patients with AR.


Assuntos
Antialérgicos/uso terapêutico , Terapias Complementares/métodos , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Terapia por Acupuntura/métodos , Administração Intranasal , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Comorbidade , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Diagnóstico Diferencial , Quimioterapia Combinada , Medicina Baseada em Evidências , Feminino , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunoglobulina E/análise , Imunoterapia/métodos , Comunicação Interdisciplinar , Antagonistas de Leucotrienos/uso terapêutico , Masculino , Procedimentos Cirúrgicos Nasais/métodos , Fitoterapia/métodos , Prevalência , Qualidade de Vida , Encaminhamento e Consulta , Rinite Alérgica/tratamento farmacológico , Rinite Alérgica/economia , Rinite Alérgica/epidemiologia , Rinite Alérgica/imunologia , Conchas Nasais/cirurgia , Estados Unidos/epidemiologia
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