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Pediatrics ; 153(Suppl 2)2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38300001


Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.

Saúde da Criança , Transtornos Mentais , Humanos , Criança , Escolaridade , Recursos Humanos
J Atten Disord ; 25(14): 2028-2036, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-32942928


OBJECTIVE: The aim of this paper is to understand associations between age and health care provider type in medication continuation among transition-aged youth with ADHD. METHOD: Using an employer-sponsored insurance claims database, we identified patients with likely ADHD and receipt of ADHD medications. Among patients who had an outpatient physician visit at baseline and maintained enrollment at follow-up 3 years later, we evaluated which ones continued to fill prescriptions for ADHD medications. RESULTS: Patients who were younger at follow-up more frequently continued medication (77% of 11-12 year-olds vs. 52% of 19-20 year-olds). Those who saw a pediatric provider at baseline and follow-up more frequently continued to fill ADHD medication prescriptions than those who saw a pediatric provider at baseline and non-pediatric providers at follow-up (71% vs. 53% among those ages 15-16 years at follow-up). CONCLUSION: Adolescents and young adults with ADHD who changed from pediatric to exclusively non-pediatric providers less frequently continued to receive ADHD medications.

Transtorno do Deficit de Atenção com Hiperatividade , Adolescente , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Prescrições de Medicamentos , Humanos , Seguro Saúde , Adulto Jovem
Psychiatr Serv ; 70(2): 123-129, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30526342


OBJECTIVE: Mental health concerns are common in pediatric primary care, but practitioners report low levels of comfort managing them. A primary care intervention addressing organizational and individual factors was developed to improve the management of common mental health conditions. METHODS: Twenty-nine practices participated in a statewide learning collaborative over 18 months. On-site training was used to teach communication and brief intervention skills and develop an organizational context supportive of mental health. Clinician confidence was measured pre- and postintervention. Medicaid claims data were used to estimate the intervention's effects on identification of mental health conditions and prescribing practices. RESULTS: Mean clinician confidence scores increased by 20% (95% confidence interval [CI]=15% to 25%), from 2.92 at baseline to 3.55 postintervention. In the first month of the preintervention year, 6.65% of patients with an office visit had at least one visit for a mental health condition, rising to 9% postintervention; this trend was driven by detection and treatment of attention-deficit hyperactivity disorder (ADHD). Rates of prescribing ADHD medication to patients with visits for ADHD increased by 0.12 percentage points per month (CI=0.02 to 0.22, p=0.022). Rates of prescribing second-generation antipsychotics to all patients with office visits decreased by 0.014 percentage points per month (CI=-.03 to -.00, p=0.028), relative to preintervention trends. CONCLUSIONS: This study suggests that a multicomponent intervention addressing individual staff and organizational factors together can promote identification and treatment of child mental health conditions in primary care. Future research is required to better understand the core components, impact on health outcomes, and sustainability.

Serviços de Saúde da Criança , Competência Clínica , Prescrições de Medicamentos , Pessoal de Saúde , Transtornos Mentais/tratamento farmacológico , Serviços de Saúde Mental , Padrões de Prática Médica , Atenção Primária à Saúde , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Pessoal de Saúde/educação , Pessoal de Saúde/estatística & dados numéricos , Humanos , Colaboração Intersetorial , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricos , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos
Curr Psychiatry Rep ; 15(7): 369, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23712720


The concepts of healthcare reform and population health are shifting the emphasis from traditional, volume-based care to a model in which value, or quality, predominates. High quality care will be increasingly rewarded, with financial consequences for poor performance. This shift will be accelerated by the use of healthcare technology, a rapidly growing industry with tools ranging from electronic health records to smart phones and web portals. In this article we highlight pertinent legislative reforms followed by a review of technologies that may play a role in the implementation of these reforms. Pediatric Attention Deficit Hyperactivity Disorder is used as an example given the large number of proposed tools for this condition. While the evidence base is weak for some technologies, research regarding web portals is better developed and will be presented as an example of a technology that may allow practitioners and organizations to improve healthcare quality in several dimensions.

Transtorno do Deficit de Atenção com Hiperatividade/terapia , Registros Eletrônicos de Saúde/normas , Reforma dos Serviços de Saúde/legislação & jurisprudência , Qualidade da Assistência à Saúde/organização & administração , Telemedicina/métodos , Adolescente , Criança , Pré-Escolar , Reforma dos Serviços de Saúde/organização & administração , Humanos , Melhoria de Qualidade , Telemedicina/tendências
J Dev Behav Pediatr ; 34(1): 45-51, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23275058


The increasing use of electronic health records (EHRs) allows for sharing of information across clinicians, quick access to laboratory results, and supports for documentation. However, this environment raises new issues of ethics and privacy, and it magnifies other issues that existed with paper records. In developmental-behavioral pediatrics (DBP) practice, which relies heavily on a team approach to blend pediatrics, mental health, and allied health, these issues are even more complicated. In this review, we highlight the ethical and privacy issues in DBP practice related to EHR use. Case examples illustrate the potential risks related to EHR access, confidentiality, and interprofessional collaboration. Suggestions to mitigate some of the ethical and privacy issues associated with EHRs at both an administrative level and a clinician level are included. With the expected increase in the adoption of EHRs by DBP clinicians in the near future, professional standards will need to be defined, and novel technological solutions may offer additional safeguards. Until then, professionals and organizations are responsible to uphold the standards of ethical practice while promoting effective information exchange to facilitate clinical care.

Registros Eletrônicos de Saúde/ética , Pediatria/ética , Adolescente , Criança , Proteção da Criança/ética , Confidencialidade/ética , Registros Eletrônicos de Saúde/normas , Feminino , Health Insurance Portability and Accountability Act , Humanos , Consentimento Informado por Menores/ética , Masculino , Psicologia da Criança/ética , Estados Unidos