Primary care pediatricians' satisfaction with subspecialty care, perceived supply, and barriers to care.

OBJECTIVES: To compare satisfaction with specialty care by primary care pediatricians (PCPs), perceived barriers to care, and adequacy of specialist supply. STUDY DESIGN: A survey of U.S. pediatricians was conducted in 2007. PCPs were asked about satisfaction with specialty care for their patients, as well as supply of specific pediatric subspecialists. Responses of rural and nonrural PCPs were compared regarding 10 potential barriers to care. RESULTS: Most PCPs are satisfied with the quality of subspecialty care. However, they were not satisfied with wait times for appointments, and the availability of many pediatric medical subspecialties and several pediatric surgical specialties. Rural PCPs were significantly more likely to report these shortages compared with nonrural pediatricians; these included 9 of the 18 medical and 5 of the 7 surgical specialties. In addition to wait times for appointments, PCPs reported that subspecialists' nonparticipation in health insurance plans and lack of acceptance of uninsured patients were also barriers to obtaining subspecialty care for their patients. CONCLUSIONS: PCPs provide valuable insight into access to the pediatric subspecialty workforce. This survey of PCPs raises significant concerns about the adequacy of children's access to pediatric subspecialists, especially in rural communities.

Sexually transmitted infections: new guidelines for an old problem on the college campus.

Approximately 80% of college-age adolescents are sexually active and at risk for sexually transmitted infections (STIs). Over 4 million STIs occur in teenagers annually and young adults between the ages of 18 and 24, while adolescents 15 to 17 years of age have higher rates of STIs than any other age group in the United States. Thus, the prevention, diagnosis, and treatment of STIs are a critical part of college health care. This article will discuss the epidemiology, diagnosis, and management of some of the most common STIs encountered in the college-age group, with an emphasis on new guidelines for treatment.

Substance abuse on the college campus.

Substance abuse is a major health and behavioral concern in college students. Alcohol and marijuana are the most commonly abused drugs on college campuses. Others include tobacco, 3,4-methylenedioxymethamphetamine, gamma-hydroxybutyrate, flunitrazepam (Rohypnol), lysergic acid, ketamine, methamphetamine, phencyclidine, cocaine, and psilocybin mushrooms. This article reviews the use of these drugs by college students. Substance use is a major contributing factor in poor academic performance and failure to successfully complete a college education.

Contraception for college students.

An important issue for human beings is the acquisition of normal sexual health, including the understanding and application of reproductive health when needed. Comprehensive sexuality education is not a topic provided to many children, adolescents, or college students in the United States, however. Students who were sexually active in high school may continue to be at risk for unwanted pregnancies and sexually transmitted diseases in their college life; those who chose abstinence in high school may abandon this concept in college, choosing coital behavior at all levels of university life-freshman through graduate levels. Most American college students are sexually active and many have multiple partners. This article reviews current contraceptive methods available to college students. College health providers and pediatricians are urged to be vigilant about the reproductive health needs of the college students they serve.

The Use of Telemedicine to Address Access and Physician Workforce Shortages.

The use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists (henceforth referred to as "pediatric physicians") has the potential to transform the practice of pediatrics. The purpose of this policy statement is to describe the expected and potential impact that telemedicine will have on pediatric physicians' efforts to improve access and physician workforce shortages. The policy statement also describes how the American Academy of Pediatrics can advocate for its members and their patients to best use telemedicine technologies to improve access to care, provide more patient- and family-centered care, increase efficiencies in practice, enhance the quality of care, and address projected shortages in the clinical workforce. As the use of telemedicine increases, it is likely to impact health care access, quality, and education and costs of care. Telemedicine technologies, applied to the medical home and its collaborating providers, have the potential to improve current models of care by increasing communication among clinicians, resulting in more efficient, higher quality, and less expensive care. Such a model can serve as a platform for providing more continuous care, linking primary and specialty care to support management of the needs of complex patients. In addition, telemedicine technologies can be used to efficiently provide pediatric physicians working in remote locations with ongoing medical education, increasing their ability to care for more complex patients in their community, reducing the burdens of travel on patients and families, and supporting the medical home. On the other hand, telemedicine technologies used for episodic care by nonmedical home providers have the potential to disrupt continuity of care and to create redundancy and imprudent use of health care resources. Fragmentation should be avoided, and telemedicine, like all primary and specialty services, should be coordinated through the medical home.

Adolescent sexuality and disability.

All human beings are sexual from birth to death and all adolescents, with or without chronic illness or disability, must incorporate appropriate concepts of sexuality into their process of development from child to adult. This chapter reviews normal adolescent development with specific reference to sexuality. Potential effects of chronic illness and disability on this process are reviewed, including coital behavior, sexual abuse, sexual dysfunction, and sexual offending. Management of sexual issues in chronically ill or disabled adolescents is considered, including comments about gynecologic needs of disabled girls.