Parents' reports of barriers to care for pediatric otolaryngology patients.

OBJECTIVE: To understand parent perceptions of types and severity of barriers to care within the pediatric otolaryngology patient population in WV. STUDY DESIGN: Descriptive survey. SETTING: University pediatric otolaryngology clinic, Morgantown, WV. SUBJECTS AND METHODS: Subjects were caretakers of pediatric patients in clinic. Subjects were asked to complete the modified validated Barriers to Care Questionnaire (BCQ) and to provide some demographic details.Each BCQ question response was reported as a Mean Total Score (MTS), ranging from 0 (complete barrier) to 100 (no barrier) and they were grouped into 5 BTC subscales. Demographic question responses were used to establish subgroups. Data for subscale groups was compared across the demographic subgroups using non-parametric methods. RESULTS: 301 parents provided responses. The overall mean BTC was 91.59 (95% CI 90.12-93.05). The Expectations and Pragmatics subscales were the two greatest barriers at 88.56 and 90.80, respectively. 26.7% reported no barriers to care. No statistically significant association was found among subscale scores and demographic subgroups. CONCLUSIONS: Parents of pediatric otolaryngology patients in WV demonstrate low expectations of the healthcare system. There are concerns about pragmatics that could create barriers. Our hope is to spur scientific interest in this understudied healthcare topic. Future studies should be conducted to identify association/causation and help establish a framework for addressing potential barriers to care in the pediatric population.

Parents' attitudes toward post-operative narcotic use in pediatric patients.

OBJECTIVE: To understand parent perceptions of post-operative narcotic use in the pediatric otolaryngology patient population. METHODS: This was a descriptive survey of caregivers on children being seen in a university pediatric otolaryngology clinic. Caregiver role, age of child, previous exposure to analgesics, choice of analgesics, comfort and concern with narcotic use in this child, knowledge of narcotic side effects, and knowledge about narcotic disposal were included. Comfort and concern questions were scored on a 10-point VAS where the higher numbers indicated more concern/discomfort. RESULTS: 301 caregivers participated, 84.5% were mothers, 11% were fathers and the rest were custodial grandparents. 45.2% knew someone addicted to narcotics. Respondents were uncomfortable with their child experiencing pain in a hypothetical postoperative situation, with 63.9% having at least some discomfort with it. First choice of medication to treat hypothetical post-tonsillectomy pain was ibuprofen (47.5%) followed by acetaminophen (38.9%). 29.9% were concerned about addiction, and 26.6% were concerned about drowsiness as a sequela of narcotic use. There were significant differences between respondents who knew a person addicted to narcotics and those who did not for comfort using narcotics in their child (VAS median 6.0 versus 5.0, p = 0.025), concern that their child would become addicted to narcotics (VAS median 5.0 versus 2.0, p = 0.001), concern about side effects (VAS median 7.0 versus 6.0, p = 0.007) and concern about having narcotics in the home (VAS median 3.0 versus 0.0, p < 0.001). CONCLUSIONS: The national opioid epidemic exposes more parents to narcotic addiction in the community, which affects their perceptions of pediatric post-operative narcotic use. These experiences may need to be considered when planning postoperative pain management strategies in children.