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1.
JAMA Pediatr ; 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32421165

RESUMO

Importance: Geographic proximity to a pediatric subspecialist is a key factor in obtaining specialized care. However, comparative data regarding the number of pediatric subspecialists, distribution of subspecialists, and patient proximity to subspecialists in the United States between 2003 and 2019 have not been explored; the last known national analysis was published in 2006 and used data from 2003. Objective: To compare the number and distribution of pediatric subspecialists and patient proximity to pediatric subspecialists in the United States between 2003 and 2019 and to assess whether the increase in the number of pediatric subspecialists is associated with improvements in patient proximity to specialized care and the geographic distribution of pediatric subspecialists. Design, Setting, and Participants: This national repeated cross-sectional study used data from the American Board of Pediatrics to examine the overall change in the number of subspecialists for 20 pediatric subspecialties between 2003 and 2019. The study included 24 375 pediatric subspecialists who were 70 years or younger, had active certification from the American Board of Pediatrics as of June 2019, and had addresses in the United States. Subspecialists' addresses were linked by zip code to child population data to evaluate the geographic distribution of subspecialists, the population-weighted averages for service areas, and the straight-line distances to subspecialists. Descriptive statistics and maps were used to examine patient proximity to subspecialists and regional subspecialist distribution and dispersion by hospital referral region. Subspecialist-to-child population ratios per 100 000 children, changes over time, and coefficients of variation were calculated to further elucidate subspecialist distribution. Data were collected in June 2019 and analyzed from July 8, 2019, to December 17, 2019. Main Outcomes and Measures: Values from 2019 were compared with data from 2003 for mean straight-line distance in miles from patients to subspecialists, by subspecialty; percentage of children younger than 18 years living at specific distance ranges; subspecialist-to-child population ratios across hospital referral regions; and coefficients of variation for population ratios. Results: Among 24 375 pediatric subspecialists 70 years and younger, 23 436 subspecialists were certified in 1 subspecialty, and 939 subspecialists were certified in more than 1 subspecialty. The number of certified pediatric subspecialists in the United States increased by 76.8% between 2003 and 2019, with increases varying across subspecialties. The estimated means for travel distances decreased among all subspecialties; however, depending on the subspecialty, an estimated 1 million to 39 million children (2%-53%) resided 80 miles or more from a subspecialist. An analysis across hospital referral regions indicated increased subspecialist-to-child ratios and an increased number of regions with a subspecialist but continued wide variation across regions for most subspecialties. Eleven subspecialties had 1 or fewer subspecialists per 100 000 children across hospital referral regions. Conclusions and Relevance: Although patient proximity to pediatric subspecialty care has improved nationally, substantial distribution gaps among specific subspecialties remain. Long-term solutions that encourage movement of subspecialists to underserved locations or that extend the practice of current subspecialties may warrant consideration, particularly among subspecialties with a limited number of practitioners.

2.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32001489

RESUMO

BACKGROUND: Interest in global health (GH) among pediatric residents continues to grow. GH opportunities in pediatric fellowship programs in the United States are poorly described. We aimed to evaluate GH offerings among accredited general and subspecialty pediatric fellowship programs and identify implementation barriers. METHODS: This was a cross-sectional study by pediatric GH educators from the Association of Pediatric Program Directors Global Health Learning Community and the American Board of Pediatrics Global Health Task Force. Fellowship program directors and GH educators at accredited US pediatric fellowship programs were surveyed. Data were analyzed by using descriptive and comparative statistics. RESULTS: Data were obtained from 473 of 819 (57.8%) fellowship programs, representing 111 institutions. Nearly half (47.4%) offered GH opportunities as GH electives only (44.2%) or GH tracks and/or fellowships (3.2%) (GHT/Fs). Pretravel preparation and supervision were variable. Programs offering GH opportunities, compared to those without, were more likely to report that GH training improves fellow education (81.9% vs 38.3%; P < .001) and recruitment (76.8% vs 35.9%; P < .001). Since 2005, 10 programs with GHT/Fs have graduated 46 fellows, most of whom are working in GH. Of those with GHT/Fs, 71% believe national accreditation of GH fellowships would define minimum programmatic standards; 64% believe it would improve recruitment and legitimize GH as a subspecialty. CONCLUSIONS: GH experiences are prevalent in accredited US pediatric fellowship programs, and programs offering GH perceive that these opportunities improve fellow education and recruitment. Responses suggest that standards for GH opportunities during fellowship would be useful, particularly regarding pretravel preparation and mentorship for trainees.


Assuntos
Bolsas de Estudo , Saúde Global/educação , Pediatria/educação , Canadá , Estudos Transversais , Bolsas de Estudo/estatística & dados numéricos , Humanos , Tutoria/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Estados Unidos
3.
Pediatrics ; 145(1)2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31818865

RESUMO

The increasing prevalence of behavioral and/or mental health (B/MH) problems among children, adolescents, and young adults is rapidly forcing the pediatric community to examine its professional responsibility in response to this epidemic. Stakeholders involved in pediatric workforce training were brought together in April 2018, invited by the American Board of Pediatrics and the National Academies of Sciences, Engineering, and Medicine, to consider facilitators and barriers for pediatrician training to enhance care for B/MH problems and to catalyze commitment to improvement efforts. During the interactive meeting, parents, young adult patients, and trainees, together with leaders of pediatric training programs and health care organizations, acknowledged the growing B/MH epidemic and discussed past and current efforts to improve training and care, including integrated delivery models. Attendees committed in writing to making a change within their department or organization to improve training. There also was agreement that organizations that set the standards for training and certification bear some responsibility to ensure that future pediatricians are prepared to meet the needs of children and adolescents. Reports on commitments to change 12 months after the meeting indicated that although attendees had encountered a variety of barriers, many had creatively moved forward to improve training at the program or organizational level. This article describes the context for the April 2018 meeting, themes arising from the meeting, results from the commitments to change, and 3 case studies. Taken together, they suggest we, as a pediatric community, can and must collaborate to improve training and, by extension, care.

4.
Pediatr Res ; 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31785593

RESUMO

BACKGROUND: Amid concerns about the pediatrician-scientist workforce, we hypothesized that declining numbers of pediatric subspecialists devote at least 25% of their professional time to research with fewer younger and female pediatricians engaged in research over the study period. METHODS: Board-certified pediatricians enrolling online in the American Board of Pediatrics (ABP's) Maintenance of Certification (MOC) program October 2009 through 2016 were invited to complete a survey with questions about the allocation of their professional time. Responses from individuals in the 14 ABP-certified subspecialties were analyzed. The number and proportions of respondents devoting 25-49% and 50% or more of professional time to research were calculated over time. Age and gender were also examined. RESULTS: We analyzed 21,367 responses over 8 years. A small number of pediatric subspecialists engaged in research with 5.2-6.7% devoting 25-49% and 5.6-8.4% at least 50% of their professional time to research across subspecialties. There was no discernable increase or decrease over time or pattern by age or gender. CONCLUSION: Less than 10% of pediatric medical subspecialists devote at least 50% of their professional time to research. Efforts to promote research among pediatric subspecialists have not increased the size of the population that reports engaging in research at this level.

5.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690710

RESUMO

BACKGROUND AND OBJECTIVES: The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers, immediately after training and over the course of their careers (ie, Maintenance of Certification [MOC]). In 2015-2016, the ABP developed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds) as an alternative assessment to the current proctored, closed-book general pediatrics (GP) MOC examination. This article is 1 of a 2-part series examining results from the MOCA-Peds pilot in 2017. METHODS: We conducted quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or end-of-year survey (January 2018) and comprise the analytic sample. RESULTS: The majority of pediatricians considered the MOCA-Peds to be feasible and acceptable as an alternative to the proctored MOC GP examination. More than 90% of respondents indicated they would participate in the proposed MOCA-Peds model instead of the examination. Participants also offered recommendations to improve the MOCA-Peds (eg, enhanced focus of questions on outpatient GP, references provided before taking questions); the ABP is carefully considering these as the MOCA-Peds is further refined. CONCLUSIONS: Pilot participant feedback in 2017 suggested that the MOCA-Peds could be implemented for GP starting in January 2019, with all 15 subspecialties launched by 2022. Current and future evaluations will continue to explore feasibility, acceptability, and learning and practice change as well as sustainability of participation.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Pediatras/psicologia , Pediatras/normas , Inquéritos e Questionários , Adulto , Idoso , Certificação/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
6.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690712

RESUMO

BACKGROUND AND OBJECTIVES: This article is the second of a 2-part series examining results regarding self-reported learning and practice change from the American Board of Pediatrics 2017 pilot of an alternative to the proctored, continuing certification examination, termed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds). Because of its design, MOCA-Peds has several learning advantages compared with the proctored examination. METHODS: Quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or the end-of-year survey (January 2018) and compose the analytic sample. RESULTS: Nearly all (97.6%) participating pediatricians said they had learned, refreshed, or enhanced their medical knowledge, and of those, 62.0% had made a practice change related to pilot participation. Differences were noted on the basis of subspecialty status, with 68.9% of general pediatricians having made a practice change compared with 41.4% of subspecialists. Within the 1456 open-ended responses about participants' most significant practice change, responses ranged widely, including both medical care content (eg, "care for corneal abrasions altered," "better inform patients about. . .flu vaccine") and nonspecific content (eg, providing better patient education, using evidence-based medicine, increased use of resources in regular practice). CONCLUSIONS: As a proctored examination alternative, MOCA-Peds positively influenced self-reported learning and practice change. In future evaluation of MOCA-Peds and other medical longitudinal assessments, researchers should study ways to further encourage learning and practice change and sustainability.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Educação Médica Continuada/normas , Aprendizagem , Pediatras/normas , Adulto , Certificação/métodos , Educação Médica Continuada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Projetos Piloto , Padrões de Prática Médica/normas , Inquéritos e Questionários
7.
Acad Pediatr ; 19(3): 256-262, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30412766

RESUMO

OBJECTIVE: Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout. METHODS: Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time. RESULTS: In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22-0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22-0.36), or a job change (aOR, 0.48; 95% CI, 0.36-0.65). CONCLUSIONS: Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians' jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.

8.
Acad Pediatr ; 19(4): 399-403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30368035

RESUMO

OBJECTIVE: Explore pediatric residents' experiences and confidence with quality improvement (QI). METHODS: Pediatric residents were surveyed nationally in July 2017 about their demographic characteristics, experiences with QI projects over the previous year, and confidence with QI skills. Descriptive statistics and distributions of each individual demographic and QI variable, as well as training program size, were calculated for each variable. QI question responses were compared to demographic characteristics of the respondents, and chi-square statistics were calculated. RESULTS: In total, 11,137 out of 11,304 (98.5%) residents completed the survey. Half of residents had participated in a QI project over the previous academic year, and 78% of third-year residents reported having done so. However, few of these residents self-reported moderate or high confidence in their ability to design a QI project (28.9%), use QI tools (23.1%), use QI methodologies (24.0%), or use data to track changes in their personal practice over time (28.9%). Residents in small or medium programs were statistically more likely to rate their confidence in certain QI abilities higher than those in large programs. CONCLUSIONS: Although recent pediatric residents appear to be participating in QI activities during training, their self-perception of their QI skills development remains low. Residents in small and medium programs provide more favorable reports.

9.
Pediatrics ; 142(6)2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30510031

RESUMO

The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers. Certification helps demonstrate that a general pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills continuous certification requirements (Maintenance of Certification [MOC]). One current component of the MOC program is a closed-book examination administered at a secure testing center (ie, the MOC Part 3 examination). In this article, we describe the development of an alternative to this examination termed the "Maintenance of Certification Assessment for Pediatrics" (MOCA-Peds) during 2015-2016. MOCA-Peds was conceptualized as an online, summative (ie, pass/fail), continuous assessment of a pediatrician's knowledge that would also promote learning. The system would consist of a set number of multiple-choice questions delivered each quarter, with immediate feedback on questions, rationales clarifying correct and incorrect answers, references for further learning, and peer benchmarking. Questions would be delivered quarterly and taken at any time within the quarter in a setting with Internet connectivity and on any device. As part of the development process in 2015-2016, the ABP actively recruited pediatricians to serve as members of a yearlong user panel or single-session focus groups. Refinements to MOCA-Peds were made on the basis of their feedback. MOCA-Peds is being actively piloted with pediatricians in 2017-2018. The ABP anticipates an expected launch in January 2019 of MOCA-Peds for General Pediatrics, Pediatric Gastroenterology, Child Abuse, and Pediatric Infectious Diseases with launch dates for the remaining pediatric subspecialties between 2020 and 2022.


Assuntos
Certificação/organização & administração , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Internato e Residência/métodos , Pediatras/educação , Avaliação de Programas e Projetos de Saúde , Conselhos de Especialidade Profissional , Criança , Avaliação Educacional , Humanos , Estados Unidos
10.
Pediatrics ; 142(5)2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30301817

RESUMO

BACKGROUND AND OBJECTIVES: Although national bodies have proclaimed the importance of incorporating quality improvement (QI) into the daily fabric of clinical care, the actual proportion of practicing pediatricians who participate in QI activities on an annual basis is unknown. Correspondingly little is known about pediatrician motivations for, attitudes about, and support received for QI participation. METHODS: Pediatric diplomates enrolling in the American Board of Pediatrics' Maintenance of Certification program during calendar year 2016 were provided with the opportunity to complete a brief survey. A portion of the survey was focused on issues related to participation in QI programs. RESULTS: Survey responses were received from 8714 of the 11 890 diplomates who enrolled in Maintenance of Certification in 2016 (response rate: 73.3%). Overall, 86.6% of respondents reported participation in at least 1 QI project in the previous year. There was variation in previous-year participation in a QI project by practice affiliation categories, ranging from 79.9% for nonacademic generalists to 92.4% for academic specialists. The extrinsic requirement for QI to maintain board certification was the dominant motivator among all respondents (50.7%), followed by 2 intrinsic factors: identify gaps in practice and implement change (40.3%) and opportunity to collaborate with others (36.9%). CONCLUSIONS: Although the results are encouraging, despite almost 2 decades of national attention to the quality of health care and efforts to embed continual QI in health care delivery activities, ∼1 in 5 nonacademic pediatricians and 1 in 10 academic pediatricians did not report participating in any QI activities in the previous year.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pediatras/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Certificação/estatística & dados numéricos , Educação Médica Continuada/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários
12.
J Pediatr ; 198: 294-300.e1, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29747937

RESUMO

OBJECTIVES: To determine, among pediatric residents, the timing and stability of decisions to pursue fellowship training and select a specific subspecialty, which can be used to inform strategies to better match the distribution of pediatric subspecialist with the needs of children. STUDY DESIGN: A longitudinal survey administered with the General Pediatrics In-training Exam to pediatric residents in the US and Canada, 2010-2014. The study included residents who responded in each of their first 3 years of residency and indicated plans to enter fellowship or matriculated, 2013-2016, into 1 of the 14 medical subspecialty fellowships for which the American Board of Pediatrics grants a certificate. Descriptive and χ2 statistics were calculated. RESULTS: Of the 7580 residents who completed 3 annual surveys (response rate 99%) 4963 (65.5%) indicated plans to pursue fellowship training and 2843 (37.5%) matriculated into fellowship. Residents who did not enter fellowship were in smaller residency programs and programs with less interest in fellowship among interns. Most residents who matriculated into fellowship (68.4%) planned to do so as interns and maintained that plan throughout residency. In contrast, 22.7% had selected a specific subspecialty as interns. Fellowship decisions were made later in residency by female residents, American Medical Graduates, and residents in programs where <50% of interns planned to pursue fellowship training. Timing and stability of decisions varied across subspecialty fields. CONCLUSIONS: Understanding the timing of pediatric medical subspecialty fellowship decisions could be used to shape medical education and, ultimately, the pediatric workforce.


Assuntos
Escolha da Profissão , Bolsas de Estudo , Internato e Residência , Pediatria/educação , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários , Adulto Jovem
15.
J Pediatr ; 195: 263-268, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29395185

RESUMO

OBJECTIVE: To assess the part-time workforce and average hours worked per week among pediatric subspecialists in the 15 medical subspecialties certified by the American Board of Pediatrics. STUDY DESIGN: We examined data from pediatric subspecialists who enrolled in Maintenance of Certification with the American Board of Pediatrics from 2009 to 2015. Data were collected via an online survey. Providers indicated whether they worked full time or part time and estimated the average number of hours worked per week in clinical, research, education, and administrative tasks, excluding time on call. We calculated and compared the range of hours worked by those in full- and part-time positions overall, by demographic characteristics, and by subspecialty. RESULTS: Overall, 9.6% of subspecialists worked part time. There was significant variation in part-time employment rates between subspecialties, ranging from 3.8% among critical care pediatricians to 22.9% among developmental-behavioral pediatricians. Women, American medical graduates, and physicians older than 70 years of age reported higher rates of part-time employment than men, international medical graduates, and younger physicians. There was marked variation in the number of hours worked across subspecialties. Most, but not all, full-time subspecialists reported working at least 40 hours per week. More than one-half of physicians working part time in hematology and oncology, pulmonology, and transplant hepatology reported working at least 40 hours per week. CONCLUSIONS: There are unique patterns of part-time employment and hours worked per week among pediatric medical subspecialists that make simple head counts inadequate to determine the effective workforce. Our findings are limited to the 15 American Board of Pediatrics-certified medical subspecialties.


Assuntos
Emprego/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Médicos/provisão & distribução , Carga de Trabalho/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Especialização , Estados Unidos
16.
Acad Pediatr ; 18(1): 94-101, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28739535

RESUMO

BACKGROUND: Children with medical complexity (CMC) account for disproportionate hospital utilization and adverse outcomes after discharge, and several gaps exist regarding the quality of hospital to home transitional care for this population. We conducted an expert elicitation process to identify important and feasible hospital to home transitional care interventions for CMC from the perspectives of parents and health care professionals. METHODS: We conducted a 2-round electronic Delphi process to identify important and feasible transitional care interventions. Panelists included parents of CMC and multidisciplinary health care professionals. In the first round, panelists rated the importance and feasibility of 39 transitional care interventions on a 9-point Likert scale; agreement between panelists was defined according to RAND/UCLA Appropriateness Methods. The second round of data collection evaluated 16 interventions that panelists did not agree on in the first round and 8 new or revised interventions, accompanied by quantitative and qualitative data summaries. RESULTS: A total of 29 parents of CMC and 37 health care professionals participated in the Delphi process (response rate 75%). Both stakeholder panels endorsed most interventions as important; health care professionals were less likely to rate several interventions as feasible compared with the parent panel. Over 2 rounds of data collection, the 2 stakeholder panels endorsed 25 interventions as important as well as feasible. These interventions related to family engagement during the hospitalization, care coordination and social support assessment, predischarge education, and written materials. CONCLUSIONS: Parents and health care professionals considered several transitional care interventions important as well as feasible. This research might inform hospitals' transitional care programs and policies.


Assuntos
Doença Crônica , Pessoal de Saúde , Hospitalização , Pais , Alta do Paciente , Participação dos Interessados , Cuidado Transicional , Adolescente , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Criança , Pré-Escolar , Técnica Delfos , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade
18.
J Pediatr Health Care ; 31(6): 654-662, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28629924

RESUMO

INTRODUCTION: Children with chronic respiratory insufficiency and mechanical ventilation often experience acute illnesses requiring unscheduled hospitalizations. Health-related quality of life (HRQL) may predict future health care utilization. METHODS: Participants were 30 days to 22 years old with chronic respiratory insufficiency (N = 120). Parent-proxies completed global HRQL and general health measures. Outcomes were total health care (emergency department, outpatient, inpatient) and inpatient days over 6 months. Adjusted negative binomial regression estimated the effects of global HRQL and general health on utilization. RESULTS: Three quarters of children had any utilization; 32% had hospitalizations. Children with poor/fair global HRQL had 3.7 times more health care days than those with very good/excellent global HRQL. Children with poor/fair global HRQL had 6.3 times more inpatient days than those with very good/excellent global HRQL. Similar relationships existed between general health and utilization. DISCUSSION: HRQL was associated with health care and inpatient days. Clinical teams can use HRQL as a marker for utilization risk, enabling potentially earlier intervention, better outcomes, and lower costs.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Hospitalização , Pais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Procurador , Qualidade de Vida , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/terapia , Adolescente , Boston , Criança , Serviços de Saúde da Criança/economia , Pré-Escolar , Doença Crônica/economia , Doença Crônica/terapia , Crianças com Deficiência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Lactente , Estudos Longitudinais , Masculino , Programas de Assistência Gerenciada , Respiração Artificial/economia , Insuficiência Respiratória/economia , Adulto Jovem
19.
Pediatrics ; 139(5)2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28557745

RESUMO

BACKGROUND: Concerns exist regarding the adequacy of the pediatric subspecialty workforce in the United States. Data on practice patterns and job characteristics are necessary to help develop policies to ensure availability. METHODS: We performed survey data analysis of all pediatric subspecialists enrolled in Maintenance of Certification in 2013 and 2014, assessing demographic information, characteristics of current positions, plans for retirement, and satisfaction with allocation of professional and clinical responsibilities. Four logistic regression models examined the independent association of demographic variables collected along with variables of practice ownership and academic appointment with the outcome variables of pediatric subspecialists reporting match of desired with current actual professional duties, match of desired with current actual clinical responsibilities, current part-time employment, and expected age of retirement <65 years of age. RESULTS: Data from 5100 subspecialists were analyzed (response rate 87.2%). Most (83%; N = 4251) reported their current allocation of professional time was what they desired in their current position; similarly, 93% (N = 4755) reported likewise for clinical responsibilities. Differences by gender and years in subspecialty were evident, with women much more likely to work part time than men (odds ratio 6.22); those >20 years in practice were less likely to retire before the age of 65 compared with those <10 years in practice (odds ratio 0.33). CONCLUSIONS: This study is the largest to date of practicing pediatric subspecialists. Variation in work patterns found between genders, with time in practice, and between subspecialties suggests that future research should focus on these issues.


Assuntos
Satisfação no Emprego , Medicina , Pediatria , Padrões de Prática Médica , Escolha da Profissão , Inquéritos Epidemiológicos , Mão de Obra em Saúde , Humanos , Aposentadoria , Fatores Sexuais , Estados Unidos , Carga de Trabalho
20.
J Clin Lipidol ; 11(1): 147-159, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28391881

RESUMO

BACKGROUND: Young adults with familial hypercholesterolemia (FH) are at a critical period for establishing behaviors to promote future cardiovascular health. OBJECTIVE: To examine challenges transitioning to adult care for young adults with FH and parents of FH-affected young adults in the context of 2 developmental tasks, transitioning from childhood to early adulthood and assuming responsibility for self-management of a chronic disorder. METHODS: Semistructured, qualitative interviews were conducted with 12 young adults with FH and 12 parents of affected young adults from a pediatric subspecialty preventive cardiology program in a northeastern academic medical center. Analyses were conducted using a modified grounded theory framework. RESULTS: Respondents identified 5 challenges: (1) recognizing oneself as a decision maker, (2) navigating emerging independence, (3) prioritizing treatment for a chronic disorder with limited signs and symptoms, (4) managing social implications of FH, and (5) finding credible resources for guidance. Both young adults and parents proposed similar recommendations for addressing these challenges, including the need for family and peer involvement to establish and maintain diet and exercise routines and to provide medication reminders. Systems-level recommendations included early engagement of adolescents in shared decision-making with health care team; providing credible, educational resources regarding FH; and using blood tests to track treatment efficacy. CONCLUSION: Young adults with FH transitioning to adult care may benefit from explicit interventions to address challenges to establishing healthy lifestyle behaviors and medication adherence as they move toward being responsible for their medical care. Further research should explore the efficacy of recommended interventions.


Assuntos
Hiperlipoproteinemia Tipo II/psicologia , Pais/psicologia , Assistência ao Paciente/psicologia , Adulto , Criança , Doença Crônica/psicologia , Tomada de Decisões , Feminino , Humanos , Relações Interpessoais , Masculino , Autocuidado , Adulto Jovem
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