Best Practices for Integrating Early Relational Health Programs in Pediatric Primary Care: A Modified Delphi Process.

Best practice guidelines for asthma management recommend education and spirometry at specific intervals. A written asthma action plan with education and spirometry is ordered at the discretion of physicians at our institution. An initial chart review revealed that asthma education and spirometry were not consistently ordered in the pediatric primary care clinics. This quality improvement study aimed to increase frequency of spirometry and asthma education in children with asthma seen in pediatric primary care through use of a respiratory therapist (RT)-driven protocol. The protocol established that spirometry and education would be done annually for children ≥ 6 y of age with intermittent asthma and every 6 months for persistent asthma. RTs identified eligible subjects and placed the electronic medical record orders before the clinic visit. Physicians were invited to complete a questionnaire before and after protocol implementation to assess barriers and protocol satisfaction. Nine hundred and thirty-two children were included. Prior to protocol implementation, spirometry and education were completed in 64.9% and 62.6% of eligible children, respectively. Following protocol implementation, spirometry and education were significantly increased to 92.7% (P < .001) and 88.5% (P < .001), respectively. Physicians identified interruption in clinic flow as the primary barrier for ordering spirometry and were satisfied with the protocol. Physicians stated that communication with RT improved through use of this protocol. Implementation of an RT-driven protocol in an out-patient pediatric primary care setting significantly increased utilization of spirometry and education for children with asthma. RTs working in the pediatric out-patient primary care setting played a vital role in achieving best practices for asthma management. The implementation of the protocol enhanced interdisciplinary communication.

The increase in behavioral health problems presenting in pediatric primary care (PPC) has led to a greater focus on the prevention and treatment of mental health concerns. As a result, care has shifted from colocation to integrated PPC models. However, the literature provides limited guidance on the development and implementation of integrated PPC models that aim to transform both PPC and the larger health care system. We developed an integrated behavioral health (IBH) approach modeled with fidelity to the Integrated Practice Assessment Tool to fully integrate behavioral health into PPC. Over the 4 years since the application of our model, we have been successful in the development of an integration process and model for practice transformation of an urban PPC center and the spread and scale of IBH services to 2 additional clinics. Four elements combine to make our integrated behavioral health program novel: (a) clear mission and vision, (b) provision of universal prevention services, (c) continuous quality improvement, and (d) emphasis on practice and systems transformation. Trends in practice and scholarly inquiry indicate the need for robust pediatric IBH models, with a clear mission and vision; articulation of how research informs the development and implementation of the model; and infrastructure to meaningfully examine the model's impact. Cognizant of these needs, Cincinnati Children's Hospital Medical Center developed an IBH program. We provide key learnings for IBH program development, PPC transformation, and innovative systems redesign. We describe these elements and make recommendations for future research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The purpose of this study is to determine the number, age, geographic distribution, and accessibility of primary care pediatricians (PCP) in Switzerland, and to model the regional need for substitutions of soon-to-retire PCPs 5 years from now. We conducted a population-based study applying the floating catchment area method (Modified Huff-model-based Variable 3 Step Floating Catchment Area, MHV3SFCA) to calculate supply density indices (SDI) and produced accessibility maps based on data on PCP of the Federal Statistical Office (FSO) and the spatial data set of the statistics on population and households (STATPOP). In 2019, 1332 PCPs were working in pediatric practices in Switzerland (average workload: 70.4%), caring for 1,335,177 children and adolescents under the age of 15 years (i.e., 1423 per PCP). We found significant regional differences: less than 60% of the recommended PCP density, particularly in the northern part of the country and in rural regions. The needed workforce is going to accentuate markedly until 2029, when around 1/4 of Swiss pediatricians currently working in private practices will be retired. Conclusion: We provided a detailed analysis of the spatial distribution of PCP in Switzerland and a simulation model of the demand within the next years based on expected retirements. Our findings show current geographic disparities in pediatric primary care provision, which will accentuate and lead to a PCP shortage in many regions of Switzerland in the near future. Without sufficient compensation, adaptations of pediatric healthcare models need to be considered to avoid dramatic underservice. Our methodology is applicable to many comparable settings worldwide.What is known:• pediatric care in many countries is challenged by impending retirement of older pediatric primary care providers• suitable statistical models are needed to identify the spatial distribution of current and future demandWhat is new:• We visualized regional differences in the accessibility of paediatric primary care in Switzerland at a small-scale level, and the spatial distribution of places in need of a replacement by 2029• Our model is applicable to other regions, countries, and disciplinesSupplementary InformationThe online version contains supplementary material available at 10.1007/s00431-025-06441-w.

Integrated behavioral health services have positive outcomes for patients and providers, but little is known about providers' perspectives on implementing these services. This community-based participatory research collaboration with a Federally Qualified Health Center examined provider perspectives on implementing a collaborative psychiatry consultation program in pediatric primary care. We interviewed providers (N = 14) from psychiatry, social work, primary care, and psychology regarding their experiences implementing the program, and their recommendations for its sustainability. Providers described interdisciplinary integration arising from the program, with accompanying benefits (e.g., increased access to care for patients with complex diagnostic profiles, increased learning and role satisfaction among providers), and challenges (e.g., increased burden on primary care providers, potential patient discomfort with team-based care). Our results highlight the complexities of implementing collaborative psychiatry consultation in pediatric primary care, and suggest the importance of supporting primary care providers and patients within this context.

Implications of the COVID-19 Pandemic for Pediatric Primary Care Practice in Europe

Impact of pharmacist integration in a pediatric primary care clinic on vaccination errors: A retrospective review

BackgroundFor years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non–face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families’ access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications.ObjectiveThe aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals.MethodsWe will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family’s side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard.ResultsRecruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits.ConclusionsWe believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals.International Registered Report Identifier (IRRID)PRR1-10.2196/52946

&lt;sec&gt;&lt;st&gt;Background and aims&lt;/st&gt; UN Convention on the Rights of the Child (UNCRC) is an essential part of child health promoting policies. Several studies were carried out on the implementation of UNCRC in secondary and tertiary health care levels but not in primary paediatric care (PPC) settings. PPC model heterogeneity in Europe is related to socioeconomic/demographic factors, paediatric education/training and child health care policies. PPC is either provided by paediatricians or family doctors/GPs. The study aim was to assess under a social paediatrics perspective UNCRC knowledge/implementation in European PPC settings. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Methods&lt;/st&gt; As to profile UNCRC in PPC, a questionnaire (Q1) was designed including 23 specific questions regarding rights of protection, provision and participation. The questionnaire was launched as a "monkey survey” to individual paediatricians practicing in PPC settings through the Council of PPC European national societies participating in the study. Specific country data (Excel table) and total merge data were analysed using SPSS tool. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Results&lt;/st&gt; 1342 responses received from 10 participating European PPC societies: -Not enough knowledge: 52%–71%. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;-Implementation&lt;/st&gt; Partly implemented 30%–67%, fully implemented 33–66% -Equal access to health care: Provided 84%–99,5% -Right to information: Available 90%. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Conclusions&lt;/st&gt; The knowledge/implementation of UNCRC in PPC varies significantly among European countries. Deep gaps on UNCRC knowledge were found. Equal access to health care is provided in urban areas. UNCRC should be included in paediatric education as well as addressed in PPC planning policies. Further research on UNCRC. &lt;/sec&gt;

Sexual Health and Relationship Abuse Interventions in Pediatric Primary Care: A Systematic Review

Long wait times for autism spectrum disorder diagnostic evaluations delay access to early intervention and disproportionately affect Hispanic families and families who speak a primary language other than English. Integrated behavioral health models in pediatric primary care offer an opportunity to improve early identification, streamline referrals, and reduce inequities in access to specialty care. We describe the implementation of a tiered, integrated autism screening and diagnostic pathway within Hasbro Children's Pediatric Primary Care Clinic in Providence, Rhode Island. The pathway embeds behavioral health consultation and secondary autism screening into routine well-child visits for children ages 0-3. Children identified as at risk for autism receive expedited referral to specialty diagnostic evaluation using gold-standard assessment tools available in English and Spanish. Program evaluation includes comparison with two historical control groups (2018 pre-COVID and 2022 post-COVID) on wait times to specialty contact and diagnostic evaluation, as well as referral completion and connection to services. Patient experience is assessed using quantitative satisfaction measures and qualitative interviews within a quality improvement framework. The clinical pathway is currently active, and data collection is underway. Outcome data are not yet available. Early implementation demonstrates the feasibility of embedding secondary autism screening and care coordination within pediatric primary care and highlights the role of behavioral health integration in addressing delays in access to specialty services. A tiered, integrated autism evaluation pathway within pediatric primary care has the potential to reduce diagnostic delays, improve equity, and enhance family-centered care. Findings from ongoing evaluation will inform refinement and replication of this model in other primary care settings.

BackgroundAlmost 80% of adolescents in the US have experienced a traumatic event, and approximately 7% have post-traumatic stress disorder. However, there is a lack of validated and feasible assessments for assessing traumatic stress symptoms in pediatric primary care, and traumatic stress symptoms are routinely unidentified. This study aimed to develop, pilot test, and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for post-traumatic stress symptoms in adolescents designed for use in pediatric primary care.MethodsThe APCTSS was developed by pediatricians, psychiatrists, psychologists, and social workers who all provide care to trauma-affected adolescent patients. The providers sought to create a developmentally appropriate tool that accurately reflected DSM-5 posttraumatic stress symptoms and that was feasible and acceptable for use in pediatric primary care. To develop the APCTSS, they combined and adapted the UCLA Post-traumatic Stress Disorder (PTSD) Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Next, 213 adolescent medicine patients were universally approached during routine clinic visits and 178 agreed to participate and were enrolled. The 178 patients were aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American, and 20.7% Hispanic/Latinx. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and the Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C).Results56.7% reported a criterion A trauma, 30.1% met criteria for DSM-5 PTSD, 7.4% met criteria for subsyndromal PTSD symptoms, and 19.0% for post-event impairing symptoms. Validity and reliability testing indicated that the APCTSS was internally consistent, had good concurrent and discriminant validity, and demonstrated good sensitivity and specificity in identifying adolescents at high risk for post-trauma symptoms. Over half of patients (56.0%) who screened positive on the APCTSS (score ≥2) would not have been identified as having a mental health concern using the PHQ-A, including 60.8% of patients who had probable PTSD, subsyndromal PTSD, or post-event impairing symptoms.ConclusionsMany youth with trauma-related mental health symptoms are unidentified in pediatric primary care, which is a missed opportunity for early identification and may contribute to a host of poor outcomes. The development of an effective and feasible traumatic stress screening tool for youth primary care may improve early intervention, and the health and well-being of trauma affected youth.

To increase Chlamydia trachomatis screening in adolescents 15-19 years of age from 7.8% to 15% following a 6-week implementation of universal chlamydia screening at three paediatric primary care (PPC) sites. Pre-implementation (1 January 2022-19 October 2022) and post-implementation (20 October 2022-1 June 2023) screening rates were tracked through run charts and compared via Chi-square testing. Universal opt-out chlamydia screening with universal urine collection for 15- to 19-year-old was implemented at well visits, along with patient and staff education, and sexually transmitted infection treatment protocols. Chlamydia trachomatis screening increased from 7.8% to 34.1% with implementation of universal opt-out chlamydia screening. Proportions of patients screened increased significantly among White individuals, males and privately insured individuals. A universal C. trachomatis screening project can be feasibly implemented in pediatric primary care and successfully increase adolescent chlamydia screening rates. Implementing a universal opt-out C. trachomatis screening project is feasible in PPC and can help achieve the public health goal of chlamydia identification and treatment. These findings will be impactful for both paediatric primary care and adolescent patients. The universal, opt-out C. trachomatis screening approach facilitated screening increases, improved equity in screening and led to increased case detection and treatment which has vast significance for those patients. This manuscript is submitted using the SQUIRE 2.0 guidelines for quality improvement reporting. Patient contribution included de-identified data collection of chlamydia screening rates of eligible adolescents 15-19 years old who attended routine well visits at the three PPC locations. The data were reviewed on a dashboard, then stratified by race, ethnicity, payor and sex assigned at birth.

Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use. There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use. Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.

Insufficient evidence exists to support obesity prevention in paediatric primary care. To test a theory-based behaviour modification intervention delivered by trained paediatric primary care providers for obesity prevention. Efficacy trial with cluster randomization (practice level) and a 12-session 12-month sweetened beverages decrease intervention or a comprehensive dietary and physical activity intervention, compared with a control intervention among children ages 8-12 years. A low recruitment rate was observed. The increase in body mass index z-score (BMIz) for the 139 subjects (11 practices) randomized to any of the two obesity interventions (combined group) was less than that of the 33 subjects (five practices) randomized to the control intervention (-0.089, 95% confidence interval [CI]: -0.170 to -0.008, P = 0.03) with a -1.44 kg weight difference (95% CI: -2.98 to +0.10 kg, P = 0.095). The incidences of obesity and excess weight gain were lower in the obesity interventions, but the number of subjects was small. Post hoc analyses comparing the beverage only to the control intervention also showed an intervention benefit on BMIz (-0.083, 95% CI: -0.165 to -0.001, P = 0.048). For participating families, an obesity prevention intervention delivered by paediatric primary care clinicians, who are compensated, trained and continuously supported by behavioural specialists, can impact children's BMIz.

The COVID-19 pandemic unfolded onto a preexisting national mental health crisis, resulting in significant increases in mental health problems among youth. Pediatric primary care practices subsequently faced an influx of families presenting for behavioral health concerns with few accessible options for evidence-based treatment. Youth CopeNYP was launched as a short-term, virtual intervention program using evidence-based principles offered to children, adolescents, and parents within the pediatric primary care setting. We describe the development and implementation of this service, including establishing a workforce, creating a referral workflow and handoff system with pediatricians, and developing a clinical manual using evidence-based practices. Adaptation from a crisis response service to a sustainable program to address the ongoing youth mental health crisis in pediatric primary care is discussed.