Stories about: primary care

Wise health care spending for children with medical complexity

Spending on children with medical complexityJay Berry, MD, MPH, is a pediatrician and hospitalist in the Complex Care Service at Boston Children’s Hospital.

Growing up, my parents repeatedly reminded me that “money doesn’t grow on trees.” They pleaded with me to spend it wisely. I’ve recently been thinking a lot about my parents and how their advice might apply to health care spending for my patients.

As a general pediatrician with the Complex Care Service at Boston Children’s Hospital, I care for “medically complex” children. These children—numbering an estimated 500,000 in the U.S.— have serious chronic health problems such as severe cerebral palsy and Pompe disease. Many of them rely on medical technology, like feeding and breathing tubes, to help maintain their health.

These children are expensive to take care of. They make frequent health care visits and tend be high utilizers of medications and equipment. Some use the emergency department and the hospital so often that they’ve been dubbed frequent flyers.

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Blood pressure, cholesterol screening in kids: Guidelines vs. real world?

Primary care visit
Is universal cardiovascular screening supported by the data, and are clinicians ready?
In 2011, the National Heart, Lung, and Blood Institute (NHLBI) guidelines for cardiovascular risk reduction in pediatrics reinforced the recommendation that primary care pediatricians (PCPs) should screen children and adolescents for cholesterol and blood pressure elevations. However, as PCPs try to incorporate it into their well childcare routine, questions are being raised about the practical implications of implementing that recommendation.

Last month, the U.S. Preventive Services Task Force (USPSTF) published its finding that there is not enough evidence to recommend for or against routine screening for primary hypertension in asymptomatic children and teens, repeating its suggestions from 2003. It has issued similar statements about lipid screening.

At this week’s 2013 American Academy of Pediatrics (AAP) conference, Sarah de Ferranti, MD, MPH, director of the Preventive Cardiology Clinic at Boston Children’s Hospital, gave a presentation titled “Universal Lipid Screening: Are Pediatricians Doing It and How Is It Working?” She spoke with Vector about screening both for cholesterol and blood pressure in children.

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Yes, PCPs can help youth with smoking, but can we get incentives to align?

Teen girl smoking cropped-shutterstock_108536432Claire McCarthy, MD, has been a primary care pediatrician and writer for more than 20 years. She blogs for the Huffington Post, Boston.com and the Children’s pediatric health blog, Thriving. She practices at the Children’s Hospital Primary Care Center. Follow her on Twitter @drClaire.

When I read about the report from the U.S. Preventive Services Task Force saying that pediatricians can “move the needle” when it comes to youth smoking, I had a few different reactions.

My first reaction was:  Cool! I don’t want youth to smoke. We all know the health problems it causes. It’s good to know that we can make a difference.

My second reaction, as I thought about it more, was:  Duh. Of course we can make a difference. We primary care pediatricians are perfectly positioned to influence the health behaviors of youth. We have relationships with them and their parents. We see them regularly, we have the opportunity to build trust and to get to know and understand them. We talk to them about all aspects of their health and well-being. While they don’t always listen to us, there’s always the chance they will.

And then, as I thought about it even more, my reaction was:  Is anyone going to help us do it?

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What’s going around: Can biosurveillance data improve patient care in real-time?

A broad view of what's going on locally may help doctors make better clinical decisions when patients come to them for things like strep throat. (zigazou76/Flickr)

Anyone’s risk of catching an infectious disease is closely linked to what epidemiologists call the disease’s incidence: the number of people in a given area infected with that disease in a given time period. We often have a kind of water-cooler-level awareness about incidence, saying things like, “I hear there’s something going around,” or “Half of my son’s class was out with something last week,” while talking to co-workers or friends about our sniffle or our child’s stomach bug.

Kenneth Mandl and Andrew Fine, in the Children’s Hospital Informatics Program, want to take this awareness a step further by collecting real-time population-level biosurveillance information and packaging it for doctors, like your primary care doctor or your child’s pediatrician. Right now, doctors rarely have access to this kind of data, and even if they do, they have few recognized methods at their disposal for formally making use of the data in their clinical decision making processes.

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