COVID-19 pandemic and families' utilization of well-child clinics and pediatric practices attendance in Germany.
Ontology highlight
ABSTRACT: Objective
The COVID-19 pandemic and the measures implemented to stop the pandemic had a broad impact on our daily lives. Besides work and social life, health care is affected on many levels. In particular, there is concern that attendance in health care programs will drop or hospital admissions will be delayed due to COVID-19-related anxieties, especially in children. Therefore, we compared the number of weekly visits to 78 German pediatric institutions between 2019 and 2020.Results
We found no significant differences during the first 10 weeks of the year. However, and importantly, from April, the weekly number of visits was more than 35% lower in 2020 than in 2019 (p = 0.005). In conclusion, the COVID-19 pandemic seems to relate to families´ utilization of outpatient well-child clinics and pediatric practice attendance in Germany.
SUBMITTER: Vogel M
PROVIDER: S-EPMC8050987 | biostudies-literature | 2021 Apr
REPOSITORIES: biostudies-literature
Publications
COVID-19 pandemic and families' utilization of well-child clinics and pediatric practices attendance in Germany.
Vogel Mandy M Beger Christoph C Gausche Ruth R Jurkutat Anne A Pfaeffle Roland R Körner Antje A Meigen Christof C Poulain Tanja T Kiess Wieland W
BMC research notes 20210416 1
<h4>Objective</h4>The COVID-19 pandemic and the measures implemented to stop the pandemic had a broad impact on our daily lives. Besides work and social life, health care is affected on many levels. In particular, there is concern that attendance in health care programs will drop or hospital admissions will be delayed due to COVID-19-related anxieties, especially in children. Therefore, we compared the number of weekly visits to 78 German pediatric institutions between 2019 and 2020.<h4>Results< ...[more]
Similar Datasets
Project description:Background and objectivesIt is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type.MethodsWe conducted a retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states. WCVs were identified by using International Classification of Diseases, Ninth and 10th Revisions and Current Procedural Terminology codes. We calculated adherence to the 13 American Academy of Pediatrics-recommended WCVs from birth to age 6 years. To address data completeness, we made 2 adherence calculations after a child's last recorded WCV: 1 in which we assumed all subsequent WCVs were attended outside the network and 1 in which we assumed none were.ResultsWe included 152 418 children in our analysis. Most children were either publicly insured (77%) or uninsured (14%). The 2-, 4-, and 6-month visits were the most frequently attended (63% [assuming no outside care after the last recorded WCV] to 90% [assuming outside care]), whereas the 15- and 18-months visits (41%-75%) and 4-year visit (19%-49%) were the least frequently attended. Patients who were publicly insured and uninsured (versus privately insured) had higher odds of missing WCVs. Hispanic and Asian American (versus non-Hispanic white) patients had higher odds of attending WCVs.DiscussionThe 15- and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs. The former represent opportunities to identify developmental delays, and the latter represents an opportunity to assess school readiness.
| S-EPMC7063686 | biostudies-literature
Project description:Affecting 10-15% of women, postpartum depression (PPD) can be debilitating and costly. While early identification has the potential to improve timely care, recommendations regarding the implementation of routine screening are inconsistent. In Alberta, screening is completed using the Edinburgh Postnatal Depression Scale during public health well child clinic visits. The objective of this study was to examine the effectiveness of screening in identifying, diagnosing and treating women at increased risk for PPD over the first year postpartum, compared to those unscreened. The All Our Families prospective pregnancy cohort was linked to public health, inpatient, outpatient, physician claims and community pharmaceutical data over the first year postpartum. Descriptive statistics and bivariate analyses examined differences in sample characteristics and PPD and non-PPD related utilization by screening category. Odds ratios and 95% confidence intervals for PPD diagnosis and mental health drugs dispensed were generated using crude and multivariable logistic regression models. Within our sample, 87% of the eligible population were screened, with 3% receiving a high-risk score, and 13% were unscreened. Compared to those unscreened, women screened high-risk had higher odds of being diagnosed with PPD (OR: 3.88, 95% CI: 2.18-6.92) and women screened low/moderate-risk had reduced odds of receiving a diagnosis (OR: 0.51, 95% CI: 0.35-0.74). High-risk women had an increased likelihood of diagnosis, higher PPD-related utilization and drugs dispensed compared to those unscreened. This information suggests that screening was effective at streamlining resources in Alberta. Future work should focus on evaluating the cost-effectiveness of PPD screening.
| S-EPMC6517566 | biostudies-literature
Project description:ImportanceTelemedicine is increasingly used to provide outpatient pediatric neurology consultations in underserved communities. Although telemedicine clinics have been shown to improve access, little is known about how they alter patients' utilization of hospital services.ObjectiveTo evaluate the association between access to telemedicine clinics and hospital utilization among underserved children with neurologic conditions.Design, setting, and participantsThis retrospective cross-sectional study included 4169 patients who received outpatient care from pediatric neurologists affiliated with an academic children's hospital in California between January 1, 2009, and July 31, 2017, either in person or using telemedicine.ExposuresConsultation modality (telemedicine or in person) in the outpatient neurology clinics.Main outcomes and measuresDemographic and clinical variables were abstracted from the hospital's electronic medical records. The association between the modality of outpatient neurology care and patients' utilization of the emergency department and hospitalizations was evaluated. Both all-cause and neurologic condition-related hospital utilization were analyzed using multivariable negative binomial regression in overall and matched samples.ResultsThe telemedicine cohort comprised 378 patients (211 [55.8%] male), and the in-person cohort comprised 3791 patients (2090 [55.1%] male). The mean (SD) age at the first encounter was 7.4 (5.4) years for the telemedicine cohort and 7.8 (5.1) years for the in-person cohort. The telemedicine cohort was more likely than the in-person cohort to have nonprivate insurance (public insurance, self-pay, or uninsured), lower education, and lower household income. The rates of all-cause and neurologic hospital encounters were lower among children who received pediatric neurology consultations over telemedicine compared with children who received care in the in-person clinics (5.7 [95% CI, 3.5-8.0] vs 20.1 [95% CI, 18.1-22.1] per 100 patient-years and 3.7 [95% CI, 2.0-5.3] vs 8.9 [95% CI, 7.8-10.0] per 100 patient-years, respectively; P < .001). Even after adjusting for demographic and clinical factors, the telemedicine cohort had a lower risk of hospital encounters (emergency department visits and admissions) with an adjusted incidence rate ratio of 0.57 (95% CI, 0.38-0.88) for all-cause encounters and an adjusted incidence rate ratio of 0.60 (95% CI, 0.36-0.99) for neurologic encounters. After matching on travel time to the neurology clinic, the adjusted incidence rate ratio was 0.19 (95% CI, 0.04-0.83) for all-cause admissions and 0.14 (95% CI, 0.02-0.82) for neurologic admissions.Conclusions and relevancePediatric neurology care through real-time, audiovisual telemedicine consultations was associated with lower hospital utilization compared with in-person consultations, suggesting that high-cost hospital encounters can be prevented by improving subspecialty access.
| S-EPMC6704740 | biostudies-literature
Project description:ImportancePediatric cancer care services in high-income nations are mainly centralized in metropolitan cities. To allow treatments closer to home, patients across Ontario, Canada, a geographically large province, are offered decentralized care via satellite clinics; however, it is unclear whether the utilization of these pediatric oncology satellite clinics differs by area-level sociodemographic factors.ObjectiveTo examine whether sociodemographic factors, such as area-level income and rurality, are independently associated with the odds of satellite clinic visit and the hazards of time to first visit among pediatric oncology patients receiving cancer treatment.Design, setting, and participantsThis is a retrospective population-based cohort study of patients aged 0 to 17 years with cancer living in a satellite catchment area in Ontario, Canada (from 2015 to 2022, with follow-up through 2023). The Pediatric Oncology Group of Ontario Networked Information System cancer registry (containing age, sex, diagnosis type, and year information) was linked to satellite, OpenStreetMap, and postal-code databases to ascertain rural or urban dwelling, neighborhood-based income, and driving time saved.ExposuresAge, sex, rural or urban dwelling, and neighborhood-level income quintiles.Main outcomes and measuresThe primary outcomes were the odds of satellite clinic attendance within 1 year of diagnosis and the hazards of first clinic visit after starting systemic therapy, derived from multivariable logistic and Cox proportional hazards models, respectively.ResultsAmong the 1280 eligible patients (median [IQR] age, 7.0 [3.0-13.0] years; 753 male [58.8%]), 844 (65.9%) visited a satellite clinic within 1 year of diagnosis with a median (IQR) of 39 (14-67) days to first visit. Driving time saved (>60 minutes) was the factor most associated with satellite use, followed by diagnostic type (with patients with central nervous system tumors least likely to visit). Rural (vs urban) patients had significantly lower odds of satellite visit within a year of diagnosis (odds ratio, 0.48; 95% CI, 0.31-0.74; P = .001) and lower instantaneous likelihood of visiting after start of treatment (hazard ratio, 0.65; 95% CI, 0.53-0.81; P < .001). Living in a lower-income (vs middle-income) area was also associated with significantly lower utilization (odds ratio, 0.53; 95% CI, 0.35-0.80; P = .009; hazard ratio, 0.73; 95% CI, 0.60-0.89; P = .002).Conclusions and relevanceThis population-based study of pediatric oncology patients found that satellite clinics, despite being designed to reduce transportation and financial burdens, were disproportionately underutilized by patients living in rural and lower-income areas. Monitoring area-level social determinants of health can help inform interventions to improve timely and equitable access to childhood cancer care closer to home.
| S-EPMC11672161 | biostudies-literature
Project description:IntroductionThe COVID-19 pandemic has affected the delivery of essential health services, such as routine immunization. We assessed the impact of the pandemic on the uptake of routine immunization in rural Gambia.MethodsWe collected real-time vaccine administration data in the Basse and Fuladu West Health & Demographic Surveillance Systems from September 01, 2019, to December 31, 2020. We assessed the monthly number of Expanded Program on Immunization (EPI) clinic attendances and vaccines administered, comparing data during the baseline period (September 01, 2019-March 31, 2020), COVID-19 interruption period (April 01-June 30, 2020), initial recovery period (Jul 01-September 30, 2020) and the late recovery period (October 01-December 31, 2020).ResultsCompared to the baseline period, there was an overall average monthly decline of 13.4% in EPI attendance and 38.3% reduction in average monthly immunizations during the interruption period. This decrease was particularly noticeable for Bacille Calmette-Guérin (BCG) (47.2%), birth dose hepatitis B (Hep B) (46.9%), 1st dose pentavalent (Penta1) (43.1%), 1st dose pneumococcal conjugate vaccine (PCV1) (42.4%), and measles vaccines (15.5%). Comparing the late recovery to baseline period, average monthly EPI attendance was 5.3% higher, with 1.9% increase in average monthly immunizations. Monthly immunizations for BCG were 3.0% greater, 2.5% greater for Hep B, 22.7% greater for oral polio vaccine (OPV1), 2.0% less for Penta1, 19.2% less for Penta2, and 2.6% less for PCV1.ConclusionThe reduced EPI attendance during the pandemic interruption period lasted only 3 months. Significant recovery in EPI attendance occurred during the late recovery period, while rates of monthly immunization returned to pre-pandemic levels for most antigens. EPI programmes should implement strategies to deliver missed antigens when infants do present to EPI clinics, aware that missed doses may be age dependent.
| S-EPMC9468317 | biostudies-literature
Project description:Middle-aged adults often have relationships with multiple family members (e.g., children and parents). The constellation of parent-child relationships within families may have implications for individuals' psychological well-being. This study created typologies of parent-child ties by combining multiple dimensions of relationships and examined the extent to which middle-aged adults showed variability across typologies of parent-child ties within multigenerational families. Using 2,252 parent-child ties across three generations from 633 middle-aged adults, this study identified typologies of parent-child ties based on 5 indicators (i.e., contact, downward and upward support, and positive and negative relationship qualities), and examined the associations of specific typologies of parent-child ties as well as within-family variability in typologies with middle-aged adults' psychological well-being. This study found 7 types of parent-child ties as distinct combinations of contact, support exchanges, and relationship quality. Within-family variability in these types was associated with more depressive symptoms, and having types characterized by conflicted ties was associated with more depressive symptoms and lower life satisfaction. Middle-aged adults seem to be happiest when they are able to maintain homogeneous, harmonious patterns of relationships with their parents and grown children. Findings were discussed with regard to factors that also may predict greater variability in family relationship patterns. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
| S-EPMC7145731 | biostudies-literature
Project description:BackgroundAppetite traits and feeding practices are important determinants of child weight and obesity.ObjectivesThis study examined whether: (1) infant appetite traits were associated with feeding practices and (2) feeding practices mediated the link between appetite traits and weight-for-age z-scores at age 3 years.MethodsWe conducted a secondary data analysis from the 'Starting Early Program' of low-income, Hispanic mother-child pairs. Appetite traits were assessed using the Baby Eating Behaviour Questionnaire. Infant feeding practices were collected using 24-h dietary recalls and surveys: (1) breastfeeding exclusivity, intensity and duration; (2) early introduction to complementary foods/liquids and (3) any 100% fruit juice consumption at age 10 months. Regression and mediation analyses were used to explore associations between appetite, feeding and weight.ResultsHigher infant Slowness in Eating scores were associated with greater breastfeeding exclusivity, intensity and duration, compared to lower Slowness in Eating. Infants with higher Slowness in Eating and Satiety Responsiveness had lower odds of early introduction to complementary foods/liquids. Infants with higher Enjoyment of Food had greater odds of 100% juice consumption. Breastfeeding duration mediated the relationship between higher infant Slowness in Eating and lower weight-for-age z-scores.ConclusionsAppetite traits represent potential targets for early life infant feeding interventions.
| S-EPMC9283219 | biostudies-literature
Project description:ObjectivesWhile most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with suspected/confirmed coronavirus disease 2019 are unknown.DesignMulti-institutional survey regarding inpatient resuscitation practices during the coronavirus disease 2019 pandemic.SettingInternet-based survey.SubjectsU.S. PICU representatives (one per institution) involved in resuscitation system planning and oversight.InterventionsNone.Measurements and main resultsOf 130 institutions surveyed, 78 (60%) responded. Forty-eight centers (62%) had admitted coronavirus disease 2019 patients; 26 (33%) reported code team activation for patients with suspected/confirmed coronavirus disease 2019. Sixty-seven respondents (86%) implemented changes to inpatient emergency response systems. The most common changes were as follows: limited number of personnel entering patient rooms (75; 96%), limited resident involvement (71; 91%), and new or refined team roles (74; 95%). New or adapted technology is being used for coronavirus disease 2019 resuscitations in 58 centers (74%). Most institutions (57; 73%) are using enhanced personal protective equipment for all coronavirus disease 2019 resuscitation events; 18 (23%) have personal protective equipment policies dependent on the performance of aerosol generating procedures. Due to coronavirus disease 2019, most respondents are intubating earlier during cardiopulmonary resuscitation (56; 72%), utilizing video laryngoscopy (67; 86%), pausing chest compressions during laryngoscopy (56; 72%), and leaving patients connected to the ventilator during cardiopulmonary resuscitation (56; 72%). Responses were varied regarding airway personnel, prone cardiopulmonary resuscitation, ventilation strategy during cardiopulmonary resuscitation without an airway in place, and extracorporeal cardiopulmonary resuscitation. Most institutions (46; 59%) do not have policies regarding limitations of resuscitation efforts in coronavirus disease 2019 patients.ConclusionsMost U.S. pediatric institutions rapidly adapted their resuscitation systems and practices in response to the coronavirus disease 2019 pandemic. Changes were commonly related to team members and roles, personal protective equipment, and airway and breathing management, reflecting attempts to balance quality resuscitation with healthcare provider safety.
| S-EPMC7340134 | biostudies-literature
Project description:ObjectivesTo explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics.Study designThis is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices.ResultsOf the 63 sites that provided contraception, 5 (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters.ConclusionsEndorsement of IUD self-removal increased to one-quarter of sites by the final timepoint.ImplicationsTwenty-five percent of family planning clinics reported provision of intrauterine device self-removal guidance by eight months into the COVID-19 pandemic, a three-fold increase from baseline; these findings suggest clinician support for patient autonomy in contraceptive self-management and limited concern for safety issues with self-removal during a public health emergency.
| S-EPMC9554323 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has disrupted healthcare, including immunization practice and well child visit attendance. Maintaining vaccination coverage is important to prevent disease outbreaks and morbidity. We assessed the impact of the COVID-19 pandemic on pediatric and adolescent vaccination administration and well child visit attendance in the United States.MethodsThis cross-sectional study used IBM MarketScan Commercial Database (IMC) with Early View (healthcare claims database) and TriNetX Dataworks Global Network (electronic medical records database) from January 2018-March 2021. Individuals ≤ 18 years of age who were enrolled during the analysis month of interest (IMC with Early View) or had ≥ 1 health encounter at a participating institution (TriNetX Dataworks) were included. We calculated the monthly percent difference between well child visit attendance and vaccine administration rates for 10 recommended pediatric/adolescent vaccines in 2020 and 2021 compared with 2018-2019. Data were stratified by the age groups 0-2 years, 4-6 years, and 9-16 years.ResultsIn IMC with Early View, the average monthly enrollment for children 0-18 years of age was 5.2 million. In TriNetX Dataworks, 12.2 million eligible individuals were included. Well child visits and vaccinations reached the lowest point in April 2020 compared with 2018-2019. Well child visit attendance and vaccine administration rates were inversely related to age, with initial reductions highest for adolescents and lowest for ages 0-2 years. Rates rebounded in June and September 2020 and stabilized to pre-pandemic levels in Fall 2020. Rates dropped below baseline in early 2021 for groups 0-2 years and 4-6 years.ConclusionsWe found substantial disruptions in well child visit attendance and vaccination administration for children and adolescents during the COVID-19 pandemic in 2020 and early 2021. Continued efforts are needed to monitor recovery and catch up to avoid outbreaks and morbidity associated with vaccine-preventable diseases.
| S-EPMC8719942 | biostudies-literature