Relating intimate partner violence to heath-care utilisation and injuries among Pacific children in Auckland: The Pacific Islands Families Study

Aim:   Despite well-known emotional and behavioural sequela, few studies investigate health-care utilisation and injury impacts of children exposed to intimate partner violence (IPV). This study examines the association between mothers' IPV experience and general practitioner (GP) and hospital presentations by their children within the first 6 years of life.
Methods:   In 2000, a cohort of Pacific infants born in Auckland was established. At 6 weeks, 2 years and 6 years post-partum, maternal home interviews were conducted and IPV experience elicited using the Conflict Tactic Scale, together with reports of children's GP and hospital visitations.
Results:   At 6 weeks, 2 years and 6 years, 1098, 921 and 799 participating mothers were in intimate relationships. Severe physical IPV was reported by 22.1, 23.0 and 7.1% of mothers, respectively, and minor IPV was reported by another 18.7, 16.9 and 6.1%, respectively. Compared with children without maternal physical IPV exposure, children of mothers disclosing severe physical IPV were 1.19 (95% confidence interval (CI): 1.08–1.31) times as likely to visit GPs, and children of mothers disclosing minor physical IPV were 1.13 (95% CI: 1.02–1.25) times as likely to visit GPs, after adjusting for socio-demographic, maternal mental health and other confounding factors. No significant association was found between maternal IPV and children's hospital visits, or GP or hospital visits for injury.
Conclusions:   IPV is common for many mothers of Pacific children, and is associated with significantly more GP visits for exposed children. Identification of maternal IPV during mothers' and children's GP and hospital visits may help guide services to prevent future presentations to children.     

Unmet health care needs and impact on families with children with disabilities in Germany.

OBJECTIVES: We sought to determine the independent effect of unmet health needs on family burden, in addition to the effects of functional impairment and parental care load, in children and adolescents with disabilities. METHODS: We conducted a cross-sectional survey of 273 families with children with disabilities using ambulatory services at an academic children's hospital in Germany. We measured family burden using a translated version of the Impact on Family Scale (FABEL). Independent variables were unmet health needs in 4 areas (medical care, care coordination, health education, and psychosocial services), level of functional disability, and nursing care load at home. Control variables included the child's age and gender, maternal employment status, and parental educational attainment. RESULTS: Most children had complex health conditions such as brain injury, congenital malformations, metabolic disease, myopathies, and brain tumors. Nearly half of families (44.6%) received home nursing cash benefits, indicating high care load. Parents reported most unmet needs in the areas of psychosocial counseling (17.2%) and care coordination (8.1%). After controlling for sociodemographic factors, unmet health needs predicted family burden independently of type (mental retardation or mobility impairment) and number of disabilities and nursing care load. Although only a few parents reported lack of medical services, this factor also contributed significantly to family burden. Multivariate analysis with these variables explained 45% of the variance in impact on the family. CONCLUSIONS: Addressing unmet health needs may alleviate the impact of caring for a child with a disability. Further studies are needed to show more definitively that families can benefit from integrated services including psychosocial counseling.     

Low parental literacy is associated with worse asthma care measures in children.

OBJECTIVE: To determine whether parental literacy is related to emergency department visits, hospitalizations, and days of school missed for children with asthma. METHODS: We performed a retrospective cohort study at a university pediatric clinic. We enrolled children between 3 and 12 years old with a diagnosis of asthma and a regular source of care at the site of the study and their parent or guardian. Primary asthma care measures included self-reported rates of emergency department visits, hospitalizations, and days of school missed. Secondary asthma care measures included rescue and controller medication use, classification of asthma severity, and parental asthma-related knowledge. RESULTS: We enrolled 150 children and their parents. Twenty-four percent of the parents had low literacy. Children of parents with low literacy had greater incidence of emergency department visits (adjusted incidence rate ratio [IRR] 1.4; 95% confidence interval 0.97, 2.0), hospitalizations (IRR 4.6; 1.8, 12), and days missed from school (IRR 2.8; 2.3, 3.4) even after adjusting for asthma-related knowledge, disease severity, medication use, and other sociodemographic factors. Parents with low literacy had less asthma-related knowledge, and their children were more likely to have moderate or severe persistent asthma and had greater use of rescue medications. CONCLUSIONS: Low parental literacy is associated with worse care measures for children with asthma.     

Safety education in a pediatric primary care setting

Parents of 171 children coming to the Yale-New Haven Hospital Primary Care Center for their 6-month checkup were randomized into an intervention group (n = 85) and a control group (n = 86). Parents in the intervention group received a three-part individualized course in child safety that required active parental participation. Parts 1, 2, and 3 were given at the 6-month, 9-month, and 12-month well-child visits, respectively. Parents in the control group received routine safety education as provided at well-child visits. The educational phase of the study was completed by 129 families, 65 in the intervention group and 64 in the control group. Safety knowledge, number of hazards in the home, and reported accidents were assessed by a "blinded" community health worker approximately 1 month after the 12-month well-child visit. A total of 109 home visits were made, 55 for the intervention group and 54 for the control group. Parental safety knowledge was assessed based upon pictorial hazard recognition. Of 13 possible hazards, the mean number of hazards recognized by the intervention group parents was 9.4 (n = 55) v 8.4 (n = 50) by the control group parents (t = 2.1, P less than .05, two-tailed). A hazard score was determined for each family based on nine possible hazards observed at the home visit. The mean hazard score for the intervention group was 2.4 (n = 55 v 3.0 (n = 54) for the control group (t = 2.4, P less than .02, two-tailed). Parentally reported accidents and accidents reported in hospital records were similar for both groups. Results of this study suggest that age-appropriate safety education that is repetitive and individualized and that requires active parental participation results in an increase in parental knowledge and an improvement in certain safety practices.     

Television,computer use and body mass index in Australian primary school children

OBJECTIVE: To investigate relationships between children's body mass index (BMI) and parent reports of children's television and video game/computer habits, controlling for other potential risk factors for paediatric obesity. METHODS: Child BMI was calculated from measured height and weight collected in 1997 as part of a large, representative, cross-sectional study of children in Victoria, Australia. Parents reported the amount of time children watched television and used video games/computers, children's eating and activity habits, parental BMI and sociodemographic details. RESULTS: A total of 2862 children aged 5-13 years participated. Child mean BMI z-score was significantly related to television (F = 10.23, P < 0.001) but not video game/computer time (F = 2.23, P = 0.09), but accounted for only 1 and 0.2% of total BMI variance, respectively. When parental BMI, parental education, number of siblings, food intake, organized exercise and general activity level were included, television ceased to be independently significantly related to child BMI. Using adjusted logistic regression, the odds of being overweight and obese generally increased with increasing television viewing. No relationship was found for video game/computer use. CONCLUSIONS: A small proportion of variance in child BMI was related to television, but not video game/computer time. This was far outweighed by the influence of other variables. Causal pathways are likely to be complex and interrelated.     

Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life

AIM: Very preterm infants represent major consumers of health services following neonatal discharge. We examined the health service utilisation of a regional cohort of very preterm infants over the first 2 years of life, including the association with neurodevelopmental outcome. METHODS: A regionally based 2-year cohort of 100 very preterm infants along with a comparison sample of 104 full term control infants matched for sex, time and place of birth were recruited. Perinatal and social background factors that predispose very preterm infants to increased risk of subsequent general practitioner (GP) and hospital service use were identified. At 2 years, all children underwent a neurodevelopmental assessment, Bayley Scales of Infant Development (BSID-II). Details of children's medical contacts obtained by parent interview were cross-checked against GP and hospital records/databases. RESULTS: Very preterm infants had a similar number of GP visits to term infants but more outpatient hospital visits. Fifty-three (55%) very preterm infants were admitted to hospital on 131 occasions compared with 26 (26%) term infants on 37 occasions (p<0.001). The main reason for hospitalisation in the preterm cohort was respiratory disorder. The frequency of hospital admissions was significantly related to birthweight (P=0.01), gestational age (P<0.001) and the number of people living in the family household (P=0.02). No associations were found between hospital admission and neurodevelopment at 2 years. CONCLUSION: Very preterm infants had higher rates of hospital admissions and visits than term infants unrelated to neurodevelopmental outcome at 2 years of age. These findings highlight that very preterm birth is associated with ongoing health morbidity.     

Comparability of acute asthma severity assessments by parents and respiratory therapists

OBJECTIVE: To compare the assessments of parents and respiratory therapists (RTs) of acute asthma severity in children discharged after emergency department (ED) treatment. DESIGN: Prospective cohort study. SETTING: Home care visit within 24 hours of discharge from an urban children's hospital ED. PARTICIPANTS: Children aged 2 to 17 years discharged to home after treatment in the ED (at least 1 inhaled bronchodilator treatment administered) were randomly selected to have a home care visit. MAIN OUTCOME MEASURES: Registered RTs went to the child's home and asked the parent questions about his or her perception of the child's symptoms. The RT performed a clinical assessment including pulse oximetry. RESULTS: Ninety children were selected for home care, and 51 patients (57%) successfully completed the home care visit; 48 (53%) underwent a complete assessment by both raters. There were no differences in demographic features or ED clinical variables between those successfully contacted and those not reached. Of those evaluated, 43 parents (84%) reported their child's asthma was improved, and the rest reported no change. Parents underestimated the degree of wheezing or work of breathing relative to the RT in 3 of 48 patients (6%), but only 1 of these was considered substantial (>1 point discrepancy). Findings were overestimated in 14 (29%) of 48 cases, but only 5 (10%) were substantial. CONCLUSIONS: Parents and RTs provide comparable assessments of acute asthma severity in children within 24 hours of discharge from the ED. Clinically important discrepancies are uncommon, and underestimation of severity by parents is rare.     

The language of breathlessness: do families and health care providers speak the same language when describing asthma symptoms?

INTRODUCTION: Effective communication about symptoms is a critical prerequisite to appropriate treatment. Study aims were to: (a) document the symptoms that children with asthma and their parents associate with asthma, (b) identify differences between the "professional model "of asthma symptoms and the "lay model," (c) describe the family's proposed action in response to symptoms, and (d) investigate the congruence between parental assessment of "good control" and severity obtained using National Asthma Education and Prevention Program criteria. METHOD: Children with asthma and their parents (N = 228) were recruited from diverse clinical practice sites. Parents and children described symptoms they associated with an asthma exacerbation and their proposed action. Perceived asthma control was compared with a structured assessment of severity. RESULTS: One hundred and thirty-six unique symptoms were reported. While 78% of parents reported at least one standard asthma symptom, 48% also reported nonstandard asthma symptoms. Sixty-five percent of parents whose children's symptoms were consistent with severe asthma reported "good control." DISCUSSION: Improved communication about symptoms would improve asthma care. Proposed strategies include standardized screening questionnaires to assess symptoms, more frequent routine visits for children with persistent asthma, and wide dissemination of realistic goals for symptom control.     

Parental asthma knowledge: Its association with readmission of children to hospital

Objectives: To assess whether poor parental knowledge about asthma was a risk factor for readmission of their children to hospital.
Methodology: Parents of children who were admitted to the paediatric facility at Newcastle Mater and John Hunter Hospitals were administered a previously validated asthma knowledge questionnaire with a maximum possible score of 31.
Results: The mean parental knowledge scores for three groups of children were determined: those with a previous diagnosis of asthma being readmitted to hospital (170 children, mean score 18.3); those with a previous diagnosis of asthma being admitted for the first time (114 children, mean score 17.2); and children being admitted with their first attack of asthma (65 children, mean score 15.6). There was a significant difference in parental asthma knowledge between the first and third group ( P <0.001) but not between the first and second group. A linear regression model with knowledge score as an outcome found that increased knowledge was associated with previously diagnosed asthma, higher parental occupation and no smoker in the home.
Conclusions: Knowledge was poor in all groups. Readmission rate was related to the severity of the child's asthma.     

Predictors of health care utilization of children with asthma in the community

The aim of this study was to assess the pattern of use of health care services among children with asthma symptoms within the community, and assess groups at increased risk of emergency department (ED) visits or hospital admissions (HA). Using International Study of Asthma and Allergies in Childhood phase II protocol, information about asthma management and utilization of health care services was collected by parental questionnaire in a community-based random sample of 5–7- and 9–11-year-old children (n = 11,094) in Dresden and Munich. Only 11.2% of children with current wheeze did not utilize any health care facility or consultation for their asthma symptoms in the 12 months prior to survey, while 86.2%, 12.3%, and 3.6% had at least one asthma related physician's consultation, ED visits, or HA, respectively. Predictors of ED visits and HA among current wheezers were: younger age, male gender, speech-limiting wheeze, level of exposure to environmental tobacco smoke. In addition, children of low socioeconomic status were more likely to have ED visits because of their asthma. Childhood asthma is a major public health problem in Germany leading to substantial morbidity and utilization of health care services. Exposure to tobacco smoke comes out as the major modifiable risk factor related to asthma morbidity in children.     

Development of specific immunoglobulin E in coughing toddlers: A medical records review of symptoms in general practice

The aim of this study was to study whether young children, originally immunoglobulin E (IgE) negative and who became sensitized to specific inhalation allergens, presented more frequently to their general practi‐tioner (GP) with other allergy‐ and asthma‐related symptoms than children who remained IgE negative. It was also investigated whether asthma was diagnosed more often in children who developed IgE to inhalant allergens. Coughing children, 1–5 years of age, visiting the participating GPs, were tested for IgE antibodies to mites, dogs, and cats by using radioallergosorbent testing (RAST). All IgE‐negative (RAST < 0.2 IU/ml) children were re‐tested after 2 years. The medical records of 162 children were reviewed on asthma‐ and allergy‐related symptoms and on prescribed medication. After 30 months, 27 of the 162 children (17%) had become IgE positive for one or more allergens. Most children (93%) had visited their GP for treatment of respiratory symptoms during this period. However, the children who had become IgE positive had visited their GP more often than the children who remained IgE negative. Differences in visits were seen for: shortness of breath (52% IgE‐positive vs. 19% IgE‐negative children, respectively), wheeze (37% vs. 17%), allergic rhinitis (33% vs. 16%), and pneumonia (22% vs. 8%), but not for coughing (89% vs. 88%). The IgE‐positive children were more frequently diagnosed by their GP as having asthma (48%) than were the IgE‐negative children (23%). In a multivariate analysis, indicators of becoming IgE positive were: a visit for shortness of breath (odds ratio [OR] = 6.9; 95% confidence interval [CI] = 2.1–23.1) and two or more visits for wheeze (OR = 6.0; 95% CI = 1.9–19.2), adjusted for breast‐feeding, age, and asthma or allergy in the family. The positive predictive value (PPV) of being IgE positive with a diagnosis of asthma was 90% (whereas the negative predictive value was 48.0%) for a child attending their GP for treatment of wheeze. For recurrent coughing (six or more visits) and shortness of breath, the PPVs were 73% and 71%, respectively. The development of sensitization to common inhalant allergens is associated with specific allergy and asthma‐related symptoms in young children. IgE‐positive children were more frequently diagnosed as having asthma by their GP. This implies that in general practice it is possible to detect children at high risk for developing allergic asthma early in life by their respiratory symptoms and by subsequent testing for specific IgE to inhalant allergens.     

Association between evidence-based standardized protocols in emergency departments with childhood asthma outcomes: a canadian population-based study

OBJECTIVE To determine whether children treated in emergency departments (EDs) with evidence-based standardized protocols (EBSPs) containing evidence-based content and format had lower risk of hospital admission or ED return visit and greater follow-up than children treated in EDs with no standardized protocols in Ontario, Canada. DESIGN Retrospective population-based cohort study of children with asthma. We used multivariable logistic regression to estimate risk of outcomes. SETTING All EDs in Ontario (N?=?146) treating childhood asthma from April 2006 to March 2009. PARTICIPANTS Thirty-one thousand one hundred thirty-eight children (aged 2 to 17 years) with asthma. MAIN EXPOSURE Type of standardized protocol (EBSPs, other standardized protocols, or none). MAIN OUTCOME MEASURES Hospital admission, high-acuity 7-day return visit to the ED, and 7-day outpatient follow-up visit. RESULTS The final cohort made 46?510 ED visits in 146 EDs. From the index ED visit, 4211 (9.1%) were admitted to the hospital. Of those discharged, 1778 (4.2%) and 7350 (17.4%) had ED return visits and outpatient follow-up visits, respectively. The EBSPs were not associated with hospitalizations, return visits, or follow-up (adjusted odds ratio, 1.17 [95% CI, 0.91-1.49]; adjusted odds ratio, 1.10 [95% CI, 0.86-1.41]; and adjusted odds ratio, 1.08 [95% CI, 0.87-1.35], respectively). CONCLUSIONS The EBSPs were not associated with improvements in rates of hospital admissions, return visits to the ED, or follow-up. Our findings suggest the need to address gaps linking improved processes of asthma care with outcomes.     

The use of parent report to assess the quality of care in primary care visits among children with asthma.

OBJECTIVE: To determine the accuracy of parent report and the accuracy of the medical record in documenting physician performance of elements of pediatric asthma care in the primary care setting. METHODS: A convenience sample of 79 English-speaking parents of 4--12-year old children with asthma presenting to medical center--affiliated inner-city primary care pediatric clinics in the Bronx, Dallas, and Chicago was enrolled, and the office visit was audiotaped. Parents were interviewed 1--16 days after the visit by telephone. OUTCOME MEASURES: Accuracy of parent report was the primary outcome. The "reference standard" was an independent evaluation of the audiotaped record of the primary care visit. The National Asthma Education and Prevention Program was used as a guide to select data elements to assess quality of pediatric asthma care during primary care visits. RESULTS: Sufficient documentation was significantly (P <.001) less likely to be present in the medical record than in the follow-up interview for each element of care. When these elements were combined into a cumulative score, 71% of parent interviews but only 37% of medical records scored > or = 5 (out of a possible 6), with 29% of medical records scoring < 3. Parents were able to accurately report (concordance of parent data with audiotape reference standard) whether or not the visit had included performance of 5 of the 6 elements of care. CONCLUSIONS: Our study suggests that parent telephone interview within 2 weeks after the visit is more accurate than the medical record for documentation of the quality of asthma care in pediatric primary care visits. The medical record was not sufficient to assess the quality of primary care related to asthma, primarily because of missing data. Therefore, our data suggest that assessing quality of care using the medical record will not only bias the findings in the direction of more deficient care but will also make improvement in care more difficult. Further validation of our strategy for using parent report to assess the quality of care in primary care visits will require its application in a variety of other primary care settings.     

Does your child have asthma? Parent reports and medication use for pediatric asthma

OBJECTIVE: To assess parental reporting of diagnosis used in surveys as an indicator of pediatric asthma prevalence. METHODS: Analysis of the Medical Expenditure Panel Survey, 1996 and 1997 (10 404 children aged from 0 to 17 years). All values are expressed as mean (SE). RESULTS: Asthma medications were purchased for 2.5% (0.2%) of children. Parents of 45.4% (4.0%) of these children failed to report asthma, including 41.3 (10.5%) of those for whom maintenance medications were purchased. These findings remained unchanged when very young children were excluded from the sample. Controlling for insurance coverage, no racial, ethnic, or socioeconomic disparities in reported asthma were found; however, poor children were more likely to have maintenance medications purchased (odds ratio, 4.9; 95% confidence interval, 2.3-10.4). CONCLUSIONS: Surveys of parental reports of asthma overlook many children with active disease. Dependence on parental reports may underestimate the prevalence of serious asthma among poor children. The parents in this study who fail to report asthma may represent a group that perceives their children's disease as less serious a problem despite active purchasing of medications.     

Children's visits to providers of complementary and alternative medicine in San Diego.

OBJECTIVE: Increased attention has been focused on the growing use of complementary and alternative medicine (CAM); however, few studies have included children in the general US population. The present study investigated children's visits to CAM providers and factors associated with these visits. METHODS: Analysis of cross-sectional data from the 2001 United Way Outcomes and Community Impact Program telephone survey, a representative sample of households in San Diego County, California. We selected households with children younger than 19 years of age (N = 1104). Parents reported on children's CAM visits in the past year. RESULTS: Approximately 23% of parents reported that their child saw a CAM provider in the past 12 months. CAM care was sought for sick and routine care. Children of white parents had greater odds of having a CAM visit in the past year compared with children whose parents were Hispanic (adjusted odds ratio 1.71, 95% confidence interval [95% CI] 1.11-2.63). Children whose parents were college graduates had a greater likelihood of seeing a CAM provider than children of parents with high school education (adjusted odds ratio = 1.82, 95% CI 1.19-2.79). Children who were insured were also more likely to have CAM visits than uninsured children (adjusted odds ratio = 2.32, 95% CI 1.04-5.21). CONCLUSIONS: Visits to CAM providers were much more common among children in the general San Diego population compared with 1996 national estimates. Pediatric health care providers should remain aware that their patients may be using CAM so they can provide coordinated care.     

Survey of the use of complementary medicines and therapies in children with asthma

OBJECTIVE: To survey the frequency of use of complementary medicines (CM) and complementary therapies (CT) in asthmatic children. METHODOLOGY: A 3-month survey of asthmatic inpatients and outpatients of a teaching hospital respiratory paediatrician was undertaken. Parents answered a structured questionnaire about their past and present usage and opinions of CM and CT. Parents and the physician independently assessed overall asthma control. 'Users' and 'non-users' of CM and CT were compared for characteristics of asthma, usage of conventional medications and parental demographics. RESULTS: One hundred and seventy-four children with 331 parents were enrolled in the study. All of the children were on bronchodilators and 150 (86.2%) were on disodium cromoglycate or inhaled steroids. Control was assessed by a physician as good in 95 children (54.6%), fair in 65 (37.4%) and poor or very poor in 13 (7.5%). Ninety (51.7%) of the children had used at least one CM in their lifetime. Out of the 145 preparations used, 90 (62.1%) were in current use. Vitamins and minerals (53.2%) and herbal preparations (29%) were used most commonly. Only 47.8% of parents had told their doctors about the use of CM. Costs ranged from $A2-$A200 (median $A10) per month. Forty-three (24.7%) of the children had been taken to an alternative practitioner at a cost of $A25-$A400 (median $A40) per month. Users of CM and CT were significantly more likely than non-users to have persistent asthma (P < 0.02), be on high-dose inhaled or oral steroids (P < 0.05), to have poor or very poor control of symptoms (P < 0.04), and more frequent doctor visits (P < 0.05). They also had more adverse reactions to relieving bronchodilators (P < 0.02) and were significantly older than non-users (P < 0.02). The most common reasons for using CM and CT were dissatisfaction with conventional therapies and concerns about steroid side-effects. CONCLUSIONS: Health professionals should be aware of the high rates of usage of CM and CT in asthmatic children and of parental attitudes to conventional and alternative therapies.     

Parents,infants and health care: utilization of health services in the first 12 months of life

OBJECTIVE: To describe patterns of health-service use in the first 12 months of life. METHODS: In this prospective cohort study, 173 first-born infants and their families living in two middle socio-economic urban areas of Melbourne were enrolled consecutively when presenting for their initial maternal and child health nurse (MCHN) visit (at approximately 4 weeks of age). Families kept a daily "health diary" for the entire 12-month period, recording use of all health services for their infant, and reasons for the contact. RESULTS: There was an 87% completion rate of diaries. The mean number of visits to any health service, including medical, hospitals, MCHN services, pharmacists, allied health services and naturopaths, was 35.7 (95% CI 34.7-36.6) during the 12 months. Of these, 31% (mean 10.9 visits) were visits to a general practitioner (GP) and 41.5% (mean 14.3 visits) were visits to the MCHN. Infants' visits to the MCHN were far more frequent in the first 6 months of life compared with the second 6 months (10.3 vs 3.6, P < 0.001). Rates of GP use were constant over the same periods (5.3 vs 5.7, P = 0.8). CONCLUSIONS: In a universal health-care system, this high rate of health-service use equates to approximately one visit to a health service every 2 weeks in the first year of life. The majority of these visits appeared unrelated to illness. This previously undocumented data has implications for future integrated service delivery, health-professional training and policy development for this age group.     

Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention

A brief educational intervention to promote effective communication between physicians, children, and parents during pediatric office visits was designed and tested. A randomized clinical trial involving 141 children (5- to 15-year-olds) tested the effectiveness of the intervention to improve the process and outcome of medical care. The intervention was contained in three brief videotapes (one each for parents, physicians, and patients) and in accompanying written materials. Materials were designed to build skills and motivation for increased child competence and participation during pediatric medical visits. Control subjects saw health education videotapes and received materials comparable in length with those of experimental subjects. Postintervention medical visit process was analyzed using videotapes of visits. Visit outcomes, assessed with standardized instruments and interviews, included children's rapport with physicians, children's anxiety, children's preference for an active health role, children's recall of information, parents' satisfaction with the medical visit, and physician satisfaction. Results indicated that physicians in the intervention group, compared with their counterparts in the control group, more often included children in discussions of medical recommendations (50% vs 29%, t = 2.39, P less than .05); that children in the intervention group, compared with control children, recalled more medication recommendations (77% vs 47%, P less than .01) and reported greater satisfaction and preference for an active health role; and that the intervention and control groups did not differ in parent satisfaction, physician satisfaction, or child anxiety. The results suggest that a brief educational intervention administered during waiting room time can positively impact physician-child rapport and children's preference for an active role in health and their acquisition of medical information.     

Long-term outcomes of physician peer teaching

Research conducted in 10 cities assessed long-term pediatric asthma outcomes from a peer teaching intervention for physicians to improve their asthma-related clinical and counseling skills. Hypotheses were better outcomes for patients, symptom reduction, less health care use, and enhanced view of the physician. Peers trained 53 intervention group pediatricians (seeing 418 patients); 48 pediatricians (seeing 452 patients) were controls. Patients provided baseline and 2-year follow-up data, collected by telephone interview and from medical records. Intent-to-treat analyses used Poisson regression and general estimation equations. Treatment physicians' patients gave them higher performance ratings ( P = .02). Patients had fewer sleep disruptions from asthma symptoms ( P = .03). Those with baseline health care use had fewer ED visits ( P = .005), hospitalizations (P = .03), and urgent office visits (P = .001), and they made fewer phone calls to the doctor's office (P = .02). Treatment physicians spent no more patient visit time than control physicians. Peer training increased patient's positive views of clinician's performance and reduced children's symptoms and health care use up to two years post program.