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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2002;156:528.
A Randomized, Controlled Trial of a Community-Based Support Program
for Families of Children With Chronic Illness: Pediatric Outcomes
Nearly 1 in 6 children in the United States has a chronic illness or
disability. Prior research has shown that these children are at risk for psychological
and emotional problems as a result of their chronic illnesses. In this article,
Chernoff and colleagues report the results of a randomized, controlled trial
of a 15-month family-based intervention to enhance the self-esteem of children
with chronic illness. The intervention had a substantial effect on improving
self-esteem, especially among children with low self-esteem at the beginning
of the trial. The intervention may be generalizable to other children with
chronic illnesses and can be delivered in a variety of settings.
(SEE ARTICLE)
Underuse of Controller Medications Among Medicaid-Insured Children
With Asthma
For the last decade, guidelines have recommended daily use of controller
medications for children with persistent asthma. This survey of 1648 children
with asthma who were insured by Medicaid and enrolled in 1 of 5 managed care
plans in Washington, Massachusetts, or California found that 59% had persistent
asthma, half of whom reported no controller medication use. Having a regular
primary care physician, a written action plan, and scheduled follow-up visits
were each associated with a doubling in the likelihood of controller medication
use. Implementation of these system changes can result in improved control
of asthma in children.
(SEE ARTICLE)
Effects of Removing Gatekeeping on Specialist Utilization by Children
in a Health Maintenance Organization
Some health plans have abandoned gatekeeping by primary care physicians
because it is not found to be cost-effective. In this study of a capitated
multispecialty group, elimination of gatekeeping did not increase the number
of visits to specialists. Visits to any specialist by children with chronic
conditions increased slightly. This study confirmed that replacing gatekeeping
with open access to all specialty physicians in a managed care organization
resulted in minimal changes on children's utilization of specialists.
(SEE ARTICLE)
Primary Care Referral of Children With Psychosocial Problems
Primary care physicians are paying increasing attention to children's
mental health problems and the need for appropriate intervention and treatment.
This sometimes includes referral to a mental health specialist. Rushton and
colleagues analyzed data from 4012 patients with identified psychosocial problems
who had been followed in the Child Behavior Study. One in 6 children was referred
to a mental health specialist at their initial visit, although fewer than
two thirds of these children actually saw a specialist in the subsequent 6
months.
(SEE ARTICLE)
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