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Physician barriers to lead testing of Medicaid-enrolled children
1Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA. kempera@med.umich.edu
Insights
Pediatricians often believe they practice in low-risk areas, leading to low blood lead testing rates in Medicaid children. Providing local risk data and facilitating onsite testing can improve screening.
Area of Science:
- Pediatric Health
- Public Health Policy
- Environmental Health
Background:
- Low rates of blood lead testing among children enrolled in Medicaid programs.
- Need for interventions to improve adherence to recommended lead testing protocols.
Purpose of the Study:
- Identify pediatrician-perceived barriers to blood lead testing in Medicaid-enrolled children.
- Inform the development of targeted interventions to enhance lead testing rates.
Main Methods:
- Mail survey developed from focus group findings with primary care providers in Michigan.
- Survey administered to a random sample of 520 primary care pediatricians.
- Analysis excluded pediatricians not accepting Medicaid.
Main Results:
- 65% response rate achieved; 68% of pediatricians routinely test 1-year-old Medicaid children.
- Practices with onsite blood testing were more likely to test routinely (79% vs 62%).
- Primary barrier: belief in practicing in a low-risk area (70%), despite 35% practicing in high-risk areas.
Conclusions:
- Public health departments should supply pediatricians with local lead poisoning risk data.
- Facilitating onsite blood collection at practices can improve lead testing rates.
- Addressing pediatrician risk perception is crucial for improving pediatric blood lead screening.
Background:
The rate of blood lead testing among Medicaid-enrolled children is low.
Objective:
To determine barriers to lead testing perceived by pediatricians to develop future interventions to improve the rate of appropriate blood lead testing.
Methods:
We developed a mail survey based on findings from 6 focus groups of primary-care providers in Michigan. We then surveyed a random sample of 520 primary-care pediatricians in Michigan. Pediatricians who did not accept Medicaid were excluded from the analysis.
Results:
The overall response rate was 65% (257 of 396 potentially eligible respondents). Most (68%) reported that they routinely test 1-year-old Medicaid-enrolled children. Practices with onsite blood testing were more likely to report routine testing of 1-year-old children (79% vs 62%; P < .01). Most (76%) who do not routinely test were aware of the Medicaid requirements for testing. The most common reason (70%) for not testing Medicaid-enrolled children was physicians' belief that they practice in a low-risk area. However, 35% of those who do not test because they practice in a low-risk area actually have their main practice site in a high-risk area.
Conclusions:
To improve the rate of blood lead testing, the public health department should provide pediatricians with data regarding the local risk of lead poisoning. The public health department should also consider working with practices to facilitate onsite blood collection for lead testing.
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