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Preventive care for children in the United States: quality and barriers
Paul J Chung1, Tim C Lee, Janina L Morrison
1Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA. paulchung@mednet.ucla.edu
Insights
Childhood preventive care quality in the US is inconsistent, with many children missing recommended well-child visits and screenings. Key barriers include lack of insurance, continuity of care, and clinician/patient factors, highlighting needs for practice and policy interventions.
Area of Science:
- Pediatrics
- Public Health
- Healthcare Quality
Background:
- Preventive healthcare is crucial for child well-being.
- Quality and access to childhood preventive services in the US show significant variation.
- Disparities in care impact health outcomes for diverse pediatric populations.
Purpose of the Study:
- To systematically review academic literature on the quality of childhood preventive care in the United States.
- To identify barriers contributing to poor or disparate quality in pediatric preventive services.
- To synthesize findings from observational studies and interventions published between 1994 and 2003.
Main Methods:
- Systematic review of academic literature from 1994-2003.
- Focused on 58 large observational studies and interventions.
- Examined well-child visit frequency, developmental surveillance, disease screening, and anticipatory guidance.
Main Results:
- While many children receive some preventive care, attendance at recommended well-child visits varies widely (37%-81%).
- Fewer than half of children receive developmental/psychosocial surveillance, risk-based screenings (e.g., lead, Chlamydia), or anticipatory guidance.
- Identified barriers include lack of insurance, continuity of care, adolescent privacy issues, clinician skill gaps, and socio-cultural factors (race, language, gender).
Conclusions:
- Childhood preventive care quality in the US is mixed, with significant disparities across different populations.
- Barriers to accessing and receiving comprehensive preventive care are multifaceted.
- Practice and policy interventions are needed to address identified barriers and improve pediatric preventive care quality and equity.
Abstract:
Our objective was to examine the academic literature covering quality of childhood preventive care in the United States and to identify barriers that contribute to poor or disparate quality. We systematically reviewed articles related to childhood preventive care published from 1994 through 2003, focusing on 58 large observational studies and interventions addressing well-child visit frequency, developmental and psychosocial surveillance, disease screening, and anticipatory guidance. Although many children attend recommended well-child visits and receive comprehensive preventive care at those visits, many do not attend such visits. Estimates of children who attend all recommended visits range widely (from 37%-81%). In most studies, less than half is the proportion of children who receive developmental or psychosocial surveillance, adolescents who are asked about various health risks, children at risk for lead exposure who are screened, adolescents at risk for Chlamydia who are tested, or children and adolescents who receive anticipatory guidance on various topics. Major barriers include lack of insurance, lack of continuity with a clinician or place of care, lack of privacy for adolescents, lack of clinician awareness or skill, racial/ethnic barriers, language-related barriers, clinician and patient gender-related barriers, and lack of time. In summary, childhood preventive care quality is mixed, with large disparities among populations. Recent research has identified barriers that might be overcome through practice and policy interventions.
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