Family health history collection and genetic testing are core elements for the successful translation of genomics into primary care practice. Yet, little is known about how pediatric providers implement these elements in practice. We surveyed the membership of the American Academy of Pediatrics regarding family health history (FHH) collection and genetic testing in the primary care setting. Three hundred forty-nine (349) responses were analyzed with the initial response rate of 43.3%. Four principal findings were noted-(1) family health history is still recognized as a critical part of the medical evaluation; (2) perceived obstacles for FHH are time in obtaining the FHH and concerns about the family's knowledge of their FHH; (3) a 3-generation family history is out of the scope of routine care and alternate methods should be considered; (4) most primary care providers (PCPs) do not feel comfortable ordering, interpreting, and counseling regarding current genetic testing. Expanded genetic/genomic education at multiple levels (undergraduate medical education, graduate medical education, and maintenance of certification) is clearly indicated to allow PCPs to integrate these vital elements into a current evaluation (acute care or health maintenance) in the primary care setting.
Background: Connect for Health is an evidence-based weight management program with clinical-and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation. Methods: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators, and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA; Denver, CO; and Greenville, SC, and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile. Results: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time, (2) developing resources that respond to family's needs, (3) using multimodal delivery options for family resources, (4) addressing childhood obesity while balancing competing demands, (5) emphasizing patient care rather than documentation and establishing sustainability plans, and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n = 400), approximately 50% were Spanishspeaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program
The Joint Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology; the American Academy of Pediatrics; and the National Association of School Nurses all recommend emergency action plans (EAPs) that direct therapy of allergic reactions in children. This study investigated the school nurse's perception of food allergies and their use of EAPs in food-allergic students in a large, socioeconomically diverse school district. An electronic and paper survey was developed and administered to all elementary and middle school nurses in Greenville County, SC. Forty-three of the eligible school nurses participated for a response rate of 64% (43/67). All of the participants worked at schools that had at least one student with food allergies (mean, nine students with food allergies per school; SD, seven students). Forty-four percent (19/43) of schools had a written action plan for all their food-allergic students, whereas in 42% (18/43) of schools, one-half or less of the food-allergic students, had an action plan. Seventy percent (30/43) of schools made at least one accommodation for students with food allergies and 23% (10/43) of schools made multiple accommodations. At least three additional school personnel were trained in administering rescue medications besides the school nurse in 86% (37/43) of schools, but in 5% (2/43) of schools no additional adults were trained to give rescue medications. Although multiple organizations recommend EAPs for food-allergic students, our study highlights their inconsistent use in this school district.
We are implementing Connect for Health, a primary care-based intervention to improve family-centered outcomes for children, ages 2–12 years, in organizations that care for low-income children. We will use the ‘Reach-Effectiveness-Adoption-Implementation-Maintenance’ framework to guide our mixed-methods evaluation to examine the effectiveness of stakeholder-informed strategies in supporting program adoption and child outcomes. We also describe characteristics of children, ages 2–12 years with a BMI ≥85th percentile and obesity-related care practices. During the period prior to implementation, 26,161 children with a BMI ≥85th percentile were seen for a primary care visit and a majority lacked recommended diagnosis codes, referrals and laboratory evaluations. The findings suggest the need to augment current approaches to increase uptake of proven-effective weight management programs. Clinical trial registration number: Clinicaltrials.gov, NCT04042493 , Registered on 2 August 2019; https://clinicaltrials.gov/ct2/show/NCT04042493 .
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