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Considering Solutions to Pediatric Care Barriers

Due to the pandemic, well-child visits and vaccine acceptance rates for children have declined in the past three years. Rural communities are seeing even lower rates due to a lack of access to health care. Some providers, like Dr. Ladell Douglas from a recent AFMC TV episode, have extended their hours of operation to 7 p.m. to allow parents to schedule appointments after work. Others, like the American Academy of Pediatrics (AAP), have encouraged pediatricians to change how they speak to patients about child and adolescent vaccinations. The Cincinnati Children’s Hospital Medical Center has even proposed EHR messaging to send to patients who have missed well-child visits. Regardless of the method, what’s important is to think about changes you can make with your care team to lessen pediatric care gaps.

AAP Recommendations to Promote Child Vaccinations

On January 26, AAP president Dr. Sandy Chung, MD, FAAP, released a statement addressing the reduced vaccination rates in children and adolescents and the research they have done to improve immunization rates. Collaborating with the FrameWorks Institute, the AAP developed evidence-based strategies providers and pediatricians can use to bolster public understanding of vaccinations, particularly for children and adolescents. The FrameWorks Institute uses social science to determine the public's mindsets and assumptions about various important health care issues. They then use this data to guide professionals in talking to patients outside the exam room setting.
The AAP’s conversational strategy is meant to improve how we talk about vaccines, whether meeting with politicians, talking with parents, posting on social media, or conducting interviews. Dr. Chung states that “these conversations in the ‘public square,’ — whether that’s in virtual or in-person spaces — ultimately will help us shape public attitudes about vaccines and their benefits.”
AAP and FrameWorks recommend the following talking points in public conversation:
  • The benefits of vaccination for the overall community
  • Improving vaccination access is a preventative public health measure
  • The benefits of vaccination on a child’s long-term well-being and overall health
  • Using a computer updates metaphor to explain how the immune system improves performance through vaccination
  • Using a literacy metaphor to explain how the immune system learns to respond to properly eradicate virus through vaccination
The AAP report also discusses additional recommendations, examples of messages, and motivational interviewing techniques.

EHR Messaging to Address Pediatric Care Barriers

Pediatric Care Barriers 20230309 v1 01Researchers at the Cincinnati Children's Hospital Medical Center have developed an automated program that coordinates with EHRs to alert patients about missed childcare appointments.
According to an article from the Annals of Family Medicine, “despite the benefits of well-child care visits, up to one-half of these visits are missed.” While there are various reasons why appointments are missed, these visits promote preventative care and ensure that children are healthy. To boost attendance rates of these visits and reduce care gaps, researchers at Cincinnati Children’s Hospital Medical Center have developed an automated program that coordinates with EHRs to alert patients about missed appointments. 
Researchers conducted a pilot project involving 900 families of patients aged 6 to 17, spread across three primary care practices in 2021. Using a platform that delivered phone and text messages, researchers saw an increase of almost 50% in scheduled well-child visits. Patients receiving standard and tailored messages were more likely to complete their appointments than those without. Simple alerts on the patient portal may increase action even more. While this project only sent out alerts for COVID-19 vaccine appointments, the 900 surveyed had higher rates of receiving COVID-19 vaccination within 8 weeks of receiving their alerts. With simple customization to include reminders for standard doctor visits, this project could encourage healthy behaviors in patients. 
The platform researchers chose for this project even allows for alerts to be sent via text or phone, depending on the recipient’s preferences. The platform easily integrates into a provider’s workflow. Messages can be customized with a patient’s first name, reminders to parents that their child is due for a well-child visit, a phone number to call, and a link to the patient portal so parents can schedule an appointment.
This EHR patient alert platform is especially impactful with underserved populations, who have experience barriers to health care access because they don’t have the technology or broadband capacity to attend virtual visits. Though they have limited access to technology, most people in underserved populations do have smartphones. People in these populations could still receive alerts with a phone number to call for appointment scheduling.
The most encouraging part of the project was that the messaging platform revealed that simple alerts like this are all it takes to bridge the gap between scheduling an appointment and following through with one. Messaging platforms like this are critical, especially since more and more children are being diagnosed with chronic conditions and illnesses not caught during the pandemic because of missed appointments. 
While further research is being done to improve this platform and enhance its capabilities, this project revealed a need for an alert system that can nudge parents (or patients in general) to schedule appointments and follow through with them. Sometimes, it takes a little push to close care gaps and ensure that patient attendance is as high as possible.
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