Emergency medicine Australasia : EMAManissa Sufian, Yao Xu, Marietta John-White, Frank Muscara, Franz E Babl, Vicki Anderson, Catherine L Wilson, Meredith L Borland, Bruce J Tonge, Kylie M Gray, …
OBJECTIVE: To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. METHODS: Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. RESULTS: A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. CONCLUSIONS: Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.
The Australian journal of rural healthEileen Boyle, Pamela Laird, Gavin D Leslie, Scott Stokes, Jenni Andrew, Jon Howard, Melanie Robinson, Tania Harris, Fenella J Gill
OBJECTIVE: To identify factors influencing implementation and integration of the paediatric ESCALATION system in country Western Australia. SETTING AND PARTICIPANTS: Health professionals (nurses and doctors) working in country Western Australia. DESIGN AND METHODS: A multi-methods study using an interpretive descriptive approach guided by the Practical Robust Implementation and Sustainability Model (PRISM) and Normalisation Process Theory (NPT). Data collection across six sites included patient chart audit, health professional survey and focus groups/interviews. Data were analysed descriptively (audit and survey) and thematically (focus groups/interviews). RESULTS: An audit of 94 patient charts showed 61.7% met escalation of care criteria, while 69.0% of cases were escalated per policy. Among 114 survey responses, findings indicated system integration, with 95.6% reporting ESCALATION was part of their role, 93.5% agreeing it supported early detection of clinical deterioration and 93.8% reporting ease of use. Fewer identified local champions (66.7%), had confidence in others' use of the system (61.1%), reported sufficient training (69.0%), or were aware of reports demonstrating system effectiveness (55.0%). Seventy-eight health professionals participated in focus groups/interviews. Three themes were interpreted through the PRISM and NPT frameworks: (i) Enhanced patient safety (intervention characteristics and participants' perspectives; coherence; cognitive participation), (ii) Strengthening clinical decision-making (implementation and sustainability infrastructure; cognitive participation; collective action), (iii) Monitoring and fidelity (implementation and sustainability infrastructure, external; collective action; reflexive monitoring). CONCLUSION: The paediatric ESCALATION system is embedded and valued, but sustaining fidelity through scale-up requires ongoing training, teamwork, confident communication and organisational support across regional, rural and remote WA health services.
MedEdPORTAL : the journal of teaching and learning resourcesStephen L Harvey, Caitlin E Crumm, Emily C B Brown, Katie L Johnson
INTRODUCTION: Medical child abuse is an underrecognized and undertaught condition with potentially fatal consequences. Clinicians must learn to recognize and manage harmful overmedicalization of children. METHODS: We developed a 2-part interactive workshop on medical child abuse for pediatric clinicians. We evaluated part 1, an interactive high-yield lecture, using a pre- and postmodule assessment of self-rated confidence and knowledge in 1 resident conference and 3 multidisciplinary grand rounds settings across 2 institutions. We evaluated part 2, a popcorn-style role-play, with an additional postmodule confidence assessment at 2 resident conferences. We excluded duplicate participants. Part 1 duration was 45 minutes and part 2 was 60 minutes. We summarized results using descriptive statistics and analyzed paired data using paired t tests for knowledge (mean ± SD), and Wilcoxon signed-rank tests for confidence (median and interquartile range [IQR]). RESULTS: A total of 203 and 36 unique participants participated in part 1 and part 2, respectively. Participant confidence in recognizing and managing medical child abuse increased from a median of 5 (IQR 4-6; n = 124) to 7 (IQR 6-8) after part 1 (P < .001). Among participants completing part 2 (n = 20), confidence increased further to 8 (IQR 8-9; P <.001). Knowledge scores increased from 66% (SD = 29%) premodule to 88% (SD = 20%) postmodule (n = 119; P < .001). DISCUSSION: This interactive 2-part workshop was adaptable across clinical audiences and settings and improved confidence and knowledge in recognition and management of medical child abuse.
Studies in health technology and informaticsTim Fondum, John Cheek
An interruptive alert as a clinical decision support tool has been implemented to reduce the ordering of unnecessary urine cultures in a tertiary paediatric emergency department. Following its introduction, there was an immediate and sustained reduction in urine culture ordering rates of 25%, with a small increase in cultures with pure growth over a twelve-month period.
Pediatric surgery internationalMarco Pensabene, Maria Patti, Fabio Baldanza, Francesco Grasso, Luca Cicero, Maria Sergio, Maria Rita Di Pace
PURPOSE: Laparoscopic training is an established component of minimally invasive surgery education, and involves different tools: virtual reality, training box and in vivo models. The use of porcine models is the most similar to human anatomy. Its role is well known during the residency program, but its specific impact on paediatric surgery consultants performance is poorly explored. METHODS: Six consultant surgeons attempted a consecutive 4-h a week laparoscopic training on porcine models for a total of 12 weeks, focusing on refinement of fine dissection, intracorporeal suturing, and management of intraoperative complications. Participants underwent pre- and post-training (respectively Period A and B) assessment of surgical effectiveness by assessment of mean operative time, intraoperative and postoperative complications on three commonly performed procedures: inguinal hernia repair, varicocelectomy and laparoscopic orchiopexy. RESULTS: 210 procedures were analysed, 109 before and 101 after the training. We observed a significant overall reduction in operative time for all procedures (p = 0.007); more precisely, inguinal hernia repair and varicocelectomy showed a significant reduction in operative time (p = 0.028 and p = 0.04 respectively), while no significant reduction in operative time for laparoscopic orchidopexy was observed (p = 0.2668). Mean age at surgical intervention was significantly reduced in period B for herniorrhaphy. CONCLUSION: Laparoscopic training in porcine models could be considered an effective tool to improve skills of paediatric surgery consultants. Its use could allow the improvement of laparoscopic confidence and effectiveness also in surgeons with an already acquired learning curve, supporting the systematic and continuous integration of such programmes into the professional development.
International journal for quality in health care : journal of the International Society for Quality in Health CareAleksandra Glos, Alejandra Santana López, Javiera Celedón Juricic
BACKGROUND: The right to play is a fundamental aspect of child-friendly healthcare. This study aims to examine the normative basis of this right and to evaluate its implementation in public hospitals in Chile. METHODS: A two-stage READ document analysis was conducted, encompassing both normative and institutional levels using qualitative and quantitative tools. First, Chilean laws and public health policies related to play in paediatric healthcare settings were reviewed. Second, institutional compliance was assessed through reports obtained via freedom of information requests from paediatric facilities across the country. RESULTS: Although Chilean legislation and health policies acknowledge the significance of children's right to play, its implementation is left to individual hospitals' discretion and is not supported by public funding. Consequently, only 9% (n = 5) of the 55 analysed hospitals achieved satisfactory standards. Hospitals reported infrastructural, material, and human resource barriers that limit satisfactory provision of play opportunities. CONCLUSION: There is a pressing need to establish standardized public health policies to guarantee the right to play in paediatric care nationwide. This study offers preliminary insights and recommendations to guide the development of a comprehensive regulatory framework.
MedEdPORTAL : the journal of teaching and learning resourcesMitchell L Phillips, Frank Yanko, Julia H Vermylen, Heather A Ballard
INTRODUCTION: Effective communication of adverse events is a critical skill for health care practitioners, particularly those in anesthesiology. Despite the importance of delivering bad news to guardians after complications, many anesthesia practitioners receive little to no formal training in this area. This curriculum aims to address this by introducing a learning activity that integrates the SPIKES and NURSE frameworks with simulated parent (SP) encounters. METHODS: A randomized waitlist control design was used to evaluate this 3-hour simulation curriculum. Learners were randomly assigned to receive either immediate training in communication skills (a 1-hour didactic session on the SPIKES and NURSE framework, followed by SP deliberate practice) or delayed training after 1 month. Both groups completed a pretest, posttest, and delayed posttest. Communication skills were evaluated using a published checklist based on the SPIKES and NURSE frameworks. Course surveys were also administered to assess changes in learners' self-reported confidence and overall course satisfaction with the training. RESULTS: Twenty-one learners (15 attending anesthesiologists and 6 certified registered nurse anesthetists) participated in this educational activity. Both groups demonstrated significant improvements in checklist-scored communication skills and self-reported confidence following the simulation curriculum (P < .001). In the Early Intervention group, these improvements in simulated communication skills were sustained after a 1-month delay. Overall, course satisfaction was high, with a median score of 5 (IQR 5-5). DISCUSSION: Our findings demonstrate that a structured curriculum incorporating the SPIKES and NURSE frameworks, combined with SP deliberate practice, enhances communication skills for difficult perioperative conversations with pediatric guardians.
JMIR formative researchJennifer K James, Mary P Shotwell, Hannah M Jensen, Shirley A James
BACKGROUND: Determining the appropriate dosage of pediatric occupational therapy, physical therapy, and speech-language pathology services is important when supporting families of children with disabilities. However, therapy dosage is inconsistently reported, and caregiver-delivered practice between sessions is rarely documented. Ecological momentary assessment (EMA) offers a method to capture caregiver practice in real time and to examine factors that influence it. OBJECTIVE: This study aims to pilot the use of EMA to measure caregiver practices between therapy sessions and to compare EMA-reported practices with caregiver recall. METHODS: This pilot prospective cohort study used convenience sampling to recruit caregivers of children receiving therapy services. During September 2024, participants completed a confidential baseline Qualtrics survey in their homes, which included recall of home practice from the previous week. Participants were then invited to complete 30 days of EMA logging of daily practice. Five participants enrolled in the EMA phase, which began 24 to 72 hours after baseline survey completion and took place during October and November 2024. Semistructured follow-up interviews were conducted immediately after the 30-day EMA period. RESULTS: Of the 34 survey participants, 5 continued to the EMA phase, contributing 150 days of data, with 82 completed entries (82/150, 55%). Caregivers primarily completed EMA logs on days when practice occurred; missing entries were coded as zero practice based on caregiver reports. Recalled practice averaged 4.5 (SD 5.65) bouts/day and 11.6 (SD 6.35) minutes/bout, totaling 71.2 (SD 121.02) minutes/day. EMA-reported practice across all days (n=150) averaged 2.7 (SD 4.39) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.2 (SD 14.12) minutes/day, which was substantially lower than recalled estimates. On days when practice was reported (n=82), EMA-documented practice averaged 5.2 (SD 3.28) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.9 (SD 14.72) minutes/day. Variability in recalled practice was high (mean 71.19, SD 121.02 min/d). Caregivers described practice as occurring in short, frequent bouts embedded within daily routines, with routine integration, child engagement, and recall of therapist strategies identified as key facilitators. CONCLUSIONS: Caregiver-delivered practice occurred in short, frequent bouts integrated into daily routines. EMA-reported practice was substantially lower than caregiver recall, suggesting that retrospective recall and prospectively reported EMA data may differ substantially. These findings highlight the importance of teaching strategies that are brief, engaging, and easily incorporated into daily routines. Despite the small sample, EMA was acceptable to a subset of caregivers who completed participation; however, substantial attrition between survey enrollment and EMA initiation suggests significant feasibility and participation barriers that warrant further investigation.
JMIR formative researchAngelica Höök, Emma Forsgren, Maria Björk, Charlotte Castor, Emma Nordh, Stefan Nilsson
BACKGROUND: Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they effectively support the user. PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool developed to enable children to remotely assess symptoms and communicate with health care professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology. OBJECTIVE: The aim was to test a digital intervention with PicPecc in pediatric oncology care through the lens of access to technology. METHODS: This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6-17 y), 5 parents, and 6 nurses from 2 pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for 2 weeks (achieving a median of 14, IQR 9.75-16 days) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed through interviews and an instrument, and by recording the consumption of PicPecc. Data analysis was based on the 5 dimensions of access (availability, accessibility, accommodation, affordability, and acceptability). RESULTS: The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way. Children and parents mentioned feeling safe when they were discharged from the hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with log-in procedures related to the PIN code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children's motivation varied depending on symptom burden. Acceptability was strong among children up to 12 years of age, who appreciated the design and gaming function, while the older children found the visual design less age-appropriate. CONCLUSIONS: Access to the mobile health tool, PicPecc outside hospital, appears promising for supporting remote symptom assessment in pediatric oncology, particularly among children up to 12 years of age. However, identified barriers, such as motivational factors and integration into the health care system, need to be addressed.
Journal of medical Internet researchSiyu Cai, Qiaohong Guo, Zishen Wang, Ruixin Wang, Xuan Zhou, Xiaoxia Peng
BACKGROUND: While artificial intelligence's (AI's) transformative potential in health care is widely acknowledged, its application in highly sensitive, humanistic domains like pediatric palliative care (PPC) remains largely unexplored. OBJECTIVE: This study aims to explore the attitudes and needs of health care providers on the PPC assisted by AI, with the goal of informing future development and implementation of AI systems in this field. METHODS: This was an explanatory sequential mixed methods study consisting of a nationwide cross-sectional questionnaire survey (March-April 2025) followed by qualitative semistructured interviews (August-October 2025). The quantitative study aimed to investigate PPC health care providers' experiences, attitudes, and needs for the application of AI. Participants included team members of all recognized PPC teams in mainland China. The qualitative study aimed to explore in greater depth the potential future roles of AI in this field, as well as the features of an ideal AI-assisted tool for PPC. Potential interviewees were recruited from the pool of quantitative survey respondents. RESULTS: Among 352 survey respondents, most (n=205, 58.24%) reported moderate familiarity with AI, with large language models being the most commonly used (n=280, 79.55%). Among large language model users, over half (161/280, 57.50%) reported using them for clinical purposes. Attitudes were generally positive: 67.05% (236/352) believed AI's benefits would outweigh drawbacks, and 75% (264/352) considered its implementation feasible. The most desired applications were patient and family education (276/352, 78.41%) and symptom management (257/352, 73.01%). Interviews with 17 providers revealed three themes: (1) clinical roles and boundaries, (2) elements for clinical integration, and (3) challenges in development and deployment. CONCLUSIONS: This study reveals that PPC providers express positive attitudes and strong demand for AI-assisted clinical work. Furthermore, the research clarifies appropriate roles for AI, outlines elements for clinical integration, and highlights potential challenges in development and integration. This study provides evidence for the feasibility of AI application in PPC and offers guidance for the future development and deployment of AI tools.
BMJ openNairong Guo, Heping Fang, Xueling Li, Ruolin Xian, Yan Zhao, Yan Hu, Ying-Cun Li
OBJECTIVE: This study aims to explore disparities in eHealth literacy and perspectives on digital health among parents of preschool children from different cities and examine how these characteristics influence their willingness to participate in digital paediatric clinical research. DESIGN: Cross-sectional online survey. SETTING: Conducted between November and December 2023 among parents of preschool children in Yongchuan District (Chongqing) and Shunyi District (Beijing), China. PARTICIPANTS: Parents of preschool children (aged 3-6 years). Among 1340 unique survey visits, 1274 started the questionnaire (response rate: 95.1%). Ultimately, 621 (321 from Yongchuan and 300 from Shunyi) were included in the final analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was parents' willingness to participate in paediatric clinical research. Secondary measures included eHealth literacy (assessed by the Chinese version of the eHealth Literacy Scale), conceptual understanding of digital health, behavioural inclinations toward digital tool use and concerns regarding digital research. RESULTS: Of the respondents, 36.9% expressed willingness to participate in paediatric clinical research, with a significantly higher proportion in Yongchuan compared with Shunyi (45.5% vs 27.7%, p<0.001). Yongchuan parents reported higher adequate eHealth literacy (59.8% vs 44.7%, p<0.001), better digital health understanding (25.9% vs 18.7%) and higher willingness to use digital tools for daily data collection (65.1% vs 54.3%) (both p=0.02). Regarding smartphone-related concerns, parents in Yongchuan were more likely to express concerns about 'Health impacts of the tools (such as radiation)' (45.8% vs 38.0%, p=0.049) and 'Possible expenses' (38.0% vs 29.7%, p=0.03). Logistic regression analysis, after adjusting for confounding factors, identified 'Support digital tools in paediatric research' as a significant predictor of higher parental willingness (OR=2.21, 95% CI 1.48 to 3.26, p<0.001). Additionally, the willingness of parents from Yongchuan was more influenced by their digital device usage behaviours compared with those in Shunyi. CONCLUSION: Parental eHealth literacy and digital health perspectives significantly influence willingness to participate in paediatric research.
Medical education onlineHillary Anderson, Amara Heard Stittum, Lisa Grefe, Molly Rideout
OBJECTIVE: To explore aspects of professional identity formation in participants of a longitudinal pediatric program for final-year medical students in the US. INTRODUCTION: Many institutions have specialty-specific courses focused on the transition to residency, typically at the end of medical school. This study examines professional identity formation among participants of a longitudinal fourth-year Pediatric Concentration. METHODS: Authors used a case study design for this qualitative research study using semi-structured interview questions based on a conceptual model of professional identity formation. Authors used purposeful sampling to identify study participants who were randomly selected from former students who completed the program between 2019 and 2021. Three interviewers independently conducted interviews with individual program participants. Thematic analysis with coder reliability was utilized for data analysis; two investigators independently coded and performed inter-rater reliability (IRR) on three sets of questions from transcriptions. After ensuring acceptable IRR, investigators coded the remaining questions and subsequently identified themes and sub-themes. FINDINGS: Eleven former students completed interviews. Following initial independent coding, IRR for three questions was 80%. After coding the 11 interviews, investigators determined that code saturation was achieved. They subsequently identified six main themes: career development, interpersonal connection, personal growth, positive role models, skill-building, and supportive learning environment. Two cross-cutting themes were recognized throughout the data: sense of belonging and gaining confidence toward starting residency. CONCLUSIONS: Participants in a longitudinal specialty-specific program in the final year of medical school experienced professional identity formation through a supportive learning environment fostering connection and personal growth while building skills, surrounded by positive role models. This community of practice cultivated a sense of belonging and helped participants gain confidence toward their residency and career. This longitudinal, specialty-specific approach to the final year of medical school may enhance professional identity formation for students entering all specialties and could facilitate transition to internship.
Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses AssociationHatice Oğuzhan, Gamze Akay, Sevda Uzun, Elif Simay Koç, Aysun Öncer
The aim of this study was to deeply examine the experiences of proxy grief among nurses providing pediatric palliative care. This qualitative phenomenological study was conducted with 16 nurses working in the pediatric ward of a hospital located in the northern region of the country. Data were analyzed using Colaizzi's phenomenological analysis method. The analysis revealed 3 themes (challenges experienced while caring for children in palliative care; secondary trauma and coping processes; proxy trauma and professional resilience) and 9 sub-themes (emotional strain during care, establishing an empathetic bond, emotional exhaustion, traumatic experiences, seeking psychological support, religious coping methods, developing a professional approach, resilience and acceptance, and motivation to continue in the profession). The study found that nurses providing pediatric palliative care experienced significant psychosocial stress. Pediatric nurses were particularly challenged emotionally when caring for palliative patients. In this context, it is important to develop stress-coping skills to help nurses manage vicarious trauma. Strengthening nurses psychologically and spiritually will positively impact their professional lives, which in turn will enhance the quality of care they provide.
European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.VFabrício Costa Fanhani, Laiene Antunes Alves, Marcel Henrique Marcondes Sari, Antônio Eduardo Matoso Mendes, Roberto Pontarolo, Luana Mota Ferreira
BACKGROUND: Extemporaneous liquid antihypertensive formulations are widely used in pediatrics but frequently lack detailed reporting of excipient safety data, particularly regarding age-specific physiological vulnerability and cumulative exposure. METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidelines to map excipients used in pediatric extemporaneous antihypertensive liquid formulations. A regulatory-oriented assessment was applied, emphasizing age-appropriate safety considerations and exposure-based risk principles, including theoretical daily intake expressed as mg/kg/day. RESULTS: Forty-two studies were included. Reporting of excipient concentrations, age targets, and safety justifications was heterogeneous and often incomplete. Vehicles, co-solvents, preservatives, buffers, antioxidants, surfactants, and flavoring agents were identified, with selection typically driven by a focus on physicochemical stability rather than patient-centered criteria, such as age-appropriate excipient safety, dose flexibility, and acceptable volumes. Exposure-based considerations were addressed by a limited number of studies (n = 5). Exposure calculations based on typical pediatric dosing showed that concentrations considered acceptable in adult formulations may translate into clinically relevant toxicity risks in neonates and infants. Based on observed patterns, a conceptual risk stratification framework was developed to categorize excipients according to age-dependent toxicity, cumulative dose burden, and functional tolerability. CONCLUSIONS: The available literature on compounding antihypertensive formulations mainly emphasizes physicochemical performance, with less attention given to exposure-related safety parameters in pediatric patients. Integrating total daily excipient exposure metrics and structured justification for excipient selection may improve alignment with regulatory expectations and support safer, patient-centered compounding practices in pediatric clinical care.
Physical medicine and rehabilitation clinics of North AmericaMichelle Poliak-Tunis, Shivani Khakhkhar, Benjamin Ayres
Chronic pain is increasing in prevalence worldwide, and practitioners should stay up to date regarding best practices for this population of patients. Certain populations can be more vulnerable to chronic pain and special attention must be paid. This article will highlight 3 special populations: children and adolescents, the elderly, as well as pregnant patients. The aim of this article is to delve into chronic pain syndromes that each population may face, as well as particular management strategies for each.
Laser procedures are safe and effective for various medical conditions in the pediatric population. Laser therapies are viewed as elective or cosmetic rather than medically necessary leading to their denial. Laser therapy can be deemed experimental or investigational, due to a lack of sufficient high-quality evidence showing that the treatment is safe, effective, and necessary for a medical condition. There is also lack of specific Current Procedural Terminology codes leading to the use of unlisted procedure codes that cause an increase in denials or initiation of prior authorizations. Overall, insurance coverage of laser procedures in pediatric patients is highly inconsistent.
Pediatric clinics of North AmericaMollie Oudenhoven, Jennifer Fernandez, Nicole Harter
This article addresses the critical shortage in the pediatric dermatology workforce despite growing demand. It explores barriers including limited early exposure, mentorship, and lengthy, costly training pathways. The authors propose new models to streamline training, including alternative residency tracks and combined programs, while emphasizing the importance of mentorship, educational resources, and institutional support. They recommend actionable strategies like requiring pediatric dermatology exposure during training and increasing preliminary pediatric positions. The article calls for collaboration and innovation to expand access, improve training pathways, and ultimately increase the number of practicing pediatric dermatologists.
Pediatric clinics of North AmericaNohra Ghaoui, Katelyn Breznak, Kalyani Marathe
Pediatric dermatology remains an underserved subspecialty due to workforce shortages, geographic disparities, and systemic barriers. This 4-year, single-center initiative implemented 15 targeted interventions, including optimization of provider roles, referral redesign, teledermatology expansion, and electronic health record-based scheduling strategies, to improve access and efficiency. The program achieved sustained improvements in fill rates, reduced no-shows, and decreased appointment lag times, enabling same-day appointments. By combining structural workflow redesign with technology-driven solutions, the initiative demonstrates a replicable model for expanding equitable access to pediatric dermatology care and may inform similar efforts in other underserved medical fields.
Pediatric clinics of North AmericaJaclyn Daigneault, Heli Patel, Robert J Smith
Pediatricians and pediatric subspecialists receive lower rates of compensation than their colleagues who care for adult patients. Systemic financial structures within the American health care system disincentivize both individual providers and larger health care systems from investing in pediatric care. The disproportionate overvaluation of procedural care over cognitive care in our Relative Value Unit designation structure encourages systems to focus their care energies on adult patients. In addition, the primary insurer of pediatric patients, Medicaid, systematically reimburses at lower rates than Medicare and commercial insurances.
Pediatric clinics of North AmericaEmily M Everdell, Kelly K Barry, Elena B Hawryluk
Pediatric dermatology has historically seen a shortage of dermatologists relative to demand, leading to limited access for patients, which is amplified in underserved communities. Telemedicine has emerged as an attractive means to supplement clinical care and a tool that may assist in overcoming many of the barriers present in pediatric dermatology. Studies have found that teledermatology increases access to care, decreases wait-times and provides cost savings for patients and health care systems, all while maintaining high patient and provider satisfaction. Despite limitations, telemedicine remains a powerful resource with the ability to expand access to pediatric dermatologists.