SCIENCE NEWS
October 10, 2007
Routine health care lags for children: study
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By Gene Emery
BOSTON (Reuters) - U.S. children are receiving less than half the routine care they need, even if they are covered by health insurance, researchers said on Wednesday.
"We're talking about the basics of what we should be providing, and in many cases it's just not happening," said Dr. Rita Mangione-Smith of the University of Washington in Seattle, who led the study.
Shortfalls were seen in vaccinating children on time, providing recommended asthma care and even monitoring growth. Parents may need to read up on needed care and come in to checkups armed with checklists, Mangione-Smith said.
The study comes amid debate over expanding childhood access to health insurance programs. Mangione-Smith's team looked at whether children were receiving all the treatment they need, even those covered by insurance.
Nurses reviewed medical records from 1,536 children and teens from 12 metropolitan areas and found that they received recommended care less than 47 percent of the time in areas ranging from basic immunizations to treatment for infections.
Nationwide, the percentage may be even lower.
Nearly 82 percent of children in this study were covered by private health insurance, so "we would expect these children to have a higher quality of care than the average child," Mangione-Smith and her colleagues wrote in their report, published in the New England Journal of Medicine.
"Their observations are shocking: the right services appear to be carried out less than half the time. Services are not delivered when they should be, or they are delivered when they should not be," Dr. James Perrin and Dr. Charles Homer of Harvard Medical School wrote in a commentary.
SURPRISING FINDINGS
"As a pediatrician I was surprised," Mangione-Smith said in a telephone interview. "Many of us had been going along comfortably thinking that care for children was better than adults. I was especially surprised that it was worse for preventive care."
The children received only 41 percent of the preventive services they needed. The ratio rose to 53 percent when it came to treatment for long-term illness and 68 percent for short-term illness.
Other studies have shown that adults typically get about 55 percent of the care they need.
One reason for the lack of care, Mangione-Smith said, may be that more doctors feel pressed for time, so they may think they have little opportunity to do preventive screening.
"We need to change the way we train pediatricians so that they are just as skilled at preventing illness as they are in treating it. Most residents in training have little exposure to kids coming in for checkups and preventive care," she added.
The study looked at 175 things doctors should be doing, depending on the health issues a child faced.
"Only 49.8 percent of children in our study who reached two years of age during the study period were fully immunized, according to their records," the researchers wrote.
Only 44 percent of children with persistent asthma were treated with anti-inflammatory medicines, the recommended care.
And only 16 percent of the very young children were tested for a urinary tract infection when they had potential symptoms, an omission that increases the risk of kidney damage.
On the other hand, the children got 92 percent of the recommended treatment for upper respiratory tract infections.
