Tools for Improving Access to Subspecialty Care Among Rural Children.

Children living in rural areas encounter unique, significant barriers to the receipt of health care, including pediatric specialty care. In this article, the authors review these barriers and evaluate the advantages and limitations of various access tools intended to better connect children to specialty care. They highlight the potential of some access tools to increase rural primary care physicians' skill and involvement in their patient care, but also the risks of increasing rural primary care providers' workload and responsibilities without increasing their resources.

Pediatric subspecialty outreach clinics: reach and impact on access to care.

Background: Recent research highlighting a shortage of pediatric subspecialists in the United States has shown wide variations in the distance from children to the nearest subspecialists but has not accounted for subspecialty outreach clinics, in which specialists may improve access in rural areas by periodically staffing clinics there. This study aimed to determine the impact of pediatric subspecialty outreach clinics on the driving times to the nearest pediatric subspecialists for children in Maine.

Methods: This cross-sectional study utilized administrative data on the schedule and location of pediatric subspecialty clinics in Maine in 2022 to estimate the driving time from each ZIP-code tabulation area to the nearest subspecialist, with and without the inclusion of outreach clinics.

General and subspecialist pediatrician perspectives on barriers and strategies for referral: a latent profile analysis.

Background: Children in need of pediatric subspecialty care may encounter multiple barriers, and multiple strategies have been suggested to improve access. The purpose of this study was to describe the perceptions of general and subspecialty pediatric physicians regarding barriers to subspecialty care and the value of strategies to improve subspecialty access.

Methods: We surveyed a national sample of 1680 general pediatricians and pediatric subspecialists in May and June 2020 regarding 11 barriers to subspecialty care and 9 strategies to improve access to subspecialty care, selected from recent literature.

Healthcare Utilization Among Children Receiving Permanent Supportive Housing.

Background And Objectives: Permanent supportive housing (PSH) integrates long-term housing and supports for families and individuals experiencing homelessness. Although PSH is frequently provided to families with children, little is known about the impacts of PSH among children. We examined changes in health care visits among children receiving PSH compared with similar children who did not receive PSH.

Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists.

Background: Evidence-based strategies are needed to support appropriate use of telemedicine for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care.

Methods: We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020.

Unscheduled Referrals and Unattended Appointments After Pediatric Subspecialty Referral.

Objectives: Incomplete subspecialty referrals, whether unscheduled or unattended, represent unmet patient needs and an opportunity to improve patient safety and experiences. Our objectives were to describe the rates of appointment scheduling and visit attendance after pediatric subspecialty referral and to examine patient and systems factors associated with scheduled referrals and attended appointments.

Methods: We conducted a retrospective review of referrals within a network of 52 primary and urgent care sites from November 2016 to October 2017.

Failure by fatigue in the field: a model of fatigue breakage for the macroalga Mazzaella, with validation.

Seaweeds inhabiting the extreme hydrodynamic environment of wave-swept shores break frequently. However, traditional biomechanical analyses, evaluating breakage due to the largest individual waves, have perennially underestimated rates of macroalgal breakage. Recent laboratory testing has established that some seaweeds fail by fatigue, accumulating damage over a series of force impositions.