Showing posts with label adolescents. Show all posts
Showing posts with label adolescents. Show all posts

Monday, October 19, 2015

Who Is Seeing the Children and Teens with Mental Health Issues—and Who Is Doing the Prescribing of Psychotropic Medications?


By: Lewis First, MD, MS; Editor-in-Chief     

          We know that there is a critical shortage of mental health services for children and teens in this country, such that primary care providers (PCPs) are called upon to often diagnose and in turn treat and follow these patients because of lack of access to psychiatrists and even psychologists and social workers.  
         So just how often are these children being managed by a PCP?  Anderson et al. (doi: 10.1542/peds.2015-0807), in a study being released this week, used a nationally representative data set to determine if children and teens from 2 to 21 years are seen in the outpatient setting for their mental health issues by PCPs, psychiatrists or psychologists and social workers and who is prescribing psychotropic medications for these patients.  More than a third of children in this database were being seen by PCPs only which may or may not surprise you.  What won’t surprise you is that more than 40% of children with attention-deficit hyperactivity disorder (ADHD) were only seen by a PCP.  These numbers may be increasing rather than decreasing as the mental health issues we uncover in our patients rise, and the mental health work force stays about the same or even decreases in the years ahead. 
How does your practice compare to the results shared in this provocative study?  What do you suggest the AAP might do to help remedy the situation? Should pediatricians be trained to prescribe psychotropic medications that go beyond an ADHD regimen more than they are currently learning how to do?  We want to know how you are dealing with the mental health problems in your practice through your response to this blog, sending us an e-letter or posting your comments on our Facebook or Twitter pages.

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Wednesday, October 7, 2015

Text Message Reminders for Adolescent Vaccination: Is It Worth A Click?

By: Terrill Bravender, MD, MPH,  


      Does your office have a reminder system for patients? Most offices have some sort of automated
reminder system for upcoming appointments, usually a letter sent home or a reminder phone call. What about calls for delayed health maintenance visits or vaccines? If so, are these also mailed letters or phone calls? Or perhaps your office is more cutting edge and uses email reminders via a patient portal. Is this helpful for reaching your adolescent patients? After all, my 15 year old son has told me multiple times: “email is for old people, you should just text me instead.” As far back as 2010, adolescents averaged sending and receiving about 4,000 texts per month. More recent data are a bit more difficult to quantify, since SMS (short message service) texts via your cell phone provider are only one way to send electronic messages.
      Facebook messenger and iMessage are not quantified by cell phone providers, and temporary messaging services such as Snapchat, Wickr, and Slingshot, and even anonymous services such as YickYak have become more and more popular. Regardless of the service used, the “phone” part of an adolescent’s cell phone seems to have become the least important component, and I’m not even sure where email falls on the list. Many physicians are cognizant of this, and have used text messaging and other similar technologies to improve asthma care, diabetes care, and even sunscreen use.
       Electronically connecting with teenagers may be helpful for those health-related behaviors over which teens have control, but what about trying to get teens into the clinic? Teens have low rates of adherence with annual exam recommendations, and their immunization rates remain unacceptably low. Most adolescents depend on their parents to make appointments and provide transportation, so texting teens about the need for annual health exams or immunizations seems unlikely to have much of an effect.
      In this issue of Pediatrics, Dr. O'Leary et al. (doi: 10.1542/peds.2015-1089) report their experience using a text messaging reminder system for parents. Teens followed by various private practices and safety-net clinics who were due to vaccines or well visits were randomized to either usual care (no messages), or to have their parents receive a text message asking for a response. Parents could respond via text asking for the clinic to call to make an appointment, indicate that they would call the clinic themselves, or text STOP to get the messages to stop.
      Although only 30% of parents responded to the texts, most of those who responded asked for the clinic to call them to make an appointment. Members of the group who were sent text messages (regardless of response) were more likely to receive needed immunizations. The authors also analyzed the costs associated with this intervention, which were moderate but not negligible. However, with increasingly prevalent use of electronic medical records, the intervention seems to have great potential for automation. So when setting up such a system, it looks like we shouldn’t forget to text the parents, too.

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Friday, September 25, 2015

Parental Supervision (or Lack Thereof) and Alcohol Intoxication in Early Maturing Girls


By: Lewis First, MD, MS; Editor-in-Chief        

          When teens mature early, there may be a tendency to assume they are more adult-like in their ability to make decisions than they really are.  As a result, some parents may decide to assume their children can have more autonomy than perhaps they deserve—but at what cost?  This week Dickson et al. (doi: 10.1542/peds.2015-1258)) describe the results of four consecutive years of surveying more than 950 adolescent girls in Sweden starting with their first year of secondary school and tracking them on their perceptions of how autonomous their parents make them feel and in turn their experience with alcohol intoxication.  
        The fact that girls who matured early and felt they had more autonomy from their parents were three times more likely to experience higher rates of alcohol intoxication than those who felt least autonomous should give you all you need to want to read more about this interesting study.  In addition, a commentary (doi: 10.1542/peds.2015-2658) by adolescent specialist Dr. Terry Bravender provides some additional insight into what this study tells us. More importantly, it suggests that some parental education about their early maturing teens (and the need for parents to be even more aware of the importance of laying down guidelines and ground rules for helping teens deal with their peers and risk-taking behaviors) are in order when you see your adolescent patients, and have the opportunity to speak with their parents or guardians.   
        Parent concerns about their teens drinking need not be a fine “whine” if you can educate them even before adolescence on the important role they play in making sure their teens autonomy doesn’t get advanced sooner than it needs to be, even if their teens are maturing and looking more adult-like sooner than later.

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