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Biomedical subjects

James M Perrin

Publications and source records attributed to James M Perrin.

34 records · Page 2Linked to original sources
PubMedDate not supplied

Breastfeeding advice given to African American and white women by physicians and WIC counselors.

OBJECTIVE: This study determined rates of breastfeeding advice given to African American and white women by medical providers and WIC nutrition counselors, and sought to determine whether racial differences in advice contributed to racial differences in rates of breastfeeding. METHODS: The study used data from the 1988 National Maternal and Infant Health Survey, a cross-sectional survey of a nationally representative sample of mothers with a live birth, infant death, or fetal death in 1988. The authors compared white women (n=3,966) and African American women (n=4,791) with a live birth in 1988 on self-reported rates of medical provider and WIC advice to breastfeed, WIC advice to bottlefeed, and breastfeeding. RESULTS: Self-reported racial identification did not predict medical provider advice. However, being African American was associated with less likelihood of breastfeeding advice and greater likelihood of bottlefeeding advice from WIC nutrition counselors. In multivariate analyses controlling for differences in advice, being African American was independently associated with lower breastfeeding rates (odds ratio [OR] = 0.41, 95% CI 0.32, 0.52). CONCLUSIONS: African American women were less likely than white women to report having received breastfeeding advice from WIC counselors and more likely to report having received bottlefeeding advice from WIC counselors. However, African American and white women were equally likely to report having received breastfeeding advice from medical providers. Lower rates of breastfeeding advice from medical or nutritional professionals do not account for lower rates of breastfeeding among African American women.

Adult↗
PubMedDate not supplied

Comparing a diagnosis list with a survey method to identify children with chronic conditions in an urban health center.

OBJECTIVE: To compare a diagnosis list to the Questionnaire for Identifying Children with Chronic Conditions (QuICCC) to assess their relative usefulness as measures for identifying children with chronic conditions. METHODS: Comparison of health encounter data and survey data for a cohort of 304 children aged 0-18 years at an urban health center affiliated with a teaching hospital. We used 2 strategies to identify children with a chronic condition: 1) identification by the existence of an encounter with an International Classification of Diseases, Ninth Revision code indicating a chronic condition and 2) identification by the QuICCC. We compared the characteristics of children identified by the diagnosis list with those of children identified by the QuICCC. RESULTS: This population had high rates of chronic conditions, with 44% identified by the diagnosis list and 36% identified by the QuICCC. These 2 methods jointly identified 66% of children, yet only half (53%) of the children who had a diagnosis of a chronic condition in the encounter data were identified by the QuICCC. Asthma, anorexia, developmental delay, and adjustment reaction were among the common chronic conditions for children identified by the diagnosis list approach only. CONCLUSIONS: We found only moderate concordance among the children identified as having chronic conditions by a diagnosis list and by the QuICCC in this high-risk urban population. These different results indicate that encounter data and survey approaches do not serve as simple substitutes for identifying children with chronic conditions for clinical or monitoring purposes.

Adolescent↗
PubMedDate not supplied

Generalist and subspecialist care for children with chronic conditions.

OBJECTIVE: To determine, among Medicaid-enrolled children with chronic conditions, associations of indicators of morbidity and expenditures with different patterns of generalist, subspecialist, and pediatric subspecialist use. DESIGN AND SETTING: Cross-sectional analysis of Medicaid claims, enrollment, and provider data from 4 states (California, Georgia, Michigan, and Tennessee). SAMPLE: All children enrolled in Supplemental Security Income (aged 0-21 years) and a sample of other Medicaid-enrolled children matched for age and gender. We included 11 chronic conditions, including both uncommon conditions (eg, spina bifida, hemophilia) and common ones (eg, asthma, attention deficit hyperactivity disorder). MAIN OUTCOME MEASURES: We determined the number of visits per year to generalists and subspecialists (pediatric and other), using only subspecialists relevant to that condition. We categorized patterns of care as generalist only, predominantly generalist, or predominantly subspecialist, and examined patterns by condition and an indicator of morbidity. Among children seeing subspecialists, we also compared morbidity by pediatric and other subspecialists. We used linear regression to determine per-year total expenditures, controlling for demographic characteristics and morbidity. RESULTS: Most children (60.7%) saw generalists only. Twenty-eight percent were in predominantly generalist arrangements, and 11% were in predominantly subspecialist arrangements. Children in predominantly generalist arrangements had higher morbidity than children in generalist-only or predominantly subspecialist arrangements. Among children seeing subspecialists, those seeing pediatric subspecialists had generally higher morbidity than those seeing other subspecialists. Mean yearly expenditures varied from 1306 dollars (attention deficit hyperactivity disorder) to 11,633 dollars (acquired immunodeficiency syndrome). Children who saw only generalists had significantly lower expenditures for 6 of the 11 conditions, after adjusting for morbidity. CONCLUSIONS: Medicaid-enrolled children in predominantly generalist arrangements appear to have more complicated conditions than children in generalist-only or predominantly subspecialist arrangements, engendering also higher expenditures. Although children who saw generalists only had lower expenditures than those seeing subspecialists, this finding may reflect unmeasured variations in morbidity.

Adolescent↗
PubMedDate not supplied

Diagnostic practices for attention deficit hyperactivity disorder: a national survey of primary care physicians.

BACKGROUND: The American Academy of Pediatrics (AAP) clinical practice guideline emphasizes the appropriate diagnosis of attention deficit hyperactivity disorder (ADHD) in school-aged children. Although previous studies have shown wide variation in diagnostic practices for ADHD, few recent studies have examined nationally representative samples. OBJECTIVE: To describe practice patterns of primary care physicians evaluating school-aged children for ADHD in the late 1990s and compare the patterns with subsequently published AAP guidelines. METHODS: We surveyed a national sample of 2000 primary care pediatricians and family physicians. Of the 1076 returned surveys, 861 (43%) met data quality criteria and were included in the analysis. We tabulated frequencies for each item and used a chi2 test to examine relationships between survey items and physician characteristics. RESULTS: Primary care physicians most commonly reported conducting 1-2 new evaluations for ADHD per month, the majority spending 15-45 minutes and at least 2 office visits to confirm a diagnosis of ADHD. Although 58% of physicians used formal diagnostic criteria, only 28% reported using criteria according to the Diagnostic and Statistical Manual of Mental Disorders. Eighty-three percent reported using any teacher or school information such as report cards and rating scales. Approximately 70% used ADHD-specific rating scales, and 60% used global behavior scales. A quarter of respondents obtained laboratory tests such as hematocrit, lead, and thyroid function profile. Most physicians reported routinely assessing for coexisting conditions, ranging from 74% for tic disorders to 91% for depression and conduct disorder. CONCLUSIONS: Before the publication of AAP guidelines, primary care physicians' evaluation practices for school-aged children with ADHD varied widely, especially with respect to use of Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and inappropriate diagnostic tests.

Attention Deficit Disorder with Hyperactivity↗