Authors: Olivia J. Lindly, Morgan K. Crossman, Amy M. Shui, Dennis Z. Kuo, Kristen M. Earl, Amber R. Kleven, James M. Perrin, and Karen A. Kuhlthau
Many children are born prematurely in the United States, yet little information exists on their healthcare access and negative family impact in the first five years of life. This study’s purpose was to (1) understand differences in healthcare access and negative family impact among young children according to if they were born prematurely and (2) determine associations of healthcare access with negative family impact among young children born prematurely. We used 2016 and 2017 National Survey of Children’s Health data on 19,482 children who were 0 to 5 years-old in the United States. This included 242 children born with very low birthweight (less than 1,500 grams at birth) and 2,205 children born with low birthweight (1,500 to 2,499 grams at birth) or preterm (born at less than 37 weeks). Healthcare access was measured by adequate health insurance, access to a medical home, and developmental screening. Negative family impact was measured by $1,000 or more in annual out-of-pocket medical costs for the child, having a parent who cut-back or stopped work, parental aggravation, mother’s health not being excellent, and father’s health not being excellent. Very low birthweight children had higher risk of having a parent cut-back or stop work compared to other children. Adequate health insurance and medical home were each associated with lower risk of $1,000 or more in annual out-of-pocket costs, having a parent cut-back or stop work, and parental aggravation among children born prematurely. Study findings show better healthcare access is linked to lower risk of negative family impact for young children born prematurely in the United States. To help increase healthcare access and decrease negative family impact for young children born prematurely, health initiatives should focus on this subgroup of children with special health care needs.
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Authors: James A. Feinstein, Jonathan Rodean, Matt Hall, Stephanie K. Doupnik, James C. Gay, Jessica L. Markham, Jessica L. Bettenhausen, Julia Simmons, Brigid Garrity, Jay G. Berry
Background and Objectives: Although opioid medications (also called narcotics) can be dangerous, we don’t know much about how they are used in children and youth with special health care needs (CYSHCN). In our study, we looked at the different types of opioids used, how frequently opioid prescriptions were filled, and the diagnoses associated with opioid use in CYSHCN. Finally, we looked at what kinds of doctors and dentists the children see when they get a prescription for opioids.
Methods: To find out how often CYSHCN are prescribed opioids, we studied 2,509,453 CYSCHN between the ages of 0 and 18 who lived in 11 different states. These children were enrolled in Medicaid during 2014 and had at least 1 chronic disease or condition. Each child was given at least one prescription for opioids that was filled at a pharmacy. We looked at their doctor and dentist visits 7 days before they got their prescriptions, 7 days after they got their prescriptions, and 30 days after they got their prescriptions.
Results: Of the 2,509,453 CYSHCN we looked at, 8% of them filled at least one prescription for opioids. Of those children who received opioids, most children were between 10 and 18 years old and 46% had at least 3 diseases or conditions. Additionally, 55% of the children evaluated in this study also took at least 5 different other medicines regularly. Most of the opioid prescriptions were only filled once and children were given enough pills to last about 5 days. The most common opioids were acetaminophen-hydrocodone (also called Vicodin), acetaminophen-codeine (also called Tylenol with codeine), and acetaminophen-oxycodone (also called Percocet). About one-third of children who visited the emergency department, one-fourth of children who had outpatient surgery, and one-fifth of children who visited their primary care doctor received an opioid prescription. Most opioids were prescribed because of an infection (26% of opioid prescriptions) or because of an injury (24% of opioid prescriptions). Only 33% of children saw their doctors 7 days after getting opioids and only 61% of children saw their doctors 30 days after getting opioids.
Conclusions: It is common for doctors and dentists to prescribe opioids to CYSHCN, especially when they have more than one disease or condition or when they take more than one medicine. In the future, we should look more closely at how and why opioids are prescribed to children with special health care needs, especially in the emergency department. We should examine whether using opioids with a child’s regular medicine causes any health problems and why many children who are using opioids are not seen again by their doctors.
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