Emerging Trends in Antibiotic Use and Their Impact on Primary Care for Children

抗生素使用的新趋势及其对儿童初级保健的影响

• 批准号: 8704969
• 负责人: JONATHAN A FINKELSTEIN
• 金额: $ 18.22万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704969
• 关键词: Accounting; Acute; Address; Affect; Antibiotics; Antiviral Agents; Attention; Attitude; Award; Behavior; Belief; Caring; Censuses; Center for Translational Science Activities; Characteristics; Child; Child health care; Childhood; Clinical Sciences; Colorado; Communities; Complex; Data; Demographic Factors; Development; Diagnosis; Educational Status; Effectiveness; Elements; Epidemiology; Fellowship Program; Focus Groups; Funding; Future; Gap Junctions; Goals; Guidelines; Health; Health Knowledge, Attitudes, Practice; Health Planning; Health Services Research; Healthcare; Immunization; Individual; Infection; Influenza; Influenza A Virus, H1N1 Subtype; Insurance Carriers; Insurance Claim Review; Judgment; Knowledge; Massachusetts; Measures; Medicaid; Medical; Mentors; Mentorship; Methicillin Resistance; Methods; Minnesota; Otitis Media; Parents; Patients; Pattern; Patterns of Care; Pediatric Research; Physicians; Population; Population Analysis; Population Heterogeneity; Prevalence; Prevention; Primary Health Care; Public Health; Recommendation; Research; Research Personnel; Resistance; Resistance development; Resources; Respiratory System; Respiratory Tract Infections; Respiratory tract structure; Scientist; Serotyping; Site; Skin Tissue; Social Environment; Socioeconomic Factors; Soft Tissue Infections; Stream; Streptococcus pneumoniae; Suggestion; Survey Methodology; Surveys; Time; United States National Institutes of Health; Viral; Work; base; care episode; care seeking; career; common treatment; design; evidence base; expectation; experience; health care service utilization; improved; innovation; meetings; member; methicillin resistant Staphylococcus aureus; novel; novel vaccines; pandemic disease; pandemic influenza; pathogen; patient oriented; patient oriented research; population based; population health; programs; public health relevance; response; seasonal influenza; social; socioeconomics; trend

DESCRIPTION (provided by applicant): Jonathan Finkelstein is an established pediatric patient-oriented researcher, with extraordinary opportunities to mentor junior scientists in studies of critical issues in child health and health care. A Mid-career Investigator Award in Patient-oriented Research (K24) will allow dedicated time for Dr. Finkelstein to improve his mentoring capacities, and to provide additional opportunities for mentees related to care for common infections and antibiotic use in childhood. Dr. Finkelstein will leverage his current NIH-funded studies, access to extensive automated data through the HMO Research Network (HMORN), and resources of Harvard's CTSC program to understand the significant changes in treatment of infections in primary care practice, including patterns of antibiotic use, in an era when resistance has become commonplace, new vaccines may dramatically affect childhood illness, and parent and physician attitudes are in flux. This revised application proposes a more integrated and comprehensive approach to studying recent trends in care-seeking and treatment of common infections. It uses analysis of population-level data, as well as focus group and survey methods to understand underlying changes in parent knowledge, attitudes, and care-seeking. It also proposes a new focus on health care disparities in treatment of common infections aligning it with one of the primary goals of the T32-funded fellowship program in pediatric research which Dr. Finkelstein leads. The proposed mentoring plan includes 1) increased focus on mentoring research fellows in the Harvard-wide Pediatric Health Services Research Fellowship Program; 2) development of new opportunities for mentorship within Harvard's recently funded NIH Clinical and Translational Science Center; and, 3) ongoing engagement in the HMORN to develop innovative programs for cross-site mentorship of child health researchers. The past decade has witnessed a dramatic monotonic decrease in the use of antibiotics in pediatric practice driven by concerns about resistance by parents and clinicians. This has been associated with changes in diagnosis of otitis media, and other changes in health care utilization. Prior work has suggested differences, by social and demographic factors, in antibiotic use rates, as well as parental knowledge and attitudes regarding treatment. Since these studies, however, both the epidemiology and social context of childhood infections has changed dramatically. Infections with resistant non-vaccine serotypes of S. pneumoniae and methicillin resistant staph aureus have become increasingly common; new universal immunization for seasonal influenza is being implemented; and, the current H1N1 influenza pandemic is likely to impact parental views of, and care seeking for, respiratory tract illness. This research will address critical remaining questions including: how much longer the rate of antibiotic use continues to decrease; what its nadir will be among children in the US; whether previously observed differences, by socioeconomic and demographic factors, in knowledge, attitudes, and prescribing rates narrow or increase; and, whether patterns of care seeking and treatment for respiratory tract infections will change in the context of pandemic influenza. Finally, this work will address the effectiveness of public health messages in diverse populations regarding both common infections and pandemic influenza. These aims will be met using mixed methods that include analysis of claims data for the diverse populations of 4 participating health plans (including the addition of a plan predominantly serving Medicaid members), focus groups of parents to assess changing parental attitudes, and a quantitative survey to assess changes in knowledge related to infections and antibiotic (and antiviral) prescribing. In addition to supporting his own work, the data streams and analytic methods developed here will allow Dr. Finkelstein's trainees to conduct high quality patient oriented research on conditions affecting both the future of pediatric primary care practice and child health in the US.

描述（由申请人提供）：乔纳森·芬克尔斯坦（Jonathan Finkelstein）是一位以患者为导向的儿科研究人员，拥有绝佳的机会指导初级科学家研究儿童健康和医疗保健的关键问题。以患者为导向的研究中的职业生涯中期研究员奖 (K24) 将为芬克尔斯坦博士提供专门的时间来提高他的指导能力，并为受训者提供与常见感染护理和儿童期抗生素使用相关的额外机会。 Finkelstein 博士将利用他目前由 NIH 资助的研究、通过 HMO 研究网络 (HMORN) 获取的广泛自动化数据以及哈佛大学 CTSC 项目的资源，了解初级保健实践中感染治疗的重大变化，包括抗生素的使用模式，在耐药性已变得司空见惯、新疫苗可能极大地影响儿童疾病、家长和医生态度不断变化的时代。该修订后的申请提出了一种更加综合和全面的方法来研究常见感染的就医和治疗的最新趋势。它利用人口层面的数据分析以及焦点小组和调查方法来了解家长知识、态度和寻求照顾的潜在变化。它还提议将新的重点放在常见感染治疗方面的医疗保健差异上，这与 Finkelstein 博士领导的 T32 资助的儿科研究奖学金计划的主要目标之一相一致。拟议的指导计划包括 1) 更加注重指导哈佛范围内的儿科健康服务研究奖学金计划的研究人员； 2) 在哈佛大学最近资助的 NIH 临床和转化科学中心内开发新的指导机会； 3) 持续参与 HMORN，制定儿童健康研究人员跨地点指导的创新计划。过去十年，由于家长和临床医生对抗生素耐药性的担忧，儿科实践中抗生素的使用急剧单调减少。这与中耳炎诊断的变化以及医疗保健利用的其他变化有关。先前的研究表明，由于社会和人口因素，抗生素使用率以及父母对治疗的知识和态度存在差异。然而，自这些研究以来，儿童感染的流行病学和社会背景都发生了巨大变化。肺炎链球菌和耐甲氧西林金黄色葡萄球菌的非疫苗耐药血清型感染已变得越来越常见；正在实施针对季节性流感的新的全民免疫；而且，当前的 H1N1 流感大流行可能会影响家长对呼吸道疾病的看法和寻求护理。这项研究将解决剩下的关键问题，包括：抗生素使用率持续下降多久；美国儿童的最低点是什么？先前观察到的社会经济和人口因素在知识、态度和处方率方面的差异是否缩小或增加；以及，在大流行性流感的背景下，呼吸道感染的护理和治疗模式是否会改变。最后，这项工作将讨论关于常见感染和大流行性流感的公共卫生信息在不同人群中的有效性。这些目标将通过混合方法来实现，包括分析 4 个参与健康计划的不同人群的索赔数据（包括增加一个主要服务于医疗补助成员的计划）、家长焦点小组以评估不断变化的家长态度，以及进行定量调查以评估与感染和抗生素（和抗病毒）处方相关的知识变化。除了支持他自己的工作外，这里开发的数据流和分析方法将使芬克尔斯坦博士的学员能够针对影响美国儿科初级保健实践和儿童健康未来的状况进行高质量的以患者为导向的研究。

项目成果

Pulmonary support on day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia.

第 30 天的肺支持作为先天性膈疝发病率和死亡率的预测因子。

• DOI: 10.1016/j.jpedsurg.2013.03.012
• 发表时间: 2013
• 期刊: Journal of pediatric surgery
• 影响因子: 2.4
• 作者: Cauley,RyanP;Stoffan,Alexander;Potanos,Kristina;Fullington,Nora;Graham,DionneA;Finkelstein,JonathanA;Kim,HeungBae;Wilson,JayM;CongenitalDiaphragmaticHerniaStudyGroup
• 通讯作者: CongenitalDiaphragmaticHerniaStudyGroup

Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews.

• DOI: 10.2196/jmir.2780
• 发表时间: 2013-12-06
• 期刊: Journal of medical Internet research
• 影响因子: 7.4
• 作者: Sharifi M;Dryden EM;Horan CM;Price S;Marshall R;Hacker K;Finkelstein JA;Taveras EM
• 通讯作者: Taveras EM

Childhood infections, antibiotics, and resistance: what are parents saying now?

• DOI: 10.1177/0009922813505902
• 发表时间: 2014-02
• 期刊: Clinical pediatrics
• 影响因子: 1.6
• 作者: Finkelstein JA;Dutta-Linn M;Meyer R;Goldman R
• 通讯作者: Goldman R

Deceased donor liver transplantation in infants and small children: are partial grafts riskier than whole organs?

• DOI: 10.1002/lt.23667
• 发表时间: 2013-07
• 期刊: LIVER TRANSPLANTATION
• 影响因子: 4.6
• 作者: Cauley, Ryan P.;Vakili, Khashayar;Potanos, Kristina;Fullington, Nora;Graham, Dionne A.;Finkelstein, Jonathan A.;Kim, Heung Bae
• 通讯作者: Kim, Heung Bae

Why Do Children With ADHD Discontinue Their Medication?

• DOI: 10.1177/0009922812446744
• 发表时间: 2012-08-01
• 期刊: CLINICAL PEDIATRICS
• 影响因子: 1.6
• 作者: Toomey, Sara L.;Sox, Colin M.;Finkelstein, Jonathan A.
• 通讯作者: Finkelstein, Jonathan A.