Background: Medicaid-enrolled children are considered at high risk for exposure to lead. Michigan Medicaid policy requires that all Medicaid-enrolled children be tested for lead at 12 and 24 months of age, or between 36-72 months of age if not already tested. The Michigan Department of Health and Human Services Lead Poisoning Prevention Program publishes monthly blood lead testing reports. Data from July 2016 reveal that statewide 76% of children enrolled in Medicaid had at least one blood lead level measured on or before their third birthday. In Washtenaw County, 66% of Medicaid-enrolled children had at least one blood lead level measured on or before their third birthday. Purpose: We conducted this survey to characterize provider knowledge, attitudes, and processes for pediatric lead screening and testing, with particular focus on identifying factors contributing to suboptimal testing of children enrolled in Medicaid at 12 and 24 months of age. Methods: A 12-question anonymous email survey was sent to a convenience sample of approximately 448 primary care providers identified as potentially providing care to children in Washtenaw County, Michigan. The sample included providers from an academic medical center, independent group practices, and private practices. The survey was available for completion via an email link from November 17, 2016 through December 09, 2016. Results: The overall response rate was 30% (137/448). While 93% of respondents would order lead testing at 12 months for a child enrolled in Medicaid, only 61% responded that they would order lead testing at 24 months for a child enrolled in Medicaid. Ninety-six providers (71%) indicated they have not had any patients with an elevated blood lead level (EBLL; blood lead level >5 mcg/dL) in the past 5 years. A higher percentage of respondents who reported experience with EBLL placed a “high priority” on lead testing. Only 13 (9.5%) respondents provided point of care testing. Among the 137 respondents, 96 (70%) provided a lead draw order for their patients with a lab housed in the same clinic building , and 22 (16%) provided a lead draw order with the lab at an offsite location. Conclusions: While nearly all respondents reported testing at 12 months for Medicaid-enrolled children, fewer were testing at 24 months. The majority of surveyed providers have not had experience with elevated blood levels, and those with experience were more likely to place a high priority on lead testing. These results highlight the challenge of maintaining priority for lead testing despite the decreasing prevalence of elevated blood levels and provide an opportunity for provider education regarding testing high risk populations at 24 months.
Pediatric Lead Testing: A Provider Survey
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Jennifer McDonald, Andrew N. Hashikawa, Ashley Dehudy, Jessie Marshall, Jane Nickert, Michael Treibwasser, Andrew Jones; Pediatric Lead Testing: A Provider Survey. Pediatrics May 2018; 142 (1_MeetingAbstract): 722. 10.1542/peds.142.1MA8.722
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