Murray Carolyn J, Olson Ardis L, Palmer Ellen L, Yang Qian, Amos Christopher I, Johnson Deborah J, Karagas Margaret R
Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, 74 College Street, Hanover, NH 03755, USA.
Prev Med Rep. 2020 Sep 12;20:101209. doi: 10.1016/j.pmedr.2020.101209. eCollection 2020 Dec.
Over 43 million U.S. residents rely on private unregulated wells for their drinking water, raising public health concerns, particularly in regions like northern New England where widespread groundwater arsenic contamination is now recognized. Children are particularly vulnerable to adverse health effects from arsenic exposure. Despite AAP Guidelines, approaches to engage pediatric clinicians in promoting private well testing have not been previously described. We sought to determine the most effective practice approaches to achieve successful well water testing in routine pediatric care. 12 primary care clinics were block randomized to one of four study arms. Two intervention variables were assessed: (1) test results access (parent only vs. parent and clinic) and (2) follow up approaches (yes/no). Parents of children under 12 months using a private well were eligible. Prepaid water tests were provided. Primary outcome was parental water test completion. Eleven clinics successfully implemented processes identifying well users. 240 testing kits were dispensed. Completion rates averaged 29% (range 10 to 61%). The study arm with both clinic results access and staff follow up system was 2.3 times more likely to achieve test completion than other arms (95% CI 1.12-4.86, p = .03). Kit distribution by clinicians versus nursing staff, irrespective of study arm, had 2.4 times greater completion (95% CI 1.13-5.11, p = .02). Systematic drinking water source screening can be improved in pediatric care. Higher testing completion was found in practices randomized to reminders and structured follow up versus single visit discussion, but clinician involvement was the most predictive factor.
超过4300万美国居民依靠未经监管的私人水井获取饮用水，这引发了公众对健康的担忧，尤其是在新英格兰北部等地区，目前已认识到该地区存在广泛的地下水砷污染。儿童特别容易受到砷暴露对健康的不利影响。尽管有美国儿科学会的指南，但此前尚未描述让儿科临床医生参与促进私人水井检测的方法。我们试图确定在常规儿科护理中实现成功的井水检测的最有效实践方法。12家初级保健诊所被整群随机分为四个研究组之一。评估了两个干预变量：（1）检测结果获取方式（仅家长获取与家长和诊所都获取）和（2）随访方式（有/无）。使用私人水井的12个月以下儿童的家长符合条件。提供了预付费的水质检测。主要结果是家长完成水质检测。11家诊所成功实施了识别水井使用者的流程。分发了240个检测试剂盒。完成率平均为29%（范围为10%至61%）。诊所可获取检测结果且有工作人员随访系统的研究组完成检测的可能性是其他组的2.3倍（95%置信区间1.12 - 4.86，p = 0.03）。无论研究组如何，由临床医生而非护理人员分发试剂盒，完成率高出2.4倍（95%置信区间1.13 - 5.11，p = 0.02）。儿科护理中的系统性饮用水源筛查可以得到改善。与单次就诊讨论相比，随机接受提醒和结构化随访的实践中检测完成率更高，但临床医生的参与是最具预测性的因素。
