Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Matern Child Health J. 2024 Jan;28(1):144-154. doi: 10.1007/s10995-023-03822-1. Epub 2023 Nov 2.
Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access.
Qualitative interviews about newborn circumcision care were conducted from April-June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care.
The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5-38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision.
Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions.
超过一半的在美国出生的男婴接受了新生儿割礼。然而，现有数据表明，公共保险覆盖的男孩，或黑人和非裔美国人，获得所需的新生儿割礼的机会较少，因此，这些人群中更集中了风险更高、成本更高的手术割礼。本研究旨在确定围产期医生在提供新生儿割礼方面的障碍和促进因素，以期为未来确保更公平获得割礼的策略提供信息。
2020 年 4 月至 6 月，在芝加哥地区的 11 家医院进行了关于新生儿割礼护理的定性访谈。提供围产期护理的医生（儿科医生、家庭医生和妇产科医生）参与了关于新生儿割礼的定性访谈。采用归纳和演绎定性编码方法，确定与新生儿割礼护理障碍和促进因素相关的主题。
23 名参与的医生（78%为女性，74%为白人，中位数为医学院毕业 16 年[范围 5-38 年]，52%担任医院领导职务，78%目前进行割礼）报告了多个障碍，包括手术流程方面的困难，以及临床医生的可用性和培训不一致；还提出了一些关于运营改进的建议。关于新生儿割礼的保险覆盖和报销，医生们报告说他们了解有限，但指出一些保险报销政策从财务上限制了临床医生和医院提供住院新生儿割礼。
医生确定了提供有意愿家庭新生儿割礼的后勤/运营和报销相关障碍。未来的研究和宣传工作应侧重于制定临床策略和医疗保健政策，以确保公平获得，并激励临床医生/医院进行新生儿割礼。
