Baranwal Navya, Hodges Abby, Breiner Courtney E, Malugen Emily, Estrem Hayley H, Sharp William G, Raol Nikhila
The Warren Alpert Medical School of Brown University, Providence, RI.
Children's Multidisciplinary Feeding Program, Children's Healthcare of Atlanta, Atlanta, GA. Dr. Hodges is now with the Oliver Behavioral Consultants. Dr. Breiner is now with the Columbia University Irving Medical Center.
J Dev Behav Pediatr. 2024;45(6):e569-e577. doi: 10.1097/DBP.0000000000001310. Epub 2024 Aug 13.
Although intensive multidisciplinary interventions (IMIs) provide benefits for patients with pediatric feeding disorders (PFD), access to these programs is limited and challenges faced by the programs remain unclear.
To better understand the barriers faced by existing day programs that provide IMI, disparities in patient care, and areas for improvement to better inform policy and improve access to treatment for PFD.
Semi-structured interviews were conducted with a leader of outpatient programs providing IMI in the United States. Data regarding leader's perspectives on disparities in patient care, barriers faced by the intensive multidisciplinary feeding day programs, and future goals and directions for their programming were collected. Afterward, a qualitative content analysis was conducted to consolidate and categorize information related to patient care, access, and barriers faced by day programs and patients with PFD.
Barriers and challenges were identified at the patient, program, and systems levels. Patient-level barriers included familial resources or socioeconomic status, geographic distance from the program site, and difficulty with the time commitment, whereas program-level barriers included limited site personnel and capacity and long wait times. System-level barriers primarily center on insurance, with inconsistent coverage of services and limited payer knowledge about PFD and IMI.
IMIs are effective in managing PFD; however, a variety of patient-level, program-level, and systems-level factors serve as barriers for patient access to care and program success. Further research, improved reimbursement, and consensus statements on effective treatments can help improve access to and coverage for care, allowing for the development and sustainability of more programs.
尽管强化多学科干预（IMIs）对患有小儿喂养障碍（PFD）的患者有益，但获得这些项目的机会有限，且这些项目面临的挑战仍不明确。
为了更好地了解提供IMI的现有日间项目所面临的障碍、患者护理方面的差异以及改进领域，以便为政策提供更充分的信息并改善PFD患者的治疗机会。
对美国提供IMI的门诊项目负责人进行了半结构化访谈。收集了有关负责人对患者护理差异、强化多学科喂养日间项目所面临的障碍以及其项目的未来目标和方向的看法的数据。之后，进行了定性内容分析，以整合和分类与患者护理、日间项目和PFD患者所面临的获得治疗机会及障碍相关的信息。
在患者、项目和系统层面发现了障碍和挑战。患者层面的障碍包括家庭资源或社会经济地位、与项目地点的地理距离以及时间投入方面的困难，而项目层面的障碍包括场地人员和能力有限以及等待时间长。系统层面的障碍主要集中在保险方面，服务覆盖不一致以及付款人对PFD和IMI的了解有限。
IMIs在管理PFD方面是有效的；然而，各种患者层面、项目层面和系统层面的因素成为患者获得护理和项目成功的障碍。进一步的研究、改善报销以及关于有效治疗的共识声明有助于改善护理的可及性和覆盖范围，从而促进更多项目的发展和可持续性。
