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预防处方(Rx):将环境卫生纳入儿科临床护理的临床工具。

Prescriptions (Rx) for Prevention: Clinical Tools for Integrating Environmental Health into Pediatric Clinical Care.

作者信息

Bland Christopher, Zajac Lauren, Wilson Joseph, Guel Luz, Pendley Sofía Curdumí, Charlesworth Annemarie, Korfmacher Katrina, Newman Nicholas, Howarth Marilyn, Balk Sophie J, Galvez Maida, Sheffield Perry

机构信息

Department of Environmental Medicine and Public Health (Mr Bland, Dr Zajac, Ms Guel, Dr Pendley, Dr Galvez, Dr Sheffield), Icahn School of Medicine at Mount Sinai, New York, New York; Harvard Kenneth C. Griffin Graduate School of Arts and Sciences (Mr Wilson), Boston, Massachusetts; Environmental Research and Translation for Health (EaRTH) Center (Ms Charlesworth), University of California, San Francisco, California; Community Engagement Core, Environmental Health Sciences Center at Department of Environmental Medicine (Dr Korfmacher), University of Rochester Medical Center, Rochester, New York; Pediatric Environmental Health and Cincinnati Children's Hospital Medical Center (Dr Newman), Cincinnati, Ohio; Philadelphia Regional Center for Children's Environmental Health, Center of Excellence in Environmental Toxicology, Perelman School of Medicine (Dr Howarth), University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Academic General Pediatrics, Children's Hospital at Montefiore (Dr Balk), Albert Einstein College of Medicine, Bronx, New York.

出版信息

J Public Health Manag Pract. 2025;31(2):244-251. doi: 10.1097/PHH.0000000000002044. Epub 2024 Sep 9.

Abstract

The integration of environmental health (EH) into routine clinical care for children is in its early stages. The vision of pediatric EH is that all clinicians caring for children are aware of and able to help connect families to needed resources to reduce harmful environmental exposures and increase health-enhancing ones. Environmental exposures include air pollution, substandard housing, lead, mercury, pesticides, consumer products chemicals, drinking water contaminants, industrial facility emissions and, increasingly, climate change-related extreme weather and heat events. An identified need is to simultaneously educate clinicians while connecting families to evidence-based EH interventions. Here, we describe a multi-decadal effort to create, refine, and disseminate a clinical tool called Prescriptions (Rxs) for Prevention that responds to that identified need. These tools are modeled on a risk communication framework and use a format that support clinicians when they screen their patients for EH concerns, to then counsel on those topics, and refer to EH resources if needed. Rxs for Prevention-tailored with local resources-are now in use at more than a dozen sites in multiple regions of the U.S. supporting the promotion of healthy homes, communities, and the broader environment for children. These Rxs are reducing barriers to EH integration by educating clinicians, linking families to community resources, and strengthening clinic and community connections. On-going evaluation can help further the implementation of the Rxs for Prevention to help achieve the long-term vision of integrating EH into routine clinical care.

摘要

将环境卫生(EH)纳入儿童常规临床护理尚处于早期阶段。儿科环境卫生的愿景是,所有照顾儿童的临床医生都能意识到并能够帮助家庭获得所需资源,以减少有害的环境暴露,并增加促进健康的环境暴露。环境暴露包括空气污染、不合标准的住房、铅、汞、农药、消费品化学品、饮用水污染物、工业设施排放,以及越来越多的与气候变化相关的极端天气和高温事件。已确定的需求是在将家庭与循证环境卫生干预措施联系起来的同时对临床医生进行教育。在此,我们描述了一项历时数十年的努力,以创建、完善并传播一种名为“预防处方(Rxs)”的临床工具,以满足这一已确定的需求。这些工具以风险沟通框架为模型,并采用一种格式,在临床医生为患者筛查环境卫生问题、就这些主题提供咨询并在需要时转介至环境卫生资源时为他们提供支持。根据当地资源量身定制的预防处方目前在美国多个地区的十几个地点使用,以支持为儿童促进健康的家庭、社区和更广泛的环境。这些处方通过对临床医生进行教育、将家庭与社区资源联系起来以及加强诊所与社区的联系,减少了环境卫生整合的障碍。持续评估有助于进一步实施预防处方,以帮助实现将环境卫生纳入常规临床护理的长期愿景。

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