Barriers to Pediatric Lead Screening: Implications From a Web-Based Survey of Vermont Pediatricians

Abstract

The pernicious effects of lead on child health are well documented. The Vermont Department of Health (VDH) recommends screening all 12-and 24-month-old children for elevated blood lead levels (BLL). In 2006, only 41.4% of 24-month-old Vermont children were screened. To identify barriers preventing pediatricians from performing blood lead screening, a survey was distributed to Vermont primary care pediatricians-divided in higher and lower screening groups. Vermont pediatricians were more likely to be lower screeners if they reported negative health outcomes began at BLL > 10 mg/dL (odds ratio [OR] = 3.64, 95% confidence interval [CI] = 1.12-11.99), practiced in Chittenden County (OR = 3.34, 95% CI = 1.14-9.78), or disagreed with the VDH's recommendation (OR = 4.90, 95% CI = 1.66-15.50). Adjusted analysis indicated the most significant determinants of lower screening rates were male gender, a perceived dangerous BLL as >10 mg/dL and low self-reported Medicaid population. The VDH may have an opportunity to increase BLL screening emphasizing the significant health risks associated with BLL ≤ 10 mg/dL.

Evaluating the Effectiveness of State-Level Policies on Childhood Blood Lead Testing Rates

“…19 Another study found that pediatricians were less likely to test if they believed that adverse health effects did not occur at BLLs of less than 10 μg/dL, disagreed with the state's testing recommendations, and served a low percentage of Medicaid-enrolled patients. 20 These studies further demonstrate the need for determining the most successful policies to inform providers' testing decisions.…”

“…One study found that although most providers were aware of testing requirements for Medicaid-enrolled children, one-third erroneously believed their practice was in a low-risk area and did not test 19. Another study found that pediatricians were less likely to test if they believed that adverse health effects did not occur at BLLs of less than 10 μg/dL, disagreed with the state's testing recommendations, and served a low percentage of Medicaid-enrolled patients 20. These studies further demonstrate the need for determining the most successful policies to inform providers' testing decisions.…”

Patterns of Children’s Blood Lead Screening and Blood Lead Levels in North Carolina, 2011–2018—Who Is Tested, Who Is Missed?

“…11 – 13 Some clinicians use screening questionnaires to identify children at risk of lead exposure who should receive blood lead testing, but these are of limited predictive utility. 14 A few studies 15 – 17 have found substantial variation in whether clinicians choose to test children’s blood for lead and have shown that this decision is a function of physicians’ knowledge, practice setting, patient demographics, and financial incentives. Second, investigations to identify possible sources of lead exposure are only triggered if a child’s BLL is above an “action level,” usually the U.S. Centers for Disease Control and Prevention (CDC) reference value.…”

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

“…The burden for prevention lies primarily on public health departments, implementation of policies by local organizations, and health care providers responsible for screening [9]. However, adherence to screening requirements remains surprisingly low [10,11]: roughly 40% of Medicaid-enrolled children do not receive screening, despite being mandated to do so through the Early Periodic Screening Diagnostic and Testing (EPSDT) program [6]. Overall, low income and minority children remain at higher risk of lead exposure [6].…”