Determining Childhood Blood Lead Level Screening Compliance Among Physicians

Abstract

Childhood Lead Poisoning Prevention Programs throughout the U.S. have addressed childhood lead poisoning by implementing primary and secondary prevention efforts. While many programs have helped increase screening rates, in some states children under the age of six still have not been tested for lead. This study aims to identify the barriers to childhood blood lead testing and develop a strategy to increase the number of children tested. Clark County physicians who work with children six and under were surveyed about blood lead level (BLL) testing practices, particularly, adherence to Centers for Disease Control and Prevention (CDC) guidelines, and parental compliance with orders to have their children tested to determine their blood lead levels. In addition, select in-person interviews were conducted with physicians who reported high parental compliance to identify best practices and barriers. Of the 77 physicians that provided data, 48% indicated they did not follow CDC guideline compared to 52% who follow guidelines. 18 of the 30 (or 60%) physicians reported more than 80% of parents complied with doctor recommended BLL testing. Twelve physicians identified cost, lack of insurance, and absence of symptomology as persistent barriers to lead screening. This study identified barriers to childhood lead screening including inadequate parental adherence to physician-ordered screenings and physician non-compliance with screening recommendations are two primary contributors. Addressing these issues could increase screening in children and reduce the risk of lead poisoning.

Child Blood Lead Testing Rates in Texas

“…Findings thus indicate a need to target health care professionals’ attitudes and cultural beliefs about the seriousness of childhood lead poisoning, in order to mitigate the problem of childhood lead poisoning in the United States. Similar to prior work, 18 our research uncovered a common attitude among health care providers that lead poisoning no longer poses a significant public health risk to most children—particularly based on their zip code. Nonetheless, all of the interviewees reported that they understood the serious physical and developmental health problems associated with blood lead poisoning.…”

“…Our work extends prior work that examined barriers to testing by examining knowledge about the prevalence of blood poisoning, attitudes about blood lead screening, and awareness of testing and reporting protocols. 18 Additionally, this work sought to identify current gaps in communication between health care providers and public health professionals regarding childhood lead testing. Findings were guided by the SDoH framework 16 and indicated a general lack of knowledge regarding the low testing rates and/or prevalence of blood lead poisoning among children in Texas.…”

Insights into the Slow Uptake of Residential Lead Paint Remediation Funds: A Lancaster, Pennsylvania, Case Study

“…Medicaid guidelines mandate universal screening of all enrollees at 12 and 24 months. In another study, 48% of doctors in Nevada did not strictly adhere to testing guidelines [41]. These studies, coupled with our findings, suggest that individuals who completely trust and rely on their physician's prompting might not be receiving adequate blood lead testing.…”

Cost‐effectiveness analysis of a community‐based colorectal cancer screening program in Shanghai, China

“…A multivariate sensitivity analysis was used to explore the influence of cost for publicity and management on QALYs gained and ICER of CRC screening in the general population. More expenditure for publicity indicated a better community education, and the operating or administrative expenses were related to the involvement of more physicians 9,28 . In the present study it was assumed that these expenditures per capita would be linearly associated with screening and colonoscopy compliance.…”