title: Physician barriers to lead testing of Medicaid-enrolled children.
abstract: BACKGROUND
  The rate of blood lead testing among Medicaid-enrolled children is low.
  
  
  OBJECTIVE
  To determine barriers to lead testing perceived by pediatricians to develop future interventions to improve the rate of appropriate blood lead testing.
  
  
  METHODS
  We developed a mail survey based on findings from 6 focus groups of primary-care providers in Michigan. We then surveyed a random sample of 520 primary-care pediatricians in Michigan. Pediatricians who did not accept Medicaid were excluded from the analysis.
  
  
  RESULTS
  The overall response rate was 65% (257 of 396 potentially eligible respondents). Most (68%) reported that they routinely test 1-year-old Medicaid-enrolled children. Practices with onsite blood testing were more likely to report routine testing of 1-year-old children (79% vs 62%; P < .01). Most (76%) who do not routinely test were aware of the Medicaid requirements for testing. The most common reason (70%) for not testing Medicaid-enrolled children was physicians' belief that they practice in a low-risk area. However, 35% of those who do not test because they practice in a low-risk area actually have their main practice site in a high-risk area.
  
  
  CONCLUSIONS
  To improve the rate of blood lead testing, the public health department should provide pediatricians with data regarding the local risk of lead poisoning. The public health department should also consider working with practices to facilitate onsite blood collection for lead testing.
authors.affiliation: Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA. kempera@med.umich.edu
authors.forename: Alex R
authors.initials: AR
authors.lastname: Kemper
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D020264:Lead Poisoning, Nervous System, Childhood / Q000175:diagnosis*; D008484:Medicaid; D008910:Minnesota; D010820:Physicians / Q000523:psychology*