title: Managing anemia in low-income toddlers: barriers, challenges and context in primary care.
abstract: Iron-deficiency remains a concern among low-income toddlers in the U.S. This formative study describes how primary care providers serving high-risk 1- to 3-year-old children in an urban ambulatory care setting approach anemia. Data collection included a retrospective review of randomly selected medical records (n=264) and semi-structured interviews with clinicians (n=41). Thirty-eight percent of the children presented with anemia (Hgb < 11.0 g/dl) at least once between 12 and 36 months of age. Just under half of these children were treated for anemia. Follow-up laboratories for iron-treated children were completed within 35 days in 16% of cases (median: 3 months). Interviews identified four key themes (iron-deficiency, communication, poverty, system) running through the two major categories of prevention and treatment. Treatment cut-points were variable. While providers felt clinically comfortable with anemia, they felt burdened and challenged by follow-up. Communication and system barriers weighed most heavily on perceived treatment outcomes.
authors.affiliation: Dept. of Nutritional Sciences, University of Connecticut (UConn), USA. Rebecca.crowell@uconn.edu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Crowell
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Pierce
authors.forename: Ann M
authors.initials: AM
authors.lastname: Ferris
authors.forename: Hilda
authors.initials: H
authors.lastname: Slivka
authors.forename: Patricia
authors.initials: P
authors.lastname: Joyce
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Bernstein
authors.forename: Suzanne
authors.initials: S
authors.lastname: Russell-Curtis
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000191:economics / Q000208:ethnology / Q000517:prevention & control*; D002675:Child, Preschool; D003142:Communication; D003237:Connecticut; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D008913:Minority Groups; D011203:Poverty / Q000208:ethnology*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D036301:Qualitative Research; D012923:Social Class; D012959:Socioeconomic Factors