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Introduction:The rapid adoption of telehealth as a result of the COVID-19 pandemic provided the opportunity to examine perceptions of health care access and use of telehealth for delivery of effective and equitable care in low-income and historically marginalized communities. Methods:Focusing on communities with high social vulnerability, a multimethod analysis of combined perspectives, collected February through August 2022 from 112 health care providers, obtained from surveys and interviews, and 23 community members via 3 focus groups on access to care and telehealth. Qualitative data were analyzed using the Health Equity and Implementation Framework to identify barriers, facilitators, and recommendations for the implementation of telehealth using a health equity lens. Results:Participants perceived that telehealth helped maintain access to health care during the pandemic by addressing barriers including provider shortages, transportation concerns, and scheduling conflicts. Additional benefits suggested were improved care quality and coordination attributed to convenient avenues for care delivery and communication among providers and patients. However, many barriers to telehealth were reported and considered to limit equitable access to care. These included restrictive or changing policies regarding allowable services provided via telehealth, and availability of technology and broadband services to enable telehealth visits. Recommendations provided insight into care delivery innovation opportunities and potential policy changes to address equitable access to care. Conclusion:Integration of telehealth into models of care delivery could improve access to health care services and promote communication among providers and patients to improve care quality. Our findings have implications that are critical for future policy reforms and telehealth research. [ABSTRACT FROM AUTHOR]

Background: Pharmacoepidemiology studies using electronic health record (EHR) data typically rely on medication prescriptions to determine which patients have received a medication. However, such data do not affirmatively indicate whether these prescriptions have been filled. External dispensing databases can bridge this information gap; however, few established methods exist for linking EHR data and pharmacy dispensing records., Objective: We described a process for linking EHR prescribing data with pharmacy dispensing records from Surescripts. As a use case, we considered the prescriptions and resulting fills for psychotropic medications among pediatric patients. We evaluated how dispensing information affects identifying patients receiving prescribed medications and assessing the association between filling prescriptions and subsequent health behaviors., Methods: This retrospective study identified all new psychotropic prescriptions to patients younger than 18 years of age at Duke University Health System in 2021. We linked dispensing to prescribing data using proximate dates and matching codes between RxNorm concept unique identifiers and National Drug Codes. We described demographic, clinical, and service use characteristics to assess differences between patients who did versus did not fill prescriptions. We fit a least absolute shrinkage and selection operator (LASSO) regression model to evaluate the predictability of a fill. We then fit time-to-event models to assess the association between whether a patient filled a prescription and a future provider visit., Results: We identified 1254 pediatric patients with a new psychotropic prescription. In total, 976 (77.8%) patients filled their prescriptions within 30 days of their prescribing encounters. Thus, we set 30 days as a cut point for defining a valid prescription fill. Patients who filled prescriptions differed from those who did not in several key factors. Those who did not fill had slightly higher BMIs, lived in more disadvantaged neighborhoods, were more likely to have public insurance or self-pay, and included a higher proportion of male patients. Patients with prior well-child visits or prescriptions from primary care providers were more likely to fill. Additionally, patients with anxiety diagnoses and those prescribed selective serotonin reuptake inhibitors were more likely to fill prescriptions. The LASSO model achieved an area under the receiver operator characteristic curve of 0.816. The time to the follow-up visit with the same provider was censored at 90 days after the initial encounter. Patients who filled prescriptions showed higher levels of follow-up visits. The marginal hazard ratio of a follow-up visit with the same provider was 1.673 (95% CI 1.463-1.913) for patients who filled their prescriptions. Using the LASSO model as a propensity-based weight, we calculated the weighted hazard ratio as 1.447 (95% CI 1.257-1.665)., Conclusions: Systematic differences existed between patients who did versus did not fill prescriptions. Incorporating external dispensing databases into EHR-based studies informs medication receipt and associated health outcomes., (© Peng Wu, Jillian H Hurst, Alexis French, Michael Chrestensen, Benjamin A Goldstein. Originally published in JMIR Medical Informatics (https://medinform.jmir.org).)

Objective: Elevated attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers are a risk factor for poorer psychiatric health, cognitive deficits, and social and academic impairment across the lifespan. The first-line treatment for these preschoolers, behavioral parent training (BPT), reduces children's disruptive behaviors and parenting stress, yet its impact on core ADHD symptoms is inconsistent. Early interventions targeting biological mechanisms linked to core ADHD pathophysiology are critically needed., Methods: This topical review explores sleep dysregulation as a potential key target for early intervention for ADHD symptoms among preschoolers., Results: Sleep dysregulation is common in school-aged children with ADHD, and treating sleep improves core ADHD symptoms in older children. Cross-sectional and prospective research with preschoolers offers compelling evidence that sleep dysregulation and ADHD symptoms are closely linked over the course of early development. BPT and behavioral sleep medicine (BSM) interventions share an underlying theoretical framework and could be streamlined to target sleep in addition to daytime behaviors., Conclusions: Novel early interventions targeting underlying biological mechanisms linked to core ADHD pathophysiology are critically needed to improve the trajectories of ADHD symptoms, comorbidity, and functional deficits for preschoolers with elevated ADHD symptoms. Sleep regulation is a promising mechanistic treatment target for this population, and future interventions may draw from the shared behavioral principles of BPT and BSM to target behaviors across the 24-hr period and employ scalable formats to optimize the number of families who can benefit from parent-based interventions targeting ADHD symptoms and sleep in early development., (© The Author(s) 2025. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)