Academic Pediatrics最新文献

{"title":"Examining the Association Between School Absences and Unmet Need for Mental Health Care Due to Cost among U.S. Children.","authors":"Nipuni Gomes, Ana Martinez-Donate, Jessie Kemmick Pintor","doi":"10.1016/j.acap.2026.103459","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103459","url":null,"abstract":"<p><strong>Objective: </strong>Prior research demonstrates associations between experiencing mental illness and school absenteeism, which leads to adverse financial and health consequences later in life. One of the starkest barriers to mental healthcare access faced by children in the United States is cost. This study aimed to examine the association between unmet need for mental healthcare and school attendance.</p><p><strong>Methods: </strong>We analyzed 2010-2018 National Health Interview Survey data to examine the relationship between unmet need for mental healthcare due to cost and missing >4 days of school due to illness/injury in children aged 5-17. We also included measures of the abbreviated Strengths and Difficulties Questionnaire (SDQ) to account for prevalence of mental health symptomology.</p><p><strong>Results: </strong>Nearly half (47.73%) of children who reported unmet need for mental health care due to cost during the past 12 months missed >4 school days, compared to only 28.23% of children without unmet need for mental healthcare (p<0.001). In adjusted logistic regression models, children with unmet need for mental healthcare due to cost had 2.18 (95% CI:1.80-2.64; p<0.01) higher odds of missing >4 days of school than children whose guardians did not report unmet need for mental healthcare due to cost. Even when including the SDQ score in our models, the association between being unable to access mental healthcare and increased school absence remained (OR=1.38 (95% CI:1.13-1.69; p=0.002)).</p><p><strong>Conclusion: </strong>Our study demonstrates that unmet need for mental healthcare due to cost is associated with missed school days due to illness/injury.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103459"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Psychometric Evaluation of the Provider Confidence in Adolescent Sexual Health (P-CASH) Scale.","authors":"Lauren Gerchow, Lauren Arnold Bell, Rebecca Schnall, Jianfang Liu","doi":"10.1016/j.acap.2026.103454","DOIUrl":"10.1016/j.acap.2026.103454","url":null,"abstract":"<p><strong>Objective: </strong>To develop and psychometrically evaluate the Provider Confidence in Adolescent Sexual Health (P-CASH) Scale and to explore primary care providers' confidence delivering sexual and reproductive health (SRH) care to adolescents.</p><p><strong>Methods: </strong>We developed scale items from a co-design study with adolescent mothers and healthcare professionals. A cross-sectional survey assessed U.S.-based primary care providers' confidence delivering SRH care using a 4-point Likert scale. Psychometric evaluation included exploratory factor analysis (EFA), internal consistency, and internal structure. We compared confidence between pediatric and non-pediatric providers using subscale means in multivariable linear regression.</p><p><strong>Results: </strong>The sample included 141 providers, primarily White, cisgender women. EFA supported a three-factor model with good fit (RMSR = 0.06): Clinical SRH (STIs, contraception, pregnancy options counseling); Healthy Relationships; and Development and Sexual Activity. Internal consistency was excellent (α = 0.90-0.95), and within-factor inter-item correlations consistently exceeded between-factor correlations, supporting the proposed factor structure. Providers reported the highest confidence in Clinical SRH and the lowest in Development and Sexual Activity. Pediatric providers reported significantly lower confidence than non-pediatric providers across all three subscales.</p><p><strong>Conclusion: </strong>The P-CASH demonstrates preliminary reliability and validity. Providers, especially pediatric specialists, report uneven confidence delivering SRH care. Research and targeted training are needed to improve provider confidence and SRH care delivery to adolescents.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103454"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges to Sustaining Dyad Group Care During COVID-19: A Mixed-Methods Study of Implementation Across Eight Practices.","authors":"Clare Viglione, Ariana Thompson-Lastad, Emma Dubinsky, Haley Powell, Michelle Gallas, Hassan Lubega, Renée Boynton-Jarrett","doi":"10.1016/j.acap.2026.103456","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103456","url":null,"abstract":"<p><strong>Objectives: </strong>CenteringParenting® is a dyad group care (DGC) model integrating well-child care with peer support. Many programs were paused during the COVID-19 pandemic, but the determinants of DGC sustainability have not been characterized. We examined barriers and facilitators that shaped DGC implementation during the pandemic, and how core components of the model fared across shifts in delivery.</p><p><strong>Methods: </strong>The GROW.V.BABY Practice-Based Research Network conducted a multi-site, retrospective, mixed-methods study using an anonymous survey and follow-up focus groups to examine pandemic-related disruptions, implementation determinants, and sustainability of dyad group care.</p><p><strong>Results: </strong>Most organizations (75%) paused programs; one sustained virtual delivery and one discontinued. Facilitators included leadership support (62.5%), access to space (62.5%), and multiple trained providers (50.0%). Barriers included COVID-19 safety protocols affecting feasibility (87.5%), restrictions on in-person interaction (75.0%), limited provider time (37.5%), and few trained providers (37.5%). Focus groups indicated that virtual delivery weakened relational components of DGC, including peer connection, rapport, and cohesion, and complicated delivery of clinical components such as vaccinations. In-person groups were described as providing relational benefits for both families and staff. Greater clinician decision-making authority was perceived to support sustainability.</p><p><strong>Conclusions: </strong>Common barriers included limited provider time and pandemic-related difficulties with recruitment and coordination. The program was difficult to implement virtually, as key relational components could not be fully replicated online. Clinicians emphasized that preserving the integrity of the model, which supports peer connection and engagement, is important for reducing staff burnout and sustaining the program as a pathway to high-quality preventive care.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103456"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing Ambulatory Antibiotic Treatment Duration for Acute Otitis Media and Community-Acquired Pneumonia.","authors":"Elysha L Pifko, Andrea Rivera-Sepulveda, Jonathan M Miller, Eddie Geagea, Magdy W Attia, Neil Rellosa, Scott O'Connor, Paul Simons, Tara Rao, Arianna Phillips, Arezoo Zomorrodi","doi":"10.1016/j.acap.2026.103455","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103455","url":null,"abstract":"<p><strong>Background and objective: </strong>Despite evidence supporting short treatment duration for acute otitis media and community-acquired pneumonia, many patients receive longer courses. The aim was to increase the proportion of short duration antibiotic therapy from 40% to 80% within 9 months in primary care, emergency department, and urgent care settings spanning three states.</p><p><strong>Methods: </strong>This quality improvement initiative was conducted from June 2022 to March 2025. Interventions were implemented through seven plan-do-study-act cycles, including creation of a clinical pathway and electronic health record tools with subsequent enhancements, education, organizational support via physician incentivization and alignment with organizational goals, data sharing, gemba walks, and positive reinforcement. Change in the outcome (percentage of encounters receiving short duration therapy and the mean duration of therapy), process (percentage of encounters utilizing order panels) and balancing (treatment failure) measures over time were analyzed using statistical process control charts.</p><p><strong>Results: </strong>51,056 patients were included, with 18,040 patients in the baseline and 33,016 in the implementation phase. Short duration antibiotic therapy increased from 40% to 88% and improved across all race, ethnicity, and child opportunity indices (p<0.001). Minimal baseline disparities were further attenuated. Mean antibiotic duration decreased from 8 to 5.9 days, saving 42,141 cumulative antibiotic days. Treatment failure remained unchanged (5%, range 2.5%-7.8%).</p><p><strong>Conclusion: </strong>Quality improvement methodology led to system-wide decrease in antibiotic duration across demographics in two common pediatric diagnoses. Aligning with organizational goals and data sharing proved to be effective strategies to promote large-scale practice change.</p><p><strong>Clinical trial registration: </strong>N/A.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103455"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Culturally Effective Care for Dual Language Learners: Pediatric Providers' Language Promotion and Developmental Surveillance.","authors":"Milton Guendica, Yu Chen, Caitlin F Canfield, Anna Miller-Fitzwater, Mariana Glusman, Adriana Weisleder","doi":"10.1016/j.acap.2026.103451","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103451","url":null,"abstract":"<p><strong>Objective: </strong>Culturally effective care for dual-language learners (DLLs) should incorporate evidence-based guidance on bilingual language development. This study assessed pediatric providers' knowledge of bilingualism and provision of culturally effective language promotion and developmental surveillance for DLLs. We also investigated provider-level factors related to these practices.</p><p><strong>Methods: </strong>Pediatric providers (N=349) who conduct birth-five well-child visits completed an online survey that asked about: knowledge of bilingual language development, self-reported language promotion with DLLs, difficulty identifying language delays, and application of culturally effective language promotion and developmental surveillance in clinical vignettes.</p><p><strong>Results: </strong>The percent of providers who agreed with the evidence-based statements testing knowledge of bilingual language development ranged from 26% to 98% depending on the statement. The percent of providers who self-reported frequently providing culturally effective language promotion to DLLs ranged from 36% to 93% depending on the item. Most (79%) providers reported difficulty identifying language delays in DLLs in cases of language non-concordance, compared to 38% in cases of language concordance and 7% for monolinguals. The percent of providers who responded correctly to hypothetical clinical vignettes ranged from 29% to 95% depending on the vignette. Providers who were bilingual, had received bilingualism training, encountered more DLL patients, and were more knowledgeable about bilingualism reported engaging in more culturally effective care.</p><p><strong>Conclusion: </strong>This study revealed gaps in pediatric providers' knowledge and provision of culturally effective language promotion and developmental surveillance for DLLs. Promoting a linguistically diverse workforce and providing training on bilingualism may be important ways to support families of DLLs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103451"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving Conceptualizations of Autonomy: A Longitudinal Study of Pediatric Hospital Medicine Fellows into Attending Practice.","authors":"Valerie Jurgens, Jamie Librizzi, Neha Shah, Priti Bhansali, Dorene F Balmer, Jimmy Beck","doi":"10.1016/j.acap.2026.103457","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103457","url":null,"abstract":"<p><strong>Objective: </strong>Promoting autonomy while ensuring appropriate supervision is a characteristic tension in graduate medical training. How autonomy is conceptualized through time, during the transition from trainee to attending, is not well understood. Thus, supervisors and trainees may have misaligned expectations for autonomy across the training continuum. This longitudinal qualitative study asked, \"How do trainees conceptualize and enact autonomy through training and into clinical practice as attendings?\"</p><p><strong>Methods: </strong>We recruited fourteen first-year pediatric hospital medicine fellows in July 2021 for a three-year study. We conducted semi-structured, recursive interviews approximately every six months. Transcripts were coded through an iterative process, and themes constructed by reviewing coded data and identifying patterns within and across longitudinal narratives.</p><p><strong>Results: </strong>Participants' conceptualization and enactment of autonomy shifted from that of complete independence to a dynamic, collaborative model. This shift often occurred during fellowship or after transition to the attending role. As fellows, participants valued independent rounding because it fostered a sense of ownership and volitional decision making, reinforcing their sense of autonomy. As new attendings, many struggled to reconcile this prior valuation of independence with their discomfort granting similar independence to trainees. Because independence and autonomy had become tightly intertwined in their thinking, new attendings approach autonomy as conditional when trainees demonstrated readiness.</p><p><strong>Conclusion: </strong>Fellows' conceptualizations and enactments of autonomy evolved across training and into unsupervised practice, underscoring its developmental, temporal nature. Recognizing how the meaning of autonomy evolves may help align trainee-supervisor expectations and support intentional approaches to fostering autonomy across the training continuum.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103457"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver Acceptability of Hospital-based Household Substance Use Screening during Pediatric Hospital Admissions.","authors":"Samara Jinks-Chang, Hoover Adger, Emily Murphy, Maria Trent, Jacqueline Toppins, Ashlé Barfield, Steven Huettner, Abigail Bunting, Pamela A Matson","doi":"10.1016/j.acap.2026.103446","DOIUrl":"10.1016/j.acap.2026.103446","url":null,"abstract":"<p><strong>Objective: </strong>Exposure to household substance use (SU) is an adverse childhood experience linked to poor long-term health outcomes. Despite guidelines, pediatricians infrequently screen for household SU, often citing concerns about offending parents. Prior outpatient studies suggest caregivers support universal outpatient screening, but acceptability in inpatient settings remains unclear. This study assessed caregiver acceptance of household SU screening during pediatric hospitalizations, differences by reported household SU, and the association between screening acceptability and caregiver trust in inpatient pediatricians.</p><p><strong>Methods: </strong>English-speaking adult caregivers of pediatric patients admitted to a community hospital's newborn or pediatric floor (October 2023-June 2024) completed an anonymous computer-based survey. Measures included items on screening acceptability, provider trust, demographics, and household SU. Chi-squared tests and multivariable logistic regression were used to assess associations.</p><p><strong>Results: </strong>Of 278 respondents, 58% were mothers, 44% were Black, and 42% were insured with Medicaid. Forty percent reported current household SU, most commonly alcohol (70%), marijuana (43%), and tobacco (28%). Most caregivers supported screening for household SU (89% to 96%), with no differences by SU in the home. Caregivers with education beyond high school (aOR 4.15) and those on the newborn floor (aOR 2.45) were more likely to find screening acceptable. Trust in inpatient pediatricians was strongly associated with acceptability (aOR 14.19, p=0.001) CONCLUSIONS: Caregivers broadly support inpatient screening for household SU, even when SU is present. Trust in providers significantly influences acceptance, highlighting the importance of building trusting relationships to support families and address intergenerational SU risk.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103446"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Decision Making in Pediatric Primary Care: A Scoping Review.","authors":"John Parkhurst, Jinann Shoshara, Julia Rabin, Andrea Fawcett, Tara Von Mach, Marilyn L Sampilo, John V Lavigne","doi":"10.1016/j.acap.2026.103458","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103458","url":null,"abstract":"<p><strong>Background: </strong>Pediatric primary care providers (PCPs) play a central and growing role in identifying and addressing mental health problems (MHPs), yet the clinical-decision making processes are poorly understood. We reviewed the literature on PCP recognition, referral, and management of pediatric MHP to identify opportunities for future research related to diagnostic accuracy and mental health service delivery in primary care.</p><p><strong>Methods: </strong>Scoping review methodology was used to examine the published research on PCP recognition, referral, and management decisions for pediatric MHPs. Data was organized by decision type and factors that influence decision making, including child characteristics, family characteristics, and clinician or practice context variables.</p><p><strong>Results: </strong>Forty-five peer-reviewed studies were included. Compared to gold standard assessments and parent-reported questionnaires, PCPs consistently under-recognized MHPs. The decision to refer patients varied by disorder and was largely influenced by problem severity and parental disclosure. Management decisions were primarily shaped by disorder and clinician comfort level. Across decision domains, problem severity, parental engagement, clinician training, and practice context emerged as consistent determinants of PCP decision making.</p><p><strong>Conclusions: </strong>PCPs face persistent challenges in addressing pediatric mental health concerns. This review underscores many opportunities to improve outcomes and reduce inequities in primary care mental health service delivery. There is a need to improve accurate identification, clarify thresholds for referral, and strengthen PCP knowledge and confidence in addressing internalizing disorders and higher acuity concerns. Future research should explore sequential screening, targeted training, and integrated behavioral health approaches to support clinicians and improve systems.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103458"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic Shifts in Childhood Housing Instability in the United States, 2022-2024.","authors":"Jonathan M Gabbay, Amanda M Stewart, Ann Chen Wu, Samantha R Levano, Kevin P Fiori","doi":"10.1016/j.acap.2026.103452","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103452","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate recent national trends in childhood housing instability, overall and across sociodemographic subgroups.</p><p><strong>Methods: </strong>We conducted a serial cross-sectional analysis of children aged 0-17 years using the 2022-2024 National Survey of Children's Health (NSCH). Our primary outcome was housing instability, a NSCH-defined composite of caregiver-reported inability to pay rent or mortgage on time in the past 12 months, lifetime experience of homelessness or living in a shelter, and frequent residential mobility in the past 12 months. We conducted survey-weighted regression models with an interaction term between sociodemographic subgroups and survey year to estimate within-group trends, adjusting for age and sex and accounting for the complex sampling design.</p><p><strong>Results: </strong>Approximately 12 million U.S. children (17%) experienced housing instability annually. Overall housing instability prevalence did not significantly change from 2022 to 2024. However, housing instability increased among children in households at 200%-399% of the family poverty level (adjusted risk ratio [aRR]: 1.11 per year; 95% CI: 1.05, 1.17), those with private insurance (aRR: 1.06; 95% CI: 1.00, 1.11), and those whose highest-educated caregiver held a college degree or higher (aRR: 1.07; 95% CI: 1.02, 1.12). Absolute prevalence remained highest among children identifying as American Indian or Alaska Native, Black or African American, Hispanic, Native Hawaiian or Pacific Islander, those publicly insured, and those in low-income households.</p><p><strong>Conclusions: </strong>Childhood housing instability is expanding in higher-income populations that are not traditionally targeted by federal assistance programs, while remaining concentrated among historically marginalized groups. Increased response strategies are needed from cross-sector collaboration among pediatricians, policymakers, and health systems.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103452"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Launching Pediatric Primary Care-Based PrEP for Adolescents in a Low HIV Prevalence Setting.","authors":"Claudia P Vicetti Miguel, Lia Mojica, Charlotte Formeller, Margaret Thew, Kevin Hartz, Wendi Ehrman","doi":"10.1016/j.acap.2026.103453","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103453","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this Quality Improvement (QI) initiative was to increase the provision of HIV pre-exposure prophylaxis (PrEP) care in pediatric primary care clinics, among adolescents at risk for HIV.</p><p><strong>Methods: </strong>We conducted a qualitive improvement initiative in 22 pediatric primary care clinics in southeast Wisconsin. After identifying barriers via provider survey, we implemented a multicomponent intervention bundle in 2023, including PrEP clinical guidance, provider education, long-acting injectable PrEP availability, best practice alerts and infectious disease electronic consultation for all PrEP-eligible adolescents. For the primary outcome we utilized PrEP prescription rates among adolescents diagnosed with a bacterial sexually transmitted infection (STI) from 2021-2025 as this was the only reliable risk factor trackable in the electronic medical record, using a statistical process control chart.</p><p><strong>Results: </strong>Among surveyed pediatric primary care providers, 93% had never prescribed PrEP, with lack of awareness and discomfort being major barriers; a targeted educational intervention significantly increased provider comfort discussing and offering PrEP (from 36% to 100%, p<0.01). Following implementation of a multicomponent QI bundle, PrEP initiation among adolescents with a bacterial STI rose from <1% to 5%. 96% of patients who started PrEP received guideline-concordant care. Injectable cabotegravir was selected by 43% of new PrEP users, and most care remained within primary care.</p><p><strong>Conclusion: </strong>This QI initiative successfully launched adolescent PrEP care in primary care through provider education, clinical guidance, and multidisciplinary support, demonstrating feasibility of improving HIV prevention even in low prevalence settings.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103453"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}