Physician Barriers to Lead Testing of Medicaid-Enrolled Children

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.

KEY WORDS:  lead poisoning , mass screening , Medicaid , pediatrics , physician's practice patterns