Stevens Gregory D, Shi Leiyu
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
J Fam Pract. 2002 Jun;51(6):573.
Healthy People 2010 calls for greater access to high-quality primary care as a means to reduce racial and ethnic disparities in children' health. Disparities in primary care quality have rarely been studied for children, and the few studies that have been conducted among adults are not readily applicable to children because of the different health care needs of the 2 populations. This study compared the quality of primary care experienced specifically by children of different racial and ethnic groups.
We used a random cross-sectional community sample of children. Parents were questioned via structured telephone interview with the Primary Care Assessment Tool about a selected child's primary care experiences. Responses were compared across racial and ethnic groups, with white children as the reference group.
The sample consisted of parents of 413 elementary school children, ages 5 to 12 years, enrolled in 1 school district spanning 3 suburban cities in San Bernardino County, California.
We measured cardinal features of primary care quality including first-contact care (accessibility and utilization), longitudinality (strength of affiliation and interpersonal relationship), comprehensiveness (services offered and received), and coordination of care.
After controlling for family demographics, socioeconomic status, and health system characteristics, minority children experienced poorer quality of primary care across most domains of care compared with white children. Asian Americans reported the lowest quality of care across most domains, but particularly in first-contact utilization, interpersonal relationship, and comprehensiveness of services received.
Racial and ethnic disparities in quality persist in many aspects of primary care delivery. The findings suggested that these disparities are not simply reflections of ability to pay, health disparities, sociodemographics, or racial variations in expectations for care. The findings in this study that parents of minority children, in particular Asian Americans, report lower quality of primary care is consistent with previous research among adults but had not been demonstrated previously for children.
《健康人民2010》呼吁增加获得高质量初级保健的机会，以此作为减少儿童健康方面种族和族裔差异的一种手段。针对儿童初级保健质量差异的研究很少，而且在成年人中进行的少数研究因这两类人群不同的医疗保健需求而不太适用于儿童。本研究比较了不同种族和族裔群体儿童所体验到的初级保健质量。
我们使用了一个随机横断面社区儿童样本。通过使用初级保健评估工具进行结构化电话访谈，向家长询问有关选定儿童的初级保健经历。将不同种族和族裔群体的回答进行比较，以白人儿童作为参照组。
样本包括加利福尼亚州圣贝纳迪诺县3个郊区城市的1个学区中413名5至12岁小学生的家长。
我们测量了初级保健质量的主要特征，包括首次接触保健（可及性和利用率）、连续性（医患关系强度和人际关系）、全面性（提供和接受的服务）以及医疗协调。
在控制了家庭人口统计学、社会经济地位和卫生系统特征后，与白人儿童相比，少数族裔儿童在大多数保健领域体验到的初级保健质量较差。在大多数领域，尤其是首次接触利用率、人际关系和接受服务的全面性方面，亚裔美国人报告的保健质量最低。
在初级保健服务的许多方面，质量方面的种族和族裔差异依然存在。研究结果表明，这些差异不仅仅是支付能力、健康差异、社会人口统计学或护理期望方面种族差异的反映。本研究中少数族裔儿童的家长，尤其是亚裔美国人，报告初级保健质量较低的结果与之前针对成年人的研究一致，但此前尚未在儿童中得到证实。
