Cabana Michael, Bruckman David, Rushton Jerry L, Bratton Susan L, Green Lee
Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan Health Care System, Ann Arbor 48109-0456, USA.
Ambul Pediatr. 2002 Nov-Dec;2(6):456-61. doi: 10.1367/1539-4409(2002)002<0456:roascb>2.0.co;2.
Although proper outpatient asthma management sometimes requires care from subspecialists, there is little information on factors affecting receipt of subspecialty care in a managed care setting.
To determine factors associated with receipt of subspecialty care for children with asthma in a managed care organization.
We conducted an analysis of the claims from 3163 children with asthma enrolled in a university-based managed care organization from January 1998 to October 2000. We used logistic regression analysis to determine factors associated with an outpatient asthma visit with an allergist or pulmonologist.
Of the 3163 patients, 443 (14%) had at least 1 subspecialist visit for asthma; 354 (80%) were seen by an allergist, 63 (14%) were seen by a pulmonologist, and 26 (6%) were seen by both. In multivariate analysis, patients with more severe asthma (odds ratio [OR], 3.81; 95% confidence interval [CI], 2.99-4.86) and older patients (OR, 1.04; 95% CI, 1.02-1.07) were more likely to receive care from a subspecialist. Compared with Medicaid patients, both non-Medicaid patients with copayment (OR, 2.52; 95% CI, 1.85-4.43) and non-Medicaid patients without any copayment (OR, 3.40; 95% CI, 2.35-4.93) were more likely to receive care from an asthma subspecialist.
Children insured by Medicaid are less likely to receive care from subspecialists for asthma. Reasons may be due to health care system-related factors, such as accessibility of subspecialists, to physician referral decisions, and/or to patient factors, such as adherence to recommendations to see a subspecialist. Our findings suggest a need to further investigate health care system barriers, physician referral, and patient acceptance and completion of subspecialty referral.
尽管适当的门诊哮喘管理有时需要专科医生的治疗，但关于管理式医疗环境中影响获得专科治疗的因素的信息却很少。
确定在一个管理式医疗组织中，与哮喘患儿获得专科治疗相关的因素。
我们对1998年1月至2000年10月在一个以大学为基础的管理式医疗组织中登记的3163名哮喘患儿的索赔进行了分析。我们使用逻辑回归分析来确定与哮喘门诊就诊于过敏症专科医生或肺科医生相关的因素。
在3163名患者中，443名（14%）至少有1次哮喘专科就诊；354名（80%）由过敏症专科医生诊治，63名（14%）由肺科医生诊治，26名（6%）由两者诊治。在多变量分析中，哮喘病情较重的患者（比值比[OR]，3.81；95%置信区间[CI]，2.99 - 4.86）和年龄较大的患者（OR，1.04；95% CI，1.02 - 1.07）更有可能接受专科医生的治疗。与医疗补助患者相比，有自付费用的非医疗补助患者（OR，2.52；95% CI，1.85 - 4.43）和无任何自付费用的非医疗补助患者（OR，3.40；95% CI，2.35 - 4.93）更有可能接受哮喘专科医生的治疗。
参加医疗补助的儿童接受哮喘专科治疗的可能性较小。原因可能与医疗保健系统相关因素有关，如专科医生的可及性、医生的转诊决定，和/或患者因素，如遵守看专科医生的建议情况。我们的研究结果表明需要进一步调查医疗保健系统障碍、医生转诊以及患者对专科转诊的接受和完成情况。
