Lee Grace M, Friedman Jennifer F, Ross-Degnan Dennis, Hibberd Patricia L, Goldmann Donald A
Division of Infectious Diseases, Children's Hospital, Boston, Massachusetts 02115, USA.
Pediatrics. 2003 Feb;111(2):231-6. doi: 10.1542/peds.111.2.231.
Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds. Parental misconceptions about the cause and appropriate treatment of colds may contribute to unnecessary health service utilization. The objective of this study was to determine predictors of reported ED use and ambulatory care use for colds among families with young children.
This study was an observational, prospective cohort study to determine attack rates for respiratory illnesses within families that have at least 1 child who is 6 months to 5 years of age and enrolled in out-of-home child care. Families were randomly selected from 5 pediatric practices in Massachusetts and were considered eligible when the child was enrolled in child care with at least 5 other children for >or=10 hours per week. Enrolled families were asked to complete a survey that assessed knowledge about colds, antibiotic indications, and frequency of health service utilization. Predictors of self-reported use of health care services were assessed in multivariate logistic regression models.
Of the 261 families enrolled in the study, 197 families (75%) returned completed surveys. Although 93% of parents understood that viruses caused colds, 66% of parents also believed that colds were caused by bacteria. Fifty-three percent believed that antibiotics were needed to treat colds. Parents reported that they would visit the ED (23%) or their doctor's office (60%) when their child had a cold. Predictors of ED use on multivariate analysis included Medicaid insurance (odds ratio [OR]: 17.6 [2.2-139.3]), history of wheezing (OR: 18.3 [4.4-75.8]), and belief that antibiotics treat colds (OR: 4.2 [1.4-12.9]). Predictors of ambulatory care use included parent younger than 30 years (OR: 10.0 [1.6-64.3]), history of wheezing (OR: 5.6 [1.1-29.7]), and belief that antibiotics treat colds (OR: 3.8 [1.7-8.5]).
Misconceptions about the appropriate treatment of colds are predictive of increased health service utilization. Targeted educational interventions for families may reduce inappropriate antibiotic-seeking behavior and unnecessary health service utilization for colds.
1998年，感冒导致儿童和成人前往急诊科就诊160万次，门诊就诊2500万次。尽管大多数感冒由病毒引起，无需医疗干预，但许多家庭仍寻求医疗服务来治疗感冒。父母对感冒病因和恰当治疗方法的误解可能导致不必要的医疗服务利用。本研究的目的是确定幼儿家庭中报告的因感冒前往急诊科就诊和门诊就医的预测因素。
本研究是一项观察性前瞻性队列研究，旨在确定至少有1名6个月至5岁儿童且参加家庭外儿童保育的家庭中呼吸道疾病的发病率。从马萨诸塞州的5家儿科诊所中随机选取家庭，当孩子参加每周至少与其他5名儿童一起保育10小时或更长时间的儿童保育项目时，该家庭被视为符合条件。入选家庭被要求完成一项调查，评估对感冒的了解、抗生素使用指征以及医疗服务利用频率。在多变量逻辑回归模型中评估自我报告的医疗服务使用的预测因素。
在参与研究的261个家庭中，197个家庭（75%）返回了完整的调查问卷。尽管93%的父母明白感冒是由病毒引起的，但66%的父母也认为感冒是由细菌引起的。53%的父母认为治疗感冒需要使用抗生素。父母报告说，当孩子感冒时，他们会带孩子去急诊科就诊（23%）或去看医生（60%）。多变量分析中，前往急诊科就诊的预测因素包括医疗补助保险（优势比[OR]：17.6[2.2 - 139.3]）、喘息病史（OR：18.3[4.4 - 75.8]）以及认为抗生素可治疗感冒（OR：4.2[1.4 - 12.9]）。门诊就医的预测因素包括年龄小于30岁的父母（OR：10.0[1.6 - 64.3]）、喘息病史（OR：5.6[1.1 - 29.7]）以及认为抗生素可治疗感冒（OR：3.8[1.7 - 8.5]）。
对感冒恰当治疗方法的误解预示着医疗服务利用的增加。针对家庭的有针对性的教育干预可能会减少不适当的寻求抗生素行为以及因感冒而产生的不必要的医疗服务利用。
