Joffe G P, Rodewald L E, Herbert T, Barth R, Szilagyi P G
Division of General Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Urban Health. 1999 Sep;76(3):322-34. doi: 10.1007/BF02345671.
To determine whether children on fee-for-service Medicaid who switch primary care doctors use less health care and are less up to date with preventive care visits than children who do not switch primary care doctors.
Retrospective cohort study using Medicaid claims data.
51,027 children enrolled on Medicaid in Monroe County, New York.
14,187 children enrolled continuously on fee-for-service Medicaid between January 1992 and December 1994.
Utilization of primary care, emergency department (ED) services, and specialty care and proportion up to date with preventive care visits according to American Academy of Pediatrics guidelines.
During the 2-year study period, 22% of children switched primary care doctors. Compared with children who did not switch primary care doctors, those who switched had more primary care visits (4.7 vs. 3.2 visits/year, P < .01), age-adjusted preventive care visits (1.2 vs. 1.0 visits/year), ED visits (0.72 vs. 0.47 visits/year, P < .01), and specialist visits (0.99 vs. 0.31, P < .01). On multivariate analysis, doctor switching was associated with increased odds of being up to date with preventive care visits (odds ratio [OR] = 1.7; 95% confidence interval [CI] 1.3 to 2.1). However, on multivariate analysis stratified by age, the association was significant only for older children (ages 11 to 14). Altogether, 68% of all children and 44% of infants less than 1 year old made the recommended number of preventive care visits during the study period.
All groups of children received less preventive care than recommended by the American Academy of Pediatrics. Children who switched primary care doctors had higher utilization of health care, including primary care, ED, and specialty care. Contrary to expectations, they were more likely to be up to date with preventive care visits. The heavy utilization of health services by doctor switchers indicates that this subgroup of children on Medicaid may not be at risk for poor access to health care, but additional research is needed to determine whether the quality of care is related to doctor switching.
确定与未更换初级保健医生的儿童相比，参加按服务付费医疗补助计划的儿童更换初级保健医生后是否使用更少的医疗保健服务，以及预防保健就诊的及时性是否更低。
使用医疗补助计划索赔数据进行回顾性队列研究。
纽约门罗县51,027名参加医疗补助计划的儿童。
1992年1月至1994年12月期间连续参加按服务付费医疗补助计划的14,187名儿童。
根据美国儿科学会指南，初级保健、急诊科（ED）服务和专科护理的使用情况，以及预防保健就诊达标的比例。
在为期2年的研究期间，22%的儿童更换了初级保健医生。与未更换初级保健医生的儿童相比，更换医生的儿童有更多的初级保健就诊次数（4.7次/年对3.2次/年，P <.01）、年龄调整后的预防保健就诊次数（1.2次/年对1.0次/年）、急诊科就诊次数（0.72次/年对0.47次/年，P <.01）和专科就诊次数（0.99次对0.31次，P <.01）。多变量分析显示，更换医生与预防保健就诊达标的几率增加相关（优势比[OR]=1.7；95%置信区间[CI]为1.3至2.1）。然而，在按年龄分层的多变量分析中，这种关联仅在年龄较大的儿童（11至14岁）中显著。在研究期间，所有儿童中有68%，1岁以下婴儿中有44%进行了推荐次数的预防保健就诊。
所有儿童组接受的预防保健均少于美国儿科学会的建议。更换初级保健医生的儿童对医疗保健的利用率更高，包括初级保健、急诊科和专科护理。与预期相反，他们进行预防保健就诊达标的可能性更大。更换医生的儿童对医疗服务的高利用率表明，这一医疗补助计划儿童亚组可能不存在获得医疗保健不足的风险，但需要进一步研究以确定医疗质量是否与更换医生有关。
