Christakis Dimitri A, Kazak Anne E, Wright Jeffrey A, Zimmerman Frederick J, Bassett Alta L, Connell Frederick A
Department of Pediatrics, University of Washington, Seattle, WA 98115-8160, USA.
Fam Med. 2004 Jan;36(1):55-60.
Although continuity of care has been found to be associated with improved health outcomes in children, little is known about what factors predict having consistent contact with a pediatric provider. This study explored what patient, family, provider, and system factors are associated with high continuity of both total and well-child care.
This cross-sectional study involved 759 patients presenting to a primary care pediatric clinic. Patients completed surveys about demographic variables, attitudes about continuity of care, and family functioning, as well as provider-level information. Outcomes were measured with a continuity of care index that quantified the degree to which a patient experienced continuous care with a provider.
In Tobit regression models, the variables associated with increased total continuity of care were continuity belief, higher family control, increased provider availability, and better provider rating. Associated with decreased total continuity of care were: number of visits, patient age, and time at clinic. For well-child care, the variables associated with increased continuity of care were continuity belief, increased provider availability, better provider rating, and greater reported household income. Provider availability was the strongest predictor of total continuity of care, and continuity belief was the strongest predictor of well-child continuity of care.
Increased provider availability may improve overall continuity of care for pediatric patients.
尽管已有研究发现儿童医疗服务的连续性与改善健康结局相关，但对于哪些因素能够预测与儿科医疗服务提供者保持持续接触却知之甚少。本研究探讨了患者、家庭、医疗服务提供者及医疗系统等因素中，哪些与全面及儿童健康保健的高连续性相关。
这项横断面研究纳入了759名到初级保健儿科诊所就诊的患者。患者完成了关于人口统计学变量、对医疗服务连续性的态度、家庭功能以及医疗服务提供者层面信息的调查。通过一个医疗服务连续性指数来衡量结果，该指数量化了患者接受某位医疗服务提供者持续医疗服务的程度。
在托比特回归模型中，与全面医疗服务连续性增加相关的变量包括连续性信念、更高的家庭掌控度、医疗服务提供者可及性增加以及更高的医疗服务提供者评分。与全面医疗服务连续性降低相关的因素有：就诊次数、患者年龄以及在诊所的就诊时间。对于儿童健康保健而言，与医疗服务连续性增加相关的变量有连续性信念、医疗服务提供者可及性增加、更高的医疗服务提供者评分以及报告的家庭收入更高。医疗服务提供者可及性是全面医疗服务连续性的最强预测因素，而连续性信念是儿童健康保健连续性的最强预测因素。
增加医疗服务提供者的可及性可能会改善儿科患者的整体医疗服务连续性。
