Buetow Stephen, Richards Deborah, Mitchell Ed, Gribben Barry, Adair Vivienne, Coster Gregor, Hight Makere
Division of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Soc Sci Med. 2004 Nov;59(9):1831-42. doi: 10.1016/j.socscimed.2004.02.025.
Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Māori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6-9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6-9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools. Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Māori, Pacific and Asian children were disproportionately represented among these 'high attendees'. Low attendees (0-2 visits) were mainly NZ Europeans. The NBRM (n=155) showed that expected visits were increased by perceived need, ill-health, asthma severity and, in particular, Māori and Pacific child ethnicity. It may be that Māori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be overcome to obtain health care.
在新西兰（NZ），全科医生（GP）对儿童哮喘的诊疗服务就诊率差异很大。目前几乎没有研究来解释这些差异，尽管毛利人和太平洋岛民等群体在获得全科医生诊疗服务方面传统上一直面临障碍。本文旨在描述并解释新西兰奥克兰6至9岁中重度哮喘儿童的全科医生哮喘诊疗服务就诊率情况。2002年期间，随机选取的学校识别出所有可能存在呼吸问题的6至9岁儿童。每位家长/监护人填写一份问卷，表明哪些儿童患有中重度哮喘，以及哪些因素影响他们获得全科医生哮喘诊疗服务。采用多水平负二项回归模型（NBRM）来解释报告的哮喘全科医生就诊次数，并对学校内部的聚类情况进行调整。26所学校（89.7%）识别出931名可能存在呼吸问题的儿童。455名儿童（48.9%）将可用问卷返还给了学校。结果显示有209名中重度哮喘儿童，据报道，几乎每三名儿童中就有一名在前一年因哮喘进行了5次或更多次全科医生就诊。在这些“高就诊者”中，毛利人、太平洋岛民和亚洲儿童的占比过高。低就诊者（0至2次就诊）主要是新西兰欧洲人。NBRM（n = 155）显示，感知到的需求、健康状况不佳、哮喘严重程度，尤其是毛利人和太平洋岛民儿童的种族，会增加预期就诊次数。可能是毛利人和太平洋岛民儿童在获得全科医生哮喘诊疗服务方面不再面临重大障碍。然而，更有可能的是，障碍仅适用于获得常规的预防性护理，导致哮喘控制不佳、病情加重需要急性护理，并且反常地增加了全科医生就诊次数。障碍可能会增加就诊总数，这对所有卫生系统中关于可将获得医疗服务定义为必须克服的障碍这一假设提出了挑战。
