Schempf Ashley H, Minkovitz Cynthia S, Strobino Donna M, Guyer Bernard
Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
Arch Pediatr Adolesc Med. 2007 Jan;161(1):50-6. doi: 10.1001/archpedi.161.1.50.
To prospectively evaluate the impact of parental satisfaction on childhood immunization and the mediating role of age-appropriate well-child care.
Secondary analyses of cohort data from the National Evaluation of Healthy Steps for Young Children. Data sources included an enrollment questionnaire, parent interview at 2 to 4 months, and medical records.
Twenty-four pediatric practices across the United States.
A total of 4896 (85%) of the initial 5565 enrolled families who were interviewed at 2 to 4 months and had abstracted medical records.
Parental satisfaction with overall pediatric care assessed at 2 to 4 months as excellent, good, or fair/poor.
Age-appropriate first dose of diphtheria-tetanus-pertussis; third dose of diphtheria-tetanus-pertussis; and measles, mumps, and rubella vaccinations; and up-to-date vaccinations at 24 months (4 diphtheria-tetanus-pertussis, 3 polio, and 1 measles, mumps, and rubella).
The majority of parents were satisfied with their child's health care; only 4% rated overall care as fair or poor. Children whose parents reported fair/poor satisfaction with care had a reduced odds of receiving age-appropriate first dose of diphtheria-tetanus-pertussis vaccination (odds ratio, 0.43; 95% confidence interval, 0.28-0.67); third dose of diphtheria-tetanus-pertussis vaccination (odds ratio, 0.52; 95% confidence interval, 0.36-0.74); and measles, mumps, and rubella vaccination (odds ratio, 0.58; 95% confidence interval, 0.37-0.92); and of being up to date by 24 months (odds ratio, 0.65; 95% confidence interval, 0.43-0.99) compared with children whose parents reported excellent care, independent of sociodemographic and maternal health care utilization variables. The negative effect of fair/poor satisfaction on immunization was largely explained by reduced utilization of age-appropriate well-child care.
Quality assurance activities that assess parental satisfaction with care may have added value in identifying children who are less likely to receive timely preventive services.
前瞻性评估父母满意度对儿童免疫接种的影响以及适龄健康儿童保健的中介作用。
对全国幼儿健康步骤评估队列数据进行二次分析。数据来源包括一份登记调查问卷、2至4个月时的家长访谈以及医疗记录。
美国24家儿科诊所。
最初登记的5565个家庭中，共有4896个（85%）家庭在2至4个月时接受了访谈并提取了医疗记录。
在2至4个月时评估的父母对整体儿科护理的满意度，分为优秀、良好或一般/较差。
适龄的第一剂白喉-破伤风-百日咳疫苗；第三剂白喉-破伤风-百日咳疫苗；麻疹、腮腺炎和风疹疫苗接种；以及24个月时的及时接种（4剂白喉-破伤风-百日咳疫苗、3剂脊髓灰质炎疫苗和1剂麻疹、腮腺炎和风疹疫苗）。
大多数父母对其孩子的医疗保健感到满意；只有4%的人将整体护理评为一般或较差。父母报告对护理满意度为一般/较差的儿童，与父母报告护理优秀的儿童相比，接受适龄第一剂白喉-破伤风-百日咳疫苗接种的几率降低（优势比，0.43；95%置信区间，0.28 - 0.67）；接受第三剂白喉-破伤风-百日咳疫苗接种的几率降低（优势比，0.52；95%置信区间，0.36 - 0.74）；接受麻疹、腮腺炎和风疹疫苗接种的几率降低（优势比，0.58；95%置信区间，0.37 - 0.92）；以及在24个月时及时接种的几率降低（优势比，0.65；95%置信区间，0.43 - 0.99），且不受社会人口统计学和母亲医疗保健利用变量的影响。满意度一般/较差对免疫接种的负面影响在很大程度上是由于适龄健康儿童保健的利用率降低所致。
评估父母对护理满意度的质量保证活动，在识别不太可能及时接受预防性服务的儿童方面可能具有附加价值。
