Brachlow Allison E, Ness Kirsten K, McPheeters Melissa L, Gurney James G
Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA.
Arch Pediatr Adolesc Med. 2007 Apr;161(4):399-405. doi: 10.1001/archpedi.161.4.399.
To assess the extent to which parents of children with autism compared with parents of children with asthma or other special health care needs report receiving primary care for their child consistent with the American Academy of Pediatrics medical home model.
Population-based cross-sectional study.
National Survey for Children's Health 2003-2004 telephone interview.
Parents of 495 children with autism, parents of 6716 children with asthma, and parents of 11,403 children with other special health care needs without asthma. Main Exposures Autism and other special health care needs including asthma.
Medical home score and components of care, as follows: personal provider and preventive; family-centered, compassionate, and culturally appropriate; accessible; comprehensive; and coordinated.
The odds of parents reporting care consistent with that in a medical home were less likely for children with autism (odds ratio, 0.45; 95% confidence interval, 0.30-0.66) and more likely for children with asthma (odds ratio, 1.17; 95% confidence interval, 1.06-1.30) compared with children with other special health care needs (1 [reference]). These differences persisted even after controlling for condition severity, personal characteristics, and insurance status. Specific components of a medical home less prevalent among children with autism than among children with other special health care needs included family-centered, comprehensive, and coordinated care.
Although we could not evaluate the reasons why, a large percentage of children with autism do not receive primary care consistent with that in a medical home.
评估与哮喘患儿或有其他特殊医疗需求患儿的父母相比，自闭症患儿的父母报告其孩子接受符合美国儿科学会医疗之家模式的初级保健的程度。
基于人群的横断面研究。
2003 - 2004年儿童健康全国电话调查。
495名自闭症患儿的父母、6716名哮喘患儿的父母以及11403名有其他特殊医疗需求但无哮喘患儿的父母。主要暴露因素为自闭症和包括哮喘在内的其他特殊医疗需求。
医疗之家评分及护理组成部分，如下：个人医疗服务提供者与预防；以家庭为中心、富有同情心且符合文化背景；可及性；全面性；协调性。
与有其他特殊医疗需求的儿童（参照值为1）相比，自闭症患儿的父母报告其孩子接受符合医疗之家模式护理的可能性较小（优势比为0.45；95%置信区间为0.30 - 0.66），而哮喘患儿的父母报告其孩子接受符合医疗之家模式护理的可能性较大（优势比为1.17；95%置信区间为1.06 - 1.30）。即使在控制病情严重程度、个人特征和保险状况后，这些差异仍然存在。与有其他特殊医疗需求的儿童相比，自闭症患儿中医疗之家的特定组成部分（以家庭为中心、全面和协调的护理）不太普遍。
尽管我们无法评估原因，但很大比例的自闭症患儿没有接受符合医疗之家模式的初级保健。
