Fleegler Eric W, Lieu Tracy A, Wise Paul H, Muret-Wagstaff Sharon
Division of Emergency Medicine, MA-001, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2007 Jun;119(6):e1332-41. doi: 10.1542/peds.2006-1505.
The objectives of this study were to characterize (1) families' cumulative burden of health-related social problems regarding access to health care, housing, food security, income security, and intimate partner violence; (2) families' experiences regarding screening and referral for social problems; and (3) parental acceptability of screening and referral.
We surveyed 205 parents of children who were 0 to 6 years of age and attended 2 urban pediatric clinics for a well-child visit using a self-administered, computer-based questionnaire. The questionnaire included previously validated questions about health-related social problems and new questions about screening and referral in the past 12 months.
A total of 205 (79%) of 260 eligible families participated. Eighty-two percent of families reported > or = 1 health-related social problem; 54% experienced problems in > or = 2 social domains. Families experienced similar types and frequencies of problems despite demographic differences between clinics. One third of families reported no screening in any domain in the previous 12 months. Of 205 families, 143 (70%) identified at least 1 need for a referral; 101 (49%) expressed > or = 1 unmet referral need. Of families who reported receiving referrals, 115 referrals were received by 79 families; of the referrals made, 63% (73 of 115) led to contact with the referral agency, and 82% (60 of 73) of the referral agencies were considered helpful. A computer-based system in a pediatrician's office for future screening and referral for health-related social problems was deemed acceptable by 92% of parents.
Urban children and families reported a significant burden of health-related social problems yet infrequent pediatric screening or referral for these problems. Of families who reported receiving referrals, a majority contacted the recommended agencies and found them helpful. This study also demonstrates the feasibility of using a computer-based questionnaire to identify health-related social problems in a routine outpatient clinic setting.
本研究的目的是描述：（1）家庭在获得医疗保健、住房、食品安全、收入保障和亲密伴侣暴力等与健康相关的社会问题方面的累积负担；（2）家庭在社会问题筛查和转诊方面的经历；（3）父母对筛查和转诊的接受程度。
我们使用基于计算机的自填问卷，对205名0至6岁儿童的父母进行了调查，这些儿童在2家城市儿科诊所进行健康儿童检查。问卷包括先前验证过的关于与健康相关社会问题的问题，以及过去12个月内关于筛查和转诊的新问题。
260个符合条件的家庭中共有205个（79%）参与。82%的家庭报告了≥1个与健康相关的社会问题；54%的家庭在≥2个社会领域遇到问题。尽管诊所之间存在人口统计学差异，但家庭遇到的问题类型和频率相似。三分之一的家庭报告在过去12个月内未在任何领域进行筛查。在205个家庭中，143个（70%）确定至少有1次转诊需求；101个（49%）表示有≥1次未满足的转诊需求。在报告收到转诊的家庭中，79个家庭共收到115次转诊；在进行的转诊中，63%（115次中的73次）导致与转诊机构取得联系，82%（73次中的60次）的转诊机构被认为是有帮助的。92%的父母认为儿科医生办公室基于计算机的系统可用于未来与健康相关社会问题的筛查和转诊。
城市儿童和家庭报告了与健康相关社会问题的重大负担，但儿科对这些问题的筛查或转诊并不常见。在报告收到转诊的家庭中，大多数人联系了推荐的机构并认为它们有帮助。本研究还证明了在常规门诊环境中使用基于计算机的问卷来识别与健康相关社会问题的可行性。
