Seid Michael
Divisions of Pulmonary Medicine and Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Pediatrics. 2008 Nov;122(5):994-1002. doi: 10.1542/peds.2007-3114.
I tested the hypothesis that, for vulnerable children with asthma, barriers to care (pragmatics, skills, knowledge and beliefs, expectations of care, and marginalization) affect primary care experiences, after accounting for financial, potential, and realized access to care, demographic features, and asthma severity.
Patients, recruited primarily from urban, federally qualified health centers, were between 3 and 12 years of age and had been diagnosed as having asthma. Bilingual, bicultural interviewers administered surveys in participants' homes. Validated instruments were used to measure barriers to care (Barriers to Care Questionnaire) and primary care experiences (Parent's Perceptions of Primary Care measure).
Of 252 families recruited, 56.6% of parents were monolingual Spanish speakers, 73.6% of mothers had not graduated from high school, and 24.5% of children were uninsured. Asthma severity was 27% mild persistent, 40.5% moderate persistent, and 32.5% severe persistent. In bivariate analyses, better access to care (being insured and having a regular provider) was related to better primary care experiences. Consistent with the hypothesis, multivariate regression analyses showed that fewer barriers (Barriers to Care Questionnaire scores) predicted better primary care (Parent's Perceptions of Primary Care total and subscale scores), after controlling for access to care, demographic features, and asthma severity (a 1-point change in Barriers to Care Questionnaire scores was associated with a 0.59-point change in Parent's Perceptions of Primary Care total scale scores). Having a regular doctor and not having experienced foregone care were also significant predictors of Parent's Perceptions of Primary Care scores in the multivariate analysis.
For vulnerable children with asthma, barriers to care explain variance in primary care characteristics beyond that explained by access, demographic factors, and disease severity.
我检验了这样一个假设，即在考虑到经济状况、潜在和实际获得医疗服务的机会、人口特征以及哮喘严重程度之后，对于易患哮喘的儿童，医疗服务障碍（语用学、技能、知识与信念、对医疗服务的期望以及边缘化）会影响初级医疗服务体验。
主要从城市中符合联邦资格的健康中心招募年龄在3至12岁且被诊断患有哮喘的患者。双语、双文化的访谈者在参与者家中进行调查。使用经过验证的工具来测量医疗服务障碍（医疗服务障碍问卷）和初级医疗服务体验（家长对初级医疗服务的认知测量）。
在招募的252个家庭中，56.6%的家长只说西班牙语，73.6%的母亲未高中毕业，24.5%的儿童未参保。哮喘严重程度为轻度持续的占27%，中度持续的占40.5%，重度持续的占32.5%。在双变量分析中，更好地获得医疗服务（参保且有固定的医疗服务提供者）与更好的初级医疗服务体验相关。与假设一致，多变量回归分析表明，在控制了获得医疗服务的机会、人口特征和哮喘严重程度后，较少的障碍（医疗服务障碍问卷得分）预示着更好的初级医疗服务（家长对初级医疗服务的认知总分及子量表得分）（医疗服务障碍问卷得分每变化1分，家长对初级医疗服务的认知总量表得分变化0.59分）。在多变量分析中，有固定的医生以及没有放弃过医疗服务也是家长对初级医疗服务认知得分的重要预测因素。
对于易患哮喘的儿童，医疗服务障碍能够解释初级医疗服务特征中的差异，且这种差异超出了由获得医疗服务的机会、人口因素和疾病严重程度所解释的范围。
