Children's Hospital Boston, Harvard Medical School, Mass. 02215, USA.
Acad Pediatr. 2010 Jan-Feb;10(1):56-63. doi: 10.1016/j.acap.2009.11.001.
The aims of our study were, among children with attention-deficit/hyperactivity disorder (ADHD) compared with children with asthma: 1) to assess characteristics associated with parent report of having a medical home for children with either of these 2 conditions; 2) to determine whether, controlling for these characteristics, the likelihood of having a medical home differs between children with ADHD and asthma; and 3) to identify the specific components of a medical home that are lacking for children with these 2 conditions.
Cross-sectional analysis of the National Survey of Children with Special Health Care Needs, 2005-2006 (NS-CSHCN) was used. The outcome variable was parent report of their child's practice having specific attributes of the medical home. We used multivariate logistic regression to test whether the likelihood of having a medical home and its components differed for children with ADHD in comparison to children with asthma.
The NS-CSHCN interviewed parents of 11 674 children with ADHD and 13 517 children with asthma aged between 4 to 17 years. Significantly fewer children with ADHD compared with children with asthma have a medical home (OR [odds ratio] 0.68; P < .001). Specifically, parents reported differences in receiving family-centered (OR 0.79; P < .001) and coordinated care (OR 0.59; P < .001).
Parents of children with ADHD report worse performance across key dimensions of primary care compared with parents of children with asthma. For primary care to be optimally effective in addressing the needs of children with ADHD, efforts to significantly strengthen these key dimensions are needed.
我们的研究目的在于，与哮喘患儿相比，评估以下两种情况的患儿父母报告其拥有“医疗之家”的特征：1）评估这两种疾病患儿的父母报告拥有“医疗之家”的相关特征；2）控制这些特征后，比较患有多动症和哮喘的患儿拥有“医疗之家”的可能性；3）确定这两种疾病患儿的“医疗之家”所缺乏的具体组成部分。
使用 2005-2006 年国家特殊儿童健康护理需求调查（NS-CSHCN）的横断面分析。因变量为父母报告其子女实践中拥有“医疗之家”的特定属性。我们使用多变量逻辑回归来检验与哮喘患儿相比，多动症患儿拥有“医疗之家”及其组成部分的可能性是否存在差异。
NS-CSHCN 调查了 11674 名年龄在 4 至 17 岁的多动症儿童和 13517 名哮喘儿童的父母。与哮喘患儿相比，患有多动症的儿童拥有“医疗之家”的可能性显著较低（比值比 [OR] 0.68；P <.001）。具体来说，父母报告在获得以家庭为中心（OR 0.79；P <.001）和协调护理（OR 0.59；P <.001）方面存在差异。
与哮喘患儿的父母相比，患有多动症儿童的父母报告其初级保健的关键维度表现更差。为了使初级保健在满足多动症儿童的需求方面发挥最佳效果，需要大力加强这些关键维度。
