Wood R, Stockton D, Brown H
Information Services Division, NHS National Services Scotland, Edinburgh, UK.
Child Care Health Dev. 2013 Nov;39(6):772-81. doi: 10.1111/j.1365-2214.2012.01423.x. Epub 2012 Aug 15.
There is a current emphasis on 'progressive universal' delivery of the UK child health programme, with a core universal service complemented by enhanced support provided according to need. In Scotland, a three-category indicator of need, the 'Health Plan Indicator' (HPI) is used to identify children requiring enhanced support from the child health programme to facilitate this.
Routine child health programme and hospital delivery records for a cohort of 36 871 Scottish children were used to explore the factors associated with being identified as requiring enhanced child health programme support using multilevel logistic regression modelling.
The following factors were all independently associated with an increased likelihood of being assessed as requiring enhanced support: (i) deprivation; (ii) young maternal age, maternal smoking and drug misuse; (iii) a previous stillbirth; (iv) prematurity; (v) being small for gestational age; (vi) no breastfeeding, admission to a special care baby unit; and (vii) medical, social or developmental concerns about the baby. There was a tendency for children living in areas with higher Health Visitor staffing levels to be more likely to be assessed as requiring enhanced support but this effect was not statistically significant. There was significant residual variation between areas in the likelihood of children being assessed as requiring enhanced support.
This study suggests Health Visitors take a complex range of factors into account when assessing which children require enhanced support from the child health programme. Health Visitors' workload may influence the likelihood of them identifying children as requiring enhanced support but this requires further clarification. There are clear differences between areas in allocation of the different HPI categories. Further work is required to explore the relationship between being identified as in need of enhanced support, the care actually provided to children, and their outcomes.
目前英国儿童健康计划强调“渐进式普及”，即以核心普及服务为基础，根据需求提供强化支持。在苏格兰，使用“健康计划指标”（HPI）这一三类需求指标来确定需要儿童健康计划强化支持的儿童，以推动这一目标的实现。
利用36871名苏格兰儿童队列的常规儿童健康计划和医院分娩记录，通过多水平逻辑回归模型探讨与被确定为需要儿童健康计划强化支持相关的因素。
以下因素均与被评估为需要强化支持的可能性增加独立相关：（i）贫困；（ii）母亲年龄小、母亲吸烟和药物滥用；（iii）既往死产史；（iv）早产；（v）小于胎龄；（vi）非母乳喂养、入住特殊护理婴儿病房；以及（vii）对婴儿的医疗、社会或发育方面的担忧。生活在健康访视员人员配备水平较高地区的儿童更有可能被评估为需要强化支持，但这种影响在统计学上不显著。在儿童被评估为需要强化支持的可能性方面，地区之间存在显著的残余差异。
本研究表明，健康访视员在评估哪些儿童需要儿童健康计划的强化支持时会考虑一系列复杂因素。健康访视员的工作量可能会影响他们将儿童确定为需要强化支持的可能性，但这需要进一步澄清。不同HPI类别在地区间的分配存在明显差异。需要进一步开展工作，以探讨被确定为需要强化支持、实际提供给儿童的护理及其结果之间的关系。
