Division of General Pediatrics, Child and Adolescent Health Measurement Initiative, Oregon Health and Science University, Portland, OR 97239, USA.
J Pediatr. 2013 Feb;162(2):409-14.e1. doi: 10.1016/j.jpeds.2012.07.022. Epub 2012 Aug 25.
To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers.
Two months after their child's specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors' offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥ 4 barriers was associated with incomplete referral.
A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors' offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥ 4 barriers were more likely than those experiencing ≤ 3 barriers to have incomplete referral.
Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals.
评估专科医疗的障碍频率，并评估哪些障碍与在社区卫生中心就诊的儿童中专科转介不完整（在初级保健提供者转介后未进行专科就诊）相关。
在孩子的专科转介后两个月，341 名家长完成了电话调查，评估是否完成了专科就诊，以及他们是否经历了 10 种医疗障碍中的任何一种。家庭/社区障碍包括难以请假、获得儿童保育、获得交通、保险不足。医疗保健系统障碍包括快速预约、理解医生和护士、与医生办公室沟通、找到办公室、获得口译员以及办公时间不方便。我们计算了障碍频率和经历的总障碍。使用逻辑回归，我们评估了哪些障碍与专科转介不完整相关，以及经历≥4 个障碍是否与专科转介不完整相关。
共有 22.9%的家庭经历了专科转介不完整。42.0%的家庭遇到了 1 个或多个障碍。最常见的障碍是请假难、获得儿童保育和获得交通。多变量分析显示，难以快速预约、难以找到医生办公室以及办公时间不方便与专科转介不完整相关。经历≥4 个障碍的家庭比经历≤3 个障碍的家庭更有可能出现专科转介不完整。
专科医疗的障碍很常见，与专科转介不完整相关。经历许多障碍的家庭更有可能出现专科转介不完整。改善家庭/社区因素可能会提高对专科医疗的满意度；然而，改善医疗系统因素可能是减少专科转介不完整的最佳方法。
