Wager J, Ruhe A, Hirschfeld G, Wamsler C, Dobe M, Hechler T, Zernikow B
Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Dr.-Friedrich-Steiner Str. 5, 45711, Datteln, Germany.
Schmerz. 2013 Jun;27(3):305-11. doi: 10.1007/s00482-013-1320-3.
The purpose of this study was to determine patients' travel distances to a tertiary paediatric pain clinic and to analyse the association between travel distance and the parents' occupational skill level and the patients' pain characteristics.
The retrospective study consisted of 2,248 children assessed at the first evaluation. All children (0-20 years) who visited the clinic during a 5-year period (2005-2010) were enrolled in this study.
The mean travel distance was 81 km, and the 80 % catchment area was 109 km. Children of parents with a high occupational skill level had a 1.5-fold higher probability of travelling from outside the catchment area. The 80 % catchment area increased constantly with increasing occupational skill level. Additional significant factors for greater distance travelled were high impairment, musculoskeletal pain, long pain duration and a high number of previous physician contacts.
The association between travel distance and parental occupational skill level suggests that there is social injustice due to access barriers based on socioeconomic deprivation and education. An increase in the number of health care facilities for chronic pain in children would be a first step in rectifying this injustice.
本研究旨在确定患者前往三级儿科疼痛诊所的出行距离,并分析出行距离与父母职业技能水平以及患者疼痛特征之间的关联。
这项回顾性研究纳入了首次评估时接受评估的2248名儿童。所有在5年期间(2005 - 2010年)到该诊所就诊的0至20岁儿童均纳入本研究。
平均出行距离为81公里,80%的服务区域半径为109公里。父母职业技能水平高的儿童从服务区域外前来就诊的概率高出1.5倍。随着职业技能水平的提高,80%的服务区域半径不断增大。出行距离更远的其他显著因素包括严重功能障碍、肌肉骨骼疼痛、疼痛持续时间长以及此前看医生的次数多。
出行距离与父母职业技能水平之间的关联表明,由于社会经济贫困和教育导致的就医障碍存在社会不公。增加儿童慢性疼痛医疗设施的数量将是纠正这种不公的第一步。