D'Agostino Jo Ann, Passarella Molly, Saynisch Philip, Martin Ashley E, Macheras Michelle, Lorch Scott A
Department of Pediatrics, and Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
Pediatrics. 2015 Oct;136(4):e794-802. doi: 10.1542/peds.2015-0745.
To assess the adherence of premature infants with the American Academy of Pediatrics health supervision visit schedule, factors affecting adherence, and the association of adherence with preventive care.
Retrospective cohort of all infants ≤35 weeks' gestation, born 2005 to 2009, receiving care at a 30-site primary care network for at least 24 months (n = 1854). Adherence was defined as having a health supervision visit within each expected time period during the first 18 months of life. Logistic regression identified sociodemographic and medical factors associated with nonadherence and risk-adjusted association between nonadherence and outcomes.
Only 43% received all expected health supervision visits. Those with Medicaid insurance (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI] 0.35-0.60), a visit without insurance (AOR 0.46, 95% CI 0.32-0.67), chronic illness (AOR 0.7, 95% CI 0.51-0.97), and black race (AOR 0.7, 95% CI 0.50-0.98) were less adherent, whereas provider continuity of care (AOR 2.89, 95% CI 1.92-4.37) and lower birth weight (AOR 1.67, 95% CI 1.02-2.73) increased adherence. Infants <100% adherent were less likely to be up to date with immunizations and receive recommended preventive care. In nearly half of missed visit windows, no health supervision visit was scheduled.
Fewer than half of premature infants were fully adherent with the preventive health schedule with associated gaps in health monitoring and immunization delays. These data suggest the importance of health supervision visits and the need to explore scheduling facilitators for those at risk for nonadherence.
评估早产婴儿对美国儿科学会健康监督访视计划的依从性、影响依从性的因素以及依从性与预防保健的关联。
对2005年至2009年出生、孕周≤35周、在一个拥有30个站点的初级保健网络接受至少24个月护理的所有婴儿（n = 1854）进行回顾性队列研究。依从性定义为在生命的前18个月内的每个预期时间段内进行健康监督访视。逻辑回归确定了与不依从相关的社会人口统计学和医学因素，以及不依从与结局之间的风险调整关联。
只有43%的婴儿接受了所有预期的健康监督访视。拥有医疗补助保险的婴儿（调整后的优势比[AOR]为0.46，95%置信区间[CI]为0.35 - 0.60）、无保险就诊的婴儿（AOR为0.46，95% CI为0.32 - 0.67）、患有慢性病的婴儿（AOR为0.7，95% CI为0.51 - 0.97）以及黑人婴儿（AOR为0.7，95% CI为0.50 - 0.98）依从性较低，而医疗服务提供者的连续护理（AOR为2.89，95% CI为1.92 - 4.37）和较低的出生体重（AOR为1.67，95% CI为1.02 - 2.73）则提高了依从性。依从率<100%的婴儿按时接种疫苗并接受推荐的预防保健的可能性较小。在近一半错过的访视时间段中，未安排健康监督访视。
不到一半的早产婴儿完全遵守预防性健康计划，在健康监测和免疫接种延迟方面存在相关差距。这些数据表明健康监督访视的重要性，以及探索为有不依从风险的婴儿安排访视的促进因素的必要性。
