University of Wisconsin-School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA.
University of Wisconsin-School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA.
Res Social Adm Pharm. 2017 May-Jun;13(3):524-529. doi: 10.1016/j.sapharm.2016.05.043. Epub 2016 May 20.
Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications.
The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have multiple, chronic, and complex medical conditions associated with severe functional limitations and high utilization of health care resources, and 2) to describe its association with receipt of effective care coordination services and level of medical complexity.
A secondary data analysis of the 2009/2010 National Survey of CSHCN, a nationally representative telephone survey of parents of CSHCN, was conducted. Logistic regression models were constructed to determine associations between unmet need for prescription medications and medical complexity and care coordination for families of CSHCN, while controlling for demographic variables such as race, insurance, education level, and household income. Analyses accounted for the complex survey design and sampling weights.
CMC represented about 3% of CSHCN. CMC parents reported significantly more unmet need for prescription medications and care coordination (4%, 68%), compared to Non-CMC parents (2%, 40%). Greater unmet need for prescription medications was associated with unmet care coordination (adjusted OR 3.81; 95% CI: 2.70-5.40) and greater medical complexity (adjusted OR 2.01; 95% CI: 1.00-4.03).
Traditional care coordination is primarily facilitated by nurses and nurse practitioners with little formal training in medication management. However, pharmacists are rarely part of the CSHCN care coordination model. As care delivery models for these children evolve, and given the complexity of and numerous transitions of care for these patients, pharmacists can play an integral role to improve unmet needs for prescription medications.
有特殊医疗需求的儿童（CSHCN）有多种未满足的医疗需求，包括处方药物。
本研究的目的有两个：1）量化和比较无医疗复杂性（CMC）和有 CMC 的 CSHCN 亚组的处方药物未满足需求 - 那些患有多种、慢性和复杂的医疗状况，与严重的功能障碍和高医疗资源利用率相关，以及 2）描述其与接受有效医疗协调服务和医疗复杂性水平的关系。
对 2009/2010 年全国有特殊医疗需求儿童调查（一项针对 CSHCN 父母的全国性电话调查）的二次数据分析。构建逻辑回归模型，以确定无处方药物需求与医疗复杂性和 CSHCN 家庭医疗协调之间的关联，同时控制种族、保险、教育程度和家庭收入等人口统计学变量。分析考虑了复杂的调查设计和抽样权重。
CMC 约占 CSHCN 的 3%。与非 CMC 父母相比，CMC 父母报告的处方药物和医疗协调需求未得到满足的比例明显更高（4%，68%）。未满足的处方药物需求与未满足的医疗协调（调整后的 OR 3.81；95%CI：2.70-5.40）和更高的医疗复杂性（调整后的 OR 2.01；95%CI：1.00-4.03）相关。
传统的医疗协调主要由接受过药物管理方面很少正式培训的护士和执业护士来提供。然而，药剂师很少参与 CSHCN 的医疗协调模式。随着这些儿童的医疗服务模式的发展，鉴于这些患者的护理复杂性和众多的护理过渡，药剂师可以发挥不可或缺的作用，以改善处方药物的未满足需求。
