1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Child Obes. 2019 Sep;15(6):363-370. doi: 10.1089/chi.2019.0011. Epub 2019 May 17.
In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before the program ends. Parents and youth have reported difficulties in accessing services as an important barrier to starting or completing programming. The purpose of this study was to understand barriers and identify potential solutions related to access to care from the perspective of health care team members from Canada and the United States. Qualitative description method guided the study design. Participants were health care team members, purposefully recruited through Canadian and US-based pediatric weight management program registries. Telephone interviews were conducted with participants between February and May 2017. Interviews were transcribed verbatim and analyzed using content analysis. Eighteen individuals from 16 sites participated ( = 8 Canada, = 8 United States). Access barriers and potential solutions were related to: (1) referral and eligibility, (2) wait lists and program capacity, (3) logistics and costs, and (4) stigma and weight bias. Barriers were similar between Canadian and US sites, with the exception of cost-related barriers. Health care providers from Canada and the United States reported multiple societal, organizational, service, and family-level barriers to accessing multidisciplinary pediatric weight management care. Proposed solutions suggest that service providers can play a key role alongside families to improve access to appropriate care. Further research is needed to demonstrate the feasibility and effectiveness of proposed solutions.
在加拿大和美国，大多数被推荐接受儿科体重管理服务的家庭并没有开始治疗。在开始治疗的家庭中，许多家庭在项目结束前就停止了治疗。家长和青少年报告说，由于难以获得服务，这是开始或完成治疗计划的一个重要障碍。本研究的目的是从加拿大和美国的医疗保健团队成员的角度了解与获得医疗保健相关的障碍，并确定潜在的解决方案。定性描述方法指导了研究设计。参与者是通过加拿大和美国的儿科体重管理项目登记处有针对性地招募的医疗保健团队成员。2017 年 2 月至 5 月期间，对参与者进行了电话访谈。采访逐字记录，并使用内容分析法进行分析。来自 16 个地点的 18 人参加了（ = 8 加拿大， = 8 美国）。访问障碍和潜在解决方案与以下方面有关：（1）转诊和资格，（2）候补名单和项目能力，（3）后勤和费用，以及（4）耻辱和体重偏见。加拿大和美国的医疗保健提供者报告了多种社会、组织、服务和家庭层面的障碍，这些障碍影响了他们获得多学科儿科体重管理护理的机会。提出的解决方案表明，服务提供者可以与家庭一起发挥关键作用，以改善获得适当护理的机会。需要进一步的研究来证明所提出的解决方案的可行性和有效性。
