Department of Child Health, TNO, Leiden, Netherlands.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
PLoS One. 2020 May 6;15(5):e0231620. doi: 10.1371/journal.pone.0231620. eCollection 2020.
There is little evidence on the child and family factors that affect the intensity of care use by children with complex problems. We therefore wished to identify changes in these factors associated with changes in care service use and its intensity, for care use in general and psychosocial care in particular.
Parents of 272 children with problems in several life domains completed questionnaires at baseline (response 69.1%) and after 12 months. Negative binominal Hurdle analyses enabled us to distinguish between using care services (yes/ no) and its intensity, i.e. number of contacts when using care.
Change in care use was more likely if the burden of adverse life events (ALE) decreased (odds ratio, OR = 0.94, 95% confidence interval, CI = 0.90-0.99) and if parenting concerns increased (OR = 1.29, CI = 1.11-1.51). Psychosocial care use became more likely for school-age children (vs. pre-school) (OR = 1.99, CI = 1.09-3.63) if ALE decreased (OR = 0.93, CI = 0.89-0.97) and if parenting concerns increased (OR = 1.26, CI = 1.10-1.45). Intensity of use (>0 contacts) of any care decreased when ALE decreased (relative risk, RR = 0.95, CI = 0.92-0.98) and when psychosocial problems became less severe (RR = 0.38, CI = 0.20-0.73). Intensity of psychosocial care also decreased when severe psychosocial problems became less severe (RR = 0.39, CI = 0.18-0.84).
Changes in care-service use (vs. no use) and its intensity (>0 contacts) are explained by background characteristics and changes in a child's problems. Care use is related to factors other than changes in its intensity, indicating that care use and its intensity have different drivers. ALE in particular contribute to intensity of any care use.
针对儿童复杂问题，有关影响儿童护理使用强度的儿童和家庭因素的证据有限。因此，我们希望确定与护理服务使用及其强度变化相关的这些因素的变化，特别是一般护理和心理社会护理的使用。
272 名生活领域存在多种问题的儿童的父母在基线（应答率 69.1%）和 12 个月后完成了问卷调查。负二项式障碍分析使我们能够区分使用护理服务（是/否）及其强度，即使用护理服务时的联系次数。
如果不良生活事件（ALE）负担减少（优势比，OR=0.94，95%置信区间，CI=0.90-0.99）并且育儿担忧增加（OR=1.29，CI=1.11-1.51），护理使用的变化更有可能。如果 ALE 减少（OR=0.93，CI=0.89-0.97）并且育儿担忧增加（OR=1.26，CI=1.10-1.45），对于学龄儿童（与学龄前儿童相比），心理社会护理的使用变得更加可能。任何护理使用的强度（>0 次接触）都随着 ALE 的减少而降低（相对风险，RR=0.95，CI=0.92-0.98），并且随着心理社会问题变得不那么严重（RR=0.38，CI=0.20-0.73）。当严重的心理社会问题变得不那么严重时，心理社会护理的强度也会降低（RR=0.39，CI=0.18-0.84）。
护理服务使用（与不使用相比）及其强度（>0 次接触）的变化是由儿童的背景特征和问题变化来解释的。护理的使用与强度变化以外的其他因素有关，这表明护理的使用及其强度有不同的驱动因素。特别是 ALE 对任何护理使用的强度有贡献。
