Adult and Child Consortium for Health Outcomes Research and Delivery Science, Mail Stop F443, 13199 E. Montview Blvd, 80025, Aurora, CO, USA; University of Colorado School of Medicine, Department of Pediatrics, Division of General Academic Pediatrics, 13123 East 16th Avenue, Box B023, 80045, Aurora, CO, USA; University of Colorado School of Medicine, Department of Internal Medicine, Division of General Internal Medicine, 12631 E. 17th Ave., Mailstop B180, 80045, Aurora, CO, USA.
Adult and Child Consortium for Health Outcomes Research and Delivery Science, Mail Stop F443, 13199 E. Montview Blvd, 80025, Aurora, CO, USA.
Disabil Health J. 2021 Apr;14(2):101016. doi: 10.1016/j.dhjo.2020.101016. Epub 2020 Nov 6.
Persons with Down syndrome (DS) require preventive care that addresses their age-/gender- and syndrome-specific needs. Yet, adolescents and adults with DS do not receive these preventive care services as recommended.
OBJECTIVE/HYPOTHESIS: To identify factors that predict receipt of age-/gender- and syndrome-specific preventive healthcare among adolescents and adults with DS. We hypothesized that more healthcare encounters and greater medical complexity would increase receipt of preventive care due to more opportunities to complete these activities.
Using Medicaid claims (2006-2010) for California, Colorado, Michigan, and Pennsylvania, we conducted a retrospective cohort study of adolescents and adults with DS (≥12 years old). We modeled receipt of both ≥1 wellness examination and ≥1 thyroid function test (TFT) in 2009-2010 as a function of receipt of those same healthcare activities in 2006-08, adjusting for demographics, key comorbidities, and medical complexity using multivariable logistic regression.
In this cohort of 3487 adolescents and adults with DS accessing Medicaid, 17% received both ≥1 wellness examination and ≥1 TFT in 2006-2008, 15% in 2009-2010, and only 7% during both time periods. Despite medical complexity and frequent healthcare interactions, the best predictor of future receipt of these activities was past receipt. State of residence variably impacted receipt of these preventive activities.
Although past receipt of wellness examination and TFT was the best predictor of future receipt of these activities, overall rates were quite low in this cohort of adolescents and adults with DS. Further work is needed to improve preventive healthcare delivery to this vulnerable population.
唐氏综合征（DS）患者需要预防保健，以满足其年龄/性别和综合征特异性需求。然而，患有 DS 的青少年和成年人并未按照建议获得这些预防保健服务。
目的/假设：确定预测患有 DS 的青少年和成年人获得年龄/性别和综合征特异性预防保健的因素。我们假设，更多的医疗保健接触和更大的医疗复杂性将增加预防保健的获得，因为这将提供更多完成这些活动的机会。
我们使用加利福尼亚州、科罗拉多州、密歇根州和宾夕法尼亚州的医疗补助（Medicaid）索赔数据（2006-2010 年），对患有 DS（≥12 岁）的青少年和成年人进行了回顾性队列研究。我们将 2009-2010 年≥1 次健康检查和≥1 次甲状腺功能测试（TFT）的接受情况建模为 2006-08 年相同医疗保健活动的接受情况的函数，调整了人口统计学、主要合并症和医疗复杂性，使用多变量逻辑回归。
在这个接受医疗补助的患有 DS 的青少年和成年人队列中，有 17%在 2006-08 年接受了≥1 次健康检查和≥1 次 TFT，15%在 2009-2010 年接受了这些检查，只有 7%在两个时期都接受了这些检查。尽管医疗复杂性和频繁的医疗保健接触，过去接受这些活动是未来接受这些活动的最佳预测指标。居住州的不同会影响这些预防活动的接受情况。
尽管过去接受健康检查和 TFT 是未来接受这些活动的最佳预测指标，但在这个患有 DS 的青少年和成年人队列中，总体接受率相当低。需要进一步努力改善对这一弱势群体的预防保健服务。
