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新西兰奥特亚罗瓦地区儿童初级卫生保健障碍的后果。

Consequences of barriers to primary health care for children in Aotearoa New Zealand.

作者信息

Jeffreys Mona, Smiler Kirsten, Ellison Loschmann Lis, Pledger Megan, Kennedy Jonathan, Cumming Jacqueline

机构信息

Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka, Victoria University of Wellington, New Zealand.

School of Health, Te Herenga Waka, Victoria University of Wellington, New Zealand.

出版信息

SSM Popul Health. 2022 Feb 5;17:101044. doi: 10.1016/j.ssmph.2022.101044. eCollection 2022 Mar.

Abstract

Inequities in the provision of accessible primary health care contribute to poor health outcomes and health inequity. This study evaluated inequities in the prevalence and consequences of barriers that children face in seeing a general practitioner (GP) in Aotearoa New Zealand. We analysed data on 5,947 children from the longitudinal study cohort on barriers to seeing a GP in the previous year, reported by mothers when their children were aged 24 months and 54 months (in 2011/12 and 2013/14 respectively); and maternal-reported hospitalisations in the year prior to age 54 months. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for consequences of these barriers. Overall, 4.7% (n = 279) of children experienced barriers to seeing a GP in the year to 24 months and 5.5% (n = 325) in the year to 54 months. At each age, and for each specific barrier studied, barriers were more prevalent among Māori (the indigenous people of Aotearoa New Zealand), and among Pacific, compared to New Zealand European, children. Children facing barriers in the year to age 24 months were twice as likely to be hospitalised in the year to 54 months (OR 2.18, 95%CI: 1.38 to 3.44). When this relationship was analysed by ethnicity, the association was strongest for Māori (OR: 2.92, 95%CI: 1.60 to 5.30), less strong for Pacific (OR 2.01, 95%CI: 0.92 to 4.37) and not present for New Zealand European (OR 1.27, 95%CI 0.39 to 4.12) families. Barriers that children face to seeing a GP have social and cost implications for families and the health system. Changes to the health system, and future health policy, must align with the New Zealand government's obligations under [The Treaty of] , to ensure that health equity becomes a reality for Māori.

摘要

提供可及的初级卫生保健方面的不公平导致了不良的健康结果和健康不平等。本研究评估了新西兰奥特亚罗瓦儿童在看全科医生(GP)时所面临障碍的患病率及后果方面的不公平。我们分析了来自纵向研究队列的5947名儿童的数据,这些数据是母亲们在孩子24个月和54个月大时(分别在2011/12年和2013/14年)报告的上一年看全科医生的障碍情况;以及母亲报告的孩子在54个月前一年的住院情况。我们使用逻辑回归来估计这些障碍后果的比值比(OR)和95%置信区间(CI)。总体而言,在24个月前的一年中,4.7%(n = 279)的儿童在看全科医生时遇到障碍,在54个月前的一年中这一比例为5.5%(n = 325)。在每个年龄段以及针对所研究的每个具体障碍,与新西兰欧洲裔儿童相比,障碍在毛利人(新西兰奥特亚罗瓦的原住民)以及太平洋岛民儿童中更为普遍。在24个月前一年面临障碍的儿童在54个月前一年住院的可能性是其他儿童的两倍(OR 2.18,95%CI:1.38至3.44)。按种族分析这种关系时,该关联在毛利人家庭中最强(OR:2.92,95%CI:1.60至5.30),在太平洋岛民家庭中较弱(OR 2.01,95%CI:0.92至4.37),在新西兰欧洲裔家庭中不存在(OR 1.27,95%CI 0.39至4.12)。儿童看全科医生时面临的障碍对家庭和卫生系统具有社会和成本影响。卫生系统的变革以及未来的卫生政策必须符合新西兰政府根据[《条约》]所承担的义务,以确保毛利人实现健康公平。

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