患有自闭症谱系障碍（ASD）的儿童和青少年的家庭医疗护理充足性与教育服务的使用有关吗？
Is medical home care adequacy associated with educational service use in children and youth with autism spectrum disorder (ASD)?
作者信息
Rizk Sabrin, Ngui Emmanuel, Benevides Teal W, Moerchen Victoria A, Khetani Mary, Barnekow Kris
机构信息
Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1919 West Taylor Street, AHSB 744, Chicago, IL, 60612, USA.
Community & Behavioral Health Promotion, University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, 1240 North 10th Street, Rm 417, Milwaukee, WI, 53205, USA.
出版信息
BMC Pediatr. 2023 Jan 9;23(1):12. doi: 10.1186/s12887-022-03776-3.
BACKGROUND
The American Academy of Pediatrics (AAP) recommends medical home care for children and youth with autism spectrum disorder (ASD) for health needs. Children and youth with ASD also receive educational services for cognitive, social, and behavioral needs. We measured whether inadequate medical home care was significantly associated with current educational service use, controlling for sociodemographic factors.
METHODS
We analyzed the 2016/2017 National Survey of Children's Health (NSCH) on 1,248 children and youth with ASD ages 1-17. Inadequate medical home care was operationalized as negative or missing responses to at least one medical home component. Educational service use was defined as current service use under individualized family service plans (IFSP) and individualized education programs (IEP).
RESULTS
Inadequate medical home care was significantly associated with higher likelihood of current educational service use (aOR = 1.95, 95% CI [1.10, 3.44], p = 0.03). After adjustment, older children (aOR = 0.91, 95% CI [0.84, 0.99], p = 0.03), lower maternal health (aOR = 0.52, 95% CI [0.29, 0.94], p = 0.03), and children without other special health care factors (aOR = 0.38, 95% CI [0.17-0.85], p = 0.02) had significantly lower odds of current educational service use.
CONCLUSIONS
Inadequate medical home care yielded higher odds of current educational service use. Child's age, maternal health, and lack of other special health care factors were associated with lower odds of current educational service use. Future research should examine medical home care defined in the NSCH and improving educational service use via medical home care.
背景
美国儿科学会（AAP）建议为患有自闭症谱系障碍（ASD）的儿童和青少年提供医疗家庭护理以满足其健康需求。患有ASD的儿童和青少年也会因认知、社交和行为需求而接受教育服务。我们在控制社会人口学因素的情况下，衡量了医疗家庭护理不足是否与当前教育服务的使用存在显著关联。
方法
我们分析了2016/2017年全国儿童健康调查（NSCH）中1248名年龄在1至17岁的患有ASD的儿童和青少年的数据。医疗家庭护理不足被定义为对至少一个医疗家庭组成部分的负面或缺失回答。教育服务的使用被定义为当前根据个性化家庭服务计划（IFSP）和个性化教育计划（IEP）接受的服务。
结果
医疗家庭护理不足与当前使用教育服务的可能性较高显著相关（校正后比值比[aOR]=1.95，95%置信区间[CI][1.10，3.44]，p=0.03）。调整后，年龄较大的儿童（aOR=0.91，95%CI[0.84，0.99]，p=0.03）、母亲健康状况较差（aOR=0.52，95%CI[0.29，0.94]，p=0.03）以及没有其他特殊医疗保健因素的儿童（aOR=0.38，95%CI[0.17 - 0.85]，p=0.02）当前使用教育服务的几率显著较低。
结论
医疗家庭护理不足导致当前使用教育服务的几率较高。儿童年龄、母亲健康状况以及缺乏其他特殊医疗保健因素与当前使用教育服务的几率较低相关。未来的研究应考察NSCH中定义的医疗家庭护理，并通过医疗家庭护理改善教育服务的使用情况。
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