Palfrey J S, Levy J C, Gilbert K L
Pediatrics. 1980 Mar;65(3):567-72.
The health care patterns of 158 children attending a medical specialty clinic at least twice a year were studied. The families were interviewed about (1) use of a primary care source, (2) continued contact with the referring physician, and (3) perceived health needs. For almost one third of the children, no source of primary care was reported. This group contained a higher percentage of older children and children from the urban center than did the group as a whole. No differences were attributable to insurance coverage. Of patients referred by a primary care provider, 62% were still in contact with that provider, whereas only 20% referred from another hospital-based program were still in touch with that program. Of the children attending specialty clinics 60% had other perceived health needs. Thirty-eight percent of the families reported health problems that they had never discussed with any medical provider. This study indicates that a large proportion of children with frequent attendance at specialty clinics perceive the hospital as the source of all their care. Health planners and providers need to take this patient perception into account as they design and manage programs for chronically ill children.
对每年至少去专科诊所两次的158名儿童的医疗模式进行了研究。研究人员就以下方面对这些家庭进行了访谈：（1）初级保健机构的使用情况；（2）与转诊医生的持续联系；（3）感知到的健康需求。近三分之一的儿童没有报告初级保健机构。与整个群体相比，该组中年龄较大的儿童和来自市中心的儿童所占比例更高。这与保险覆盖情况无关。在由初级保健提供者转诊的患者中，62%仍与该提供者保持联系，而从另一个医院项目转诊的患者中只有20%仍与该项目保持联系。在前往专科诊所就诊的儿童中，60%有其他感知到的健康需求。38%的家庭报告了他们从未与任何医疗提供者讨论过的健康问题。这项研究表明，经常前往专科诊所的儿童中，很大一部分将医院视为他们所有医疗护理的来源。卫生规划者和提供者在为慢性病儿童设计和管理项目时需要考虑到患者的这种认知。
