Riportella-Muller R, Selby-Harrington M L, Richardson L A, Donat P L, Luchok K J, Quade D
Department of Consumer Science, University of Wisconsin-Madison, Wisconsin 53706-1575, USA.
Public Health Rep. 1996 Jan-Feb;111(1):71-7.
This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid's Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.
本文介绍了针对那些被列为外展工作目标的父母进行访谈的结果，这些外展工作旨在鼓励他们使用医疗补助计划中的早期定期筛查、诊断与治疗（EPSDT）项目。EPSDT项目始于20世纪70年代，承诺确保贫困儿童能够获得全面的预防性保健服务。然而，在美国只有三分之一符合条件的儿童接受了EPSDT检查，该项目尚未兑现其承诺。本研究旨在通过访谈来了解父母对于使用EPSDT的障碍的看法，访谈对象包括：（a）110名在接触外展工作后未为其子女安排EPSDT检查的父母，以及（b）30名已为子女安排检查的父母。尽管EPSDT项目旨在免费提供医疗保健服务，并在预约安排和交通方面提供帮助，但这些低收入父母指出了获得医疗服务的重大障碍。不使用EPSDT服务的原因包括：（a）家庭或个人事务及优先事项相互冲突；（b）医疗保健系统中存在的感知到的或实际的障碍；（c）与外展工作直接相关的问题。成功克服这些障碍并获得EPSDT服务的父母还遇到了其他障碍，例如，预约和交通困难、候诊时间长，或者他们认为医疗服务对其医疗需求无反应或缺乏人际尊重。本文还讨论了对未来外展工作以及改善预防性医疗保健服务可及性的启示。
