O'Malley A S, Forrest C B
University of Maryland Medical Center, Baltimore, USA.
J Community Health. 1996 Jun;21(3):159-73. doi: 10.1007/BF01557996.
This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17,110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiently improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.
本研究评估了社区卫生诊所（CHC）中儿童和青少年的连续性护理如何影响预防性护理的接受情况以及门诊护理的总体水平。这是对1988年《国家健康访谈调查儿童健康补充调查》的二次数据分析。在抽样人群的17110名儿童中，将CHC视为常规护理来源的1465名儿童构成了研究人群。场所连续性被定义为将CHC识别为常规护理和患病护理的来源，与临床医生的连续性被定义为为患病就诊识别特定的临床医生。在双变量分析中，与CHC的连续性以及与特定临床医生的连续性均与预防性护理和总体门诊护理水平的提高相关。在逻辑回归模型中，连续性护理与接受适龄预防性护理的几率增加近两倍相关。另外，保险状况是总体门诊护理接受情况的更好预测指标。我们得出结论，仅扩大经济准入不太可能充分改善低收入儿童获得社区卫生诊所服务的机会。可能需要额外强调在单一地点或与特定临床医生提供常规护理和患病护理服务，以实现更高水平的预防性护理和总体门诊护理。
