Milgrom P, Mancl L, King B, Weinstein P, Wells N, Jeffcott E
Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA.
Med Care. 1998 Apr;36(4):554-66. doi: 10.1097/00005650-199804000-00011.
Factors related to the utilization of dental care by 5- to 11-year-old children from low-income households were investigated using a comprehensive multivariate model that assessed the contribution of structure, history, cognition, and expectations. The influence of dentist-patient interactions, psychosocial and health beliefs, particularly fear of the dentist, on utilization were investigated.
Children were chosen randomly from public schools, and 895 mothers were surveyed and their children were interviewed in the home. Utilization was studied during the 1991-1992 school year, including a 6-month follow-up period after the interview.
The overall utilization rate was 63.2%, and the rate for nonemergent (preventive) visits was 59.9%. Utilization was unrelated to actual oral health status. Race and years the guardian lived in the United States were predictive of an episode of care. Preventive medical visits and perceived need were strong predictors of a visit to the dentist, as were beliefs in the efficacy of dental care. Mothers who were satisfied with their own care and oral health and whose children were covered by insurance were more likely to utilize children's dental care. In contrast, child dental fear and absences from school for family problems were associated with lower rates of utilization.
Mutable factors that govern the use of care in this population were identified. These findings have implications for the design of dental care delivery systems for children and their families.
使用一个综合多变量模型来调查与低收入家庭5至11岁儿童牙科护理利用相关的因素，该模型评估了结构、病史、认知和期望的作用。研究了医患互动、心理社会和健康观念，尤其是对牙医的恐惧对利用率的影响。
从公立学校随机挑选儿童，对895名母亲进行了调查，并在其家中对她们的孩子进行了访谈。在整个1991 - 1992学年研究了利用率，包括访谈后的6个月随访期。
总体利用率为63.2%，非紧急（预防性）就诊率为59.9%。利用率与实际口腔健康状况无关。种族以及监护人在美国居住的年限可预测就诊情况。预防性医疗就诊和感知到的需求是看牙医的有力预测因素，对牙科护理疗效的信念也是如此。对自己的护理和口腔健康感到满意且孩子有保险的母亲更有可能利用儿童牙科护理。相比之下，儿童对牙医的恐惧以及因家庭问题缺课与较低的利用率相关。
确定了影响该人群护理使用的可变因素。这些发现对儿童及其家庭牙科护理提供系统的设计具有启示意义。
