Carraccio C L, Dettmer K S, duPont M L, Sacchetti A D
Department of Pediatrics, University of Maryland, Baltimore, Maryland 21201, USA.
Pediatrics. 1998 Aug;102(2 Pt 1):367-70. doi: 10.1542/peds.102.2.367.
Advances in medical care have led to a growing population of special needs children who are at risk for suboptimal care when they present to a physician with no previous knowledge of their medical history. This risk may be amplified in the emergency department setting when time-sensitive interventions must be initiated without immediate access to consultants or past records. Our purpose in this study was to evaluate caretakers' knowledge of their children's chronic medical problems and their ability to relate this knowledge to unfamiliar health care providers.
Caretaker/child pairs presenting for specialty visits were surveyed. Questions focused on knowledge of the child's illness, medicine regime, and how to contact the specialist. Chart review confirmed responses of caretakers and provided sociodemographic information. Descriptive statistics and chi2 were used in data analysis.
Of the 49 caretakers interviewed, 85% were parents, 53% were African-American, and 43% were Caucasian. One-half of the group received medical assistance. The mean age of the children was 55 months. Responses showed that 53% of caretakers were unable to provide their children's specific diagnoses. Of these, one half could provide a lay diagnosis whereas the remaining one half could only identify the organ system involved or that there was a problem. For children on medications, 29% of caretakers could not provide an accurate list. Name of the subspecialist and phone number of the subspecialty clinic was unknown by 25% of caretakers. No child wore medical identification jewelry.
Caretakers are not always able to accurately relay vital information on their child's essential medical needs, a problem that may be compounded in emergency situations. The use of some form of independent identification and information set is needed to assure proper treatment of children with special health care needs encountering an unfamiliar health care provider.
医疗护理的进步导致特殊需求儿童的数量不断增加，这些儿童在就医时若医生对其病史一无所知，就有接受不充分护理的风险。当在急诊科必须立即启动对时间敏感的干预措施，却无法立即联系到会诊医生或获取过往病历记录时，这种风险可能会加剧。我们开展这项研究的目的是评估看护人对其孩子慢性疾病的了解程度，以及他们向不熟悉的医疗服务提供者传达这些信息的能力。
对前来进行专科就诊的看护人/儿童组合进行了调查。问题集中在对孩子病情、用药方案以及如何联系专科医生的了解上。查阅病历证实了看护人的回答，并提供了社会人口统计学信息。数据分析采用描述性统计和卡方检验。
在接受访谈的49名看护人中，85%是父母，53%是非裔美国人，43%是白种人。该群体中有一半获得了医疗救助。孩子的平均年龄为55个月。调查结果显示，53%的看护人无法说出孩子的具体诊断。其中，一半能够给出一个大概的诊断，而另一半只能指出涉及的器官系统或存在问题。对于正在服药的孩子，29%的看护人无法提供准确的用药清单。25%的看护人不知道专科医生的姓名和专科门诊的电话号码。没有孩子佩戴医疗识别首饰。
看护人并不总是能够准确传达孩子基本医疗需求的关键信息，在紧急情况下这个问题可能会更加严重。需要使用某种形式的独立识别和信息集，以确保有特殊医疗需求的儿童在遇到不熟悉的医疗服务提供者时能得到妥善治疗。
