Perceived Parent Financial Burden and Asthma Outcomes in Low-Income, Urban Children
Perceived Parent Financial Burden and Asthma Outcomes in Low-Income, Urban Children
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DOI：
10.1007/s11524-012-9774-7
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发表时间：
2013-04-01
影响因子：
6.6
通讯作者：
Clark, Noreen M.
中科院分区：
文献类型：
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作者：
Patel, Minal R.;Brown, Randall W.;Clark, Noreen M.
本研究的目的是描述低收入父母的人口统计学特征，这些父母认为管理孩子的哮喘有经济负担，以及与孩子的哮喘结局和临床特征的相关性。我们假设：（1）报告负担和不报告负担的父母之间存在可识别的差异;（2）无论获得护理的机会如何，如果父母认为在为孩子的病情获得护理方面存在经济负担，那么哮喘的结果会更糟。本研究分析了一项随机试验的基线数据，该试验评估了以学校为基础的哮喘干预措施的效果。835名家长通过电话采访了他们的孩子的哮喘管理。人口统计学和临床因素与经济负担感知之间的关联采用双变量分析进行了研究。多变量回归分析用于检查经济负担和哮喘结果之间的关系，包括急诊室就诊，住院和缺课。10%（n = 79）的父母明显感到经济负担。女性户主（chi（2）（3）= 7.41; p < 0.05）、最低收入水平（chi（2）（3）= 12.14; p < 0.01）和儿童哮喘控制不佳（chi（2）（2）= 49.42; p < 0.001）最有可能感受到经济负担。在控制了哮喘控制水平、收入和哮喘护理的常规来源的模型中，认为经济负担的父母更有可能让孩子至少去一次急诊室（OR = 1.95; 95% CI = 1.15 - 3.29），住院治疗（OR = 3.99; 95% CI = 2.03 ~ 7.82），或前一年因哮喘缺课（OR = 3.26; 95% CI = 1.60 ~ 6.67）。我们的研究结果支持了我们的假设。在哮喘儿童的低收入父母中，大多数人不认为获得护理的经济负担。然而，在那些确实感受到负担的父母中，无论家庭收入如何，无论是否有哮喘护理的常规来源，因哮喘而导致的紧急护理使用和缺课都显着更高。母亲和祖母户主家庭和那些照顾儿童与控制哮喘最有可能报告负担。这些发现对临床实践有一定的意义，因为医疗保健提供者可以采取简单的行动来确定患者的财务相关观念，纠正误解，并帮助患者考虑他们的全方位选择来管理孩子的哮喘。
The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child's asthma and related associations with their children's asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child's condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. Eight hundred thirty-five parents were interviewed by telephone regarding their child's asthma management. Associations between demographic and clinical factors and perception of financial burden were examined using bivariate analysis. Multivariate regression analyses were used to examine associations between perceptions of financial burden and asthma outcomes, including emergency department visits, hospitalizations, and missed school days. Perceived financial burden was evident in 10 % (n = 79) of parents. Female heads of household (chi (2) (3) = 7.41; p < 0.05), those at the lowest income levels (chi (2) (3) = 12.14; p < 0.01), and those whose child's asthma was poorly controlled (chi (2) (2) = 49.42; p < 0.001) were most likely to perceive financial burden. In models controlling for level of asthma control, income, and having a usual source of asthma care, parents who perceived financial burden were more likely to have children who had at least one emergency department visit (OR = 1.95; 95 % CI = 1.15 to 3.29), hospitalization (OR = 3.99; 95 % CI = 2.03 to 7.82), or missed school days due to asthma (OR = 3.26; 95 % CI = 1.60 to 6.67) in the previous year. Our results supported our hypotheses. Among low-income parents of children with asthma, the majority do not perceive financial burden to obtaining care. However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a usual source of asthma care. Mothers and grandmothers heading families and those caring for children with uncontrolled asthma were most likely to report burden. These findings have implications for clinical practice in that health care providers may be able to take simple actions to determine patients' financial-related perceptions, correct misconceptions, and help patients consider their full range of options to manage their child's asthma.