Disparities in pediatric psychosocial oncology utilization.
Disparities in pediatric psychosocial oncology utilization.
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DOI：
10.1002/pbc.29342
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发表时间：
2021-11
影响因子：
3.2
通讯作者：
Bona K
中科院分区：
文献类型：
--
作者：
Zheng DJ;Umaretiya PJ;Schwartz ER;Al-Sayegh H;Raphael JL;van Litsenburg RRL;Ma C;Muriel AC;Bona K
综合行为健康模型已被提议作为护理提供方法，以减轻初级保健机构中的心理健康差异。然而，这些模型尚未在儿科肿瘤医疗机构中广泛采用或评估。我们对 2013 年 4 月至 2017 年 1 月在丹娜法伯/波士顿儿童癌症和血液疾病中心 (DF/BCH) 的 394 名新诊断癌症的儿童进行了一项回顾性队列研究。从病历中提取了诊断后 12 个月的基线社会人口学特征和精神病学利用结果。家庭物质困难（HMH）的严重程度，即具体的贫困暴露，在诊断和种族/族裔中通过家长报告使用心理社会评估工具2.0（PAT）进行表征。使用多变量逻辑回归模型评估社会人口特征与接受精神病学咨询之间的关联。在 394 名儿童中，29% 在诊断后 12 个月内接受了精神病咨询。其中，88% 的人收到了新的精神科诊断，76% 的人收到了精神药理学建议，62% 的人收到了新的行为干预建议。在调整年龄、癌症诊断和 PAT 总分的多变量逻辑回归中，HMH 严重程度或家庭收入与精神病学利用率之间不存在统计学显着关联。被认定为少数种族/族裔的儿童接受精神病学咨询的可能性明显较低（OR=0.48，95% CI：0.27-0.84）。在具有综合行为健康模型的儿科肿瘤医疗之家中，社会经济地位与不同的精神病学利用无关。然而，精神病学利用方面仍然存在深刻的种族/民族差异，突出表明需要进行额外的研究和护理提供干预。
Integrated behavioral health models have been proposed as care delivery approaches to mitigate mental health disparities in primary care settings. However, these models have not yet been widely adopted or evaluated in pediatric oncology medical homes. We conducted a retrospective cohort study of 394 children with newly diagnosed cancer at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center (DF/BCH) from April 2013 to January 2017. Baseline sociodemographic characteristics and psychiatry utilization outcomes at 12-months following diagnosis were abstracted from the medical record. The severity of household material hardship (HMH), a concrete poverty exposure, at diagnosis and race/ethnicity were characterized by parent-report using the Psychosocial Assessment Tool 2.0 (PAT). Associations between sociodemographic characteristics and receipt of psychiatry consultation were assessed with multivariable logistic regression models. Among 394 children, 29% received a psychiatric consultation within 12-months post-diagnosis. Of these, 88% received a new psychiatric diagnosis, 76% received a psychopharmacologic recommendation, and 62% received a new behavioral intervention recommendation. In multivariable logistic regression adjusting for age, cancer diagnosis, and PAT total score, there was no statistically significant association between HMH severity or household income and psychiatry utilization. Children who identified as racial/ethnic minorities were significantly less likely to receive a psychiatry consultation (OR=0.48, 95% CI: 0.27-0.84). In a pediatric oncology medical home with an integrated behavioral health model, socioeconomic status was not associated with disparate psychiatry utilization. However, there remained a profound racial/ethnic disparity in psychiatry utilization highlighting the need for additional research and care delivery intervention.
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影响因子：
3.2
作者：
Scialla MA;Canter KS;Chen FF;Kolb EA;Sandler E;Wiener L;Kazak AE
通讯作者：
Kazak AE
影响因子：
3.2
作者：
Zheng DJ;Shyr D;Ma C;Muriel AC;Wolfe J;Bona K
通讯作者：
Bona K
影响因子：
3.2
作者：
Muriel, Anna C.;Burgers, Darcy E.;Samsel, Chase
通讯作者：
Samsel, Chase
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
影响因子：
8
作者：
Shonkoff, Jack P.;Garner, Andrew S.
通讯作者：
Garner, Andrew S.