Disparities in pediatric preventive care in the United States, 1993-2002
Disparities in pediatric preventive care in the United States, 1993-2002
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DOI：
10.1001/archpedi.161.1.30
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Steiner, John F.
中科院分区：
文献类型：
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作者：
Hambidge, Simon J.;Emsermann, Caroline Bublitz;Steiner, John F.
目标：量化健康儿童就诊 (WCV) 期间医生报告的预防性咨询和筛查，并检查这些活动中的种族和民族差异。设计：使用 1993 年 1 月至 2002 年 12 月全国流动医疗调查进行的横断面研究。背景：基于办公室的医生实践。参与者：由医生就诊进行 WCV 的从出生到 18 岁的儿童。主要成果指标：预防性咨询和筛查。结果：拉丁裔儿童的健康儿童就诊时间短于白人或黑人儿童。在 WCV 中，白人儿童比黑人或拉丁裔儿童更有可能接受预防性咨询（分别为 72% vs 61% vs 61%；P=0.01），但接受血压升高、贫血、视力和听力敏锐度或铅中毒筛查的可能性并不高。对于白人、黑人或拉丁裔儿童，在 WCV 进行的二次诊断没有差异（分别为 15%、17% 和 14%；P=.65）。接受最少咨询的儿童是公共部门非健康维护组织环境中的拉丁裔儿童（占就诊次数的 39%）和自费就诊的拉丁裔儿童（占就诊次数的 26%）。在调整了可能的混杂因素（包括就诊时开出的药物）后，黑人和拉丁裔儿童比白人儿童接受咨询的可能性较小（比值比为 0.68 和 0.63；95% 置信区间分别为 0.48-0.97 和 0.44-0.90），黑人儿童接受预防性筛查服务的可能性也较小（比值比为 0.65；95% 置信区间， 0.45-0.93）。结论：根据全国代表性样本的医生报告，黑人和拉丁裔儿童在 WCV 接受的咨询少于白人儿童。这些差异无法用其他二次诊断或处方或分发药物的竞争需求来解释。
Objectives: To quantify physician-reported preventive counseling and screening during well-child visits (WCVs) and to examine racial and ethnic disparities in these activities.Design: Cross-sectional study using the National Ambulatory Medical Care Survey, January 1993 through December 2002. Setting: Office-based physician practices.Participants: Children from birth to 18 years old who were seen by a physician for a WCV. Main Outcome Measure: Preventive counseling and screening.Results: Well-child visits were shorter for Latino children than for white or black children. At WCVs, white children were more likely to receive preventive counseling than were black or Latino children (72% vs 61% vs 61%, respectively; P=.01) but not more likely to receive screening for elevated blood pressure, anemia, vision and hearing acuity, or lead toxicity. There were no differences in secondary diagnoses made at WCVs for white, black, or Latino children (15% vs 17% vs 14%, respectively; P=.65). The children who received the least counseling were Latino children in the public sector non health maintenance organization setting (counseled at 39% of visits) and Latino children who self-paid for the visits ( counseled at 26% of visits). After adjusting for possible confounders, including medications prescribed at the visit, black and Latino children were less likely to receive counseling than were white children ( odds ratios, 0.68 and 0.63; 95% confidence interval, 0.48-0.97 and 0.44-0.90, respectively), and black children were less likely to receive preventive screening services ( odds ratios, 0.65; 95% confidence interval, 0.45-0.93).Conclusions: By physician report in a nationally representative sample, black and Latino children received less counseling at WCVs than did white children. These disparities were unexplained by the competing demands of other secondary diagnoses or medications prescribed or dispensed.