Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT
Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT
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DOI：
10.1542/peds.2014-2888
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发表时间：
2015-02-01
期刊：
影响因子：
8
通讯作者：
Freeman, Elmer
中科院分区：
文献类型：
--
作者：
Garg, Arvin;Toy, Sarah;Freeman, Elmer
目的：评价以诊所为基础的筛查和转介系统(良好儿童护理、评估、社区资源、宣传、转诊、教育[WE CARE])对家庭接受未得到满足的基本需求的社区资源的影响。方法：在8个城市社区卫生中心进行整群随机对照试验，招募健康婴儿的母亲。在4家WE CARE诊所，母亲们完成了一份自我报告筛查工具，评估了儿童保育、教育、就业、食品安全、家庭供暖和住房方面的需求。提供者为家庭提供转介；工作人员提供必要的申请，并在1个月内打电话给转介的母亲。4个控制社区卫生中心的家庭得到了通常的护理。我们用广义混合效应模型对结果进行了分析。结果：336名母亲参加了研究，每只手臂168名。大多数家庭的家庭收入相当于2个未得到满足的基本需要。更多我们关心的母亲在指数访问中得到>；=1个转介(70%比8%；调整后的优势比[AOR]=29.6；95%的可信区间[CI]，14.7-59.6)。在12个月的访问中，更多的我们关心母亲登记了新的社区资源(39%比24%；AOR=2.1；95%CI，1.2-3.7)。我们关心的母亲有更大的就业机会(AOR=44.495%CI，9.8-201.4)。我们关心的孩子在托儿所的几率更大(AOR=6.3；95%CI，1.5-26.0)。我们关心的家庭接受燃料援助的几率更高(AOR=11.9；95%CI，1.7-82.9)，而住在无家可归者收容所的几率更低(AOR=0.2；95%CI，0.1-0.9)。结论：在良好的托儿期间，系统地筛选和参考社会决定因素，可以为家庭获得更多的社区资源。
OBJECTIVE: To evaluate the effect of a clinic-based screening and referral system (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education [WE CARE]) on families' receipt of community-based resources for unmet basic needs.METHODS: We conducted a cluster randomized controlled trial at 8 urban community health centers, recruiting mothers of healthy infants. In the 4 WE CARE clinics, mothers completed a self-report screening instrument that assessed needs for child care, education, employment, food security, household heat, and housing. Providers made referrals for families; staff provided requisite applications and telephoned referred mothers within 1 month. Families at the 4 control community health centers received the usual care. We analyzed the results with generalized mixed-effect models.RESULTS: Three hundred thirty-six mothers were enrolled in the study (168 per arm). The majority of families had household incomes = 2 unmet basic needs. More WE CARE mothers received >= 1 referral at the index visit (70% vs 8%; adjusted odds ratio [aOR] = 29.6; 95% confidence interval [CI], 14.7-59.6). At the 12-month visit, more WE CARE mothers had enrolled in a new community resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7). WE CARE mothers had greater odds of being employed (aOR = 44.4; 95% CI, 9.8-201.4). WE CARE children had greater odds of being in child care (aOR = 6.3; 95% CI, 1.5-26.0). WE CARE families had greater odds of receiving fuel assistance (aOR = 11.9; 95% CI, 1.7-82.9) and lower odds of being in a homeless shelter (aOR = 0.2; 95% CI, 0.1-0.9).CONCLUSIONS: Systematically screening and referring for social determinants during well child care can lead to the receipt of more community resources for families.