Mother-child interactions and the associations with child healthcare utilization in low-income urban families.
Mother-child interactions and the associations with child healthcare utilization in low-income urban families.
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低收入城市家庭母子互动及其与儿童保健利用的关系。
DOI：
10.1007/s10995-010-0719-z
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发表时间：
2012
影响因子：
2.3
通讯作者：
Temkin-Greener,Helena
中科院分区：
文献类型：
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作者：
Holland,MargaretL;Yoo,Byung-Kwang;Kitzman,Harriet;Chaudron,Linda;Szilagyi,PeterG;Temkin-Greener,Helena
研究表明，低收入家庭往往对急诊科(ED)和医院服务的利用率高得不成比例，而对预防性就诊的利用率低。一个可能的因素是，一些母亲可能没有对婴儿的健康需求做出最佳反应，要么是因为她们自己的反应能力，要么是因为孩子发出信号的能力。这些母子互动是可以衡量的，也是可以改变的。我们研究了低收入家庭中母子互动和儿童医疗保健利用之间的关系。我们分析了来自孟菲斯的护士-家庭伙伴关系试验的数据，田纳西州对照组(n=1432)。数据收集自儿童医疗记录(出生至24个月)、母亲访谈(产后12个月和24个月)和母子互动观察(产后12个月)。我们使用Logistic回归和有序Logistic回归来评估母婴互动和儿童医疗保健利用措施之间的独立关联：住院、急诊就诊、患病儿童初级保健就诊和健康儿童就诊。通过母亲对孩子的反应来衡量，更好的母婴互动与减少住院(OR：0.51；95%CI：0.32，0.81)、减少对门诊护理敏感的急诊(OR：0.65，95%CI：0.44，0.96)和增加健康儿童就诊(OR：1.55，95%CI：1.06，2.28)相关。母亲对孩子的反应与孩子的医疗保健利用有关。改善母婴互动的干预措施可能适合于儿童保健利用似乎不平衡、初级保健不足和紧急护理过剩的母婴二元组。认识到这些相互作用也可能改善临床医生为家庭提供的护理。
Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants’ health needs, either due to their own responsiveness or due to the child’s ability to send cues. These mother–child interactions are measurable and amenable to change. We examined the associations between mother–child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n= 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother–child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother–child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother–child interactions, as measured by mother’s responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother’s responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother–child interactions may be appropriate for mother–child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.