Mobility and social deprivation on primary care utilisation among paediatric patients with asthma.
Mobility and social deprivation on primary care utilisation among paediatric patients with asthma.
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DOI：
10.1136/fmch-2021-001085
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发表时间：
2021-07
影响因子：
6.1
通讯作者：
Heintzman J
中科院分区：
文献类型：
--
作者：
Lucas JA;Marino M;Giebultowicz S;Fankhauser K;Suglia SF;Bailey SR;Bazemore A;Heintzman J
哮喘护理受到邻里社会和环境因素的负面影响，并且移动与不良哮喘结果相关。然而，人们对进入和生活在高度贫困地区与初级保健使用之间的关系知之甚少。我们研究了哮喘儿童的邻里特征、流动性和初级保健利用率之间的关系，以探讨这些社会因素在初级保健环境中的相关性。在这项队列研究中，我们进行了负二项回归，以检查初级保健就诊率和每年流感疫苗接种率，并进行了logistic回归，以研究肺炎球菌疫苗接种率。所有模型均针对患者水平的协变量进行了调整。我们使用了来自15个OCHIN州的社区卫生中心的数据。该样本包括2012年至2017年期间不同程度社会剥夺的23773名3 - 17岁哮喘儿童。我们进行了负二项回归，以检查初级保健访问率和每年流感疫苗接种率，并进行逻辑回归，以研究肺炎球菌疫苗接种率。所有模型均针对患者水平的协变量进行了调整。生活在或迁往贫困程度较高地区的儿童的门诊就诊率高于生活在贫困程度较低地区的儿童（比率（RR）1.09，95%CI 1.02至1.17; RR 1.05，95%CI 1.00至1.11）。与那些搬家但留在低贫困社区的儿童相比，在同样高贫困水平的社区搬家的儿童流感疫苗接种的RR增加（RR 1.13，95% CI 1.03至1.23）。进入和生活在高度贫困的地区与更多的初级保健使用相关，并且可能有更多的机会减少不良哮喘结果。这些结果强调了在初级保健访问中关注患者移动的必要性，并增加以社区为目标的人口管理，以改善哮喘儿童的公平和护理。
Asthma care is negatively impacted by neighbourhood social and environmental factors, and moving is associated with undesirable asthma outcomes. However, little is known about how movement into and living in areas of high deprivation relate to primary care use. We examined associations between neighbourhood characteristics, mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting. In this cohort study, we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates. We used data from community health centres in 15 OCHIN states. The sample included 23 773 children with asthma aged 3–17 across neighbourhoods with different levels of social deprivation from 2012 to 2017. We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates. Clinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation (rate ratio (RR) 1.09, 95% CI 1.02 to 1.17; RR 1.05, 95% CI 1.00 to 1.11). Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination (RR 1.13, 95% CI 1.03 to 1.23) than those who moved but stayed in neighbourhoods of low deprivation. Movement into and living within areas of high deprivation is associated with more primary care use, and presumably greater opportunity to reduce undesirable asthma outcomes. These results highlight the need to attend to patient movement in primary care visits, and increase neighbourhood-targeted population management to improve equity and care for children with asthma.
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影响因子：
8
作者：
Beck, Andrew F.;Huang, Bin;Kahn, Robert S.
通讯作者：
Kahn, Robert S.
DOI：
10.1007/s11524-019-00356-2
发表时间：
2019-08-01
影响因子：
6.6
作者：
Cantu, P.;Kim, Y.;Cubbin, Catherine
通讯作者：
Cubbin, Catherine
DOI：
10.1016/j.ssmph.2017.03.002
发表时间：
2017-12
期刊：
SSM - population health
影响因子：
--
作者：
Martin G;Gavine A;Inchley J;Currie C
通讯作者：
Currie C
影响因子：
3
作者：
Huguet, Nathalie;Kaufmann, Jorge;Marino, Miguel
通讯作者：
Marino, Miguel
影响因子：
3.4
作者：
Butler, Danielle C.;Petterson, Stephen;Bazemore, Andrew W.
通讯作者：
Bazemore, Andrew W.