Misconceptions about colds and predictors of health service utilization
Misconceptions about colds and predictors of health service utilization
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DOI：
10.1542/peds.111.2.231
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发表时间：
2003-02-01
期刊：
影响因子：
8
通讯作者：
Goldmann, DA
中科院分区：
文献类型：
--
作者：
Lee, GM;Friedman, JF;Goldmann, DA
Objective. 1998年，儿童和成人因感冒急诊160万次，门诊2500万次。虽然大多数感冒是由病毒引起的，不需要医疗干预，但许多家庭寻求医疗保健来治疗感冒。父母对感冒的原因和适当治疗的误解可能会导致不必要的医疗服务使用。本研究的目的是确定有幼儿的家庭中使用艾德和门诊护理治疗感冒的预测因素。这项研究是一项观察性、前瞻性队列研究，旨在确定至少有1名6个月至5岁儿童并参加家庭外儿童护理的家庭中呼吸道疾病的发病率。从马萨诸塞州的5个儿科诊所中随机选择家庭，当孩子与至少5名其他孩子一起参加每周大于或等于10小时的儿童保育时，家庭被认为是合格的。登记的家庭被要求完成一项调查，评估有关感冒，抗生素适应症和卫生服务利用频率的知识。采用多因素Logistic回归模型对自我报告的医疗服务使用情况的预测因素进行评估。在参加研究的261个家庭中，有197个家庭（75%）返回了完成的调查。虽然93%的父母了解病毒导致感冒，但66%的父母也认为感冒是由细菌引起的。53%的人认为需要抗生素来治疗感冒。父母报告说，当他们的孩子感冒时，他们会去艾德（23%）或医生办公室（60%）。多变量分析中预测艾德使用的因素包括医疗补助保险（优势比[OR]：17.6 [2.2-139.3]）、喘息史（OR：18.3 [4.4-75.8]）和认为抗生素治疗感冒（OR：4.2 [1.4-12.9]）。使用门诊护理的预测因素包括父母年龄小于30岁（OR：10.0 [1.6-64.3]）、喘息史（OR：5.6 [1.1-29.7]）和认为抗生素治疗感冒（OR：3.8 [1.7-8.5]）。对适当治疗感冒的误解预示着卫生服务利用率的增加。对家庭进行有针对性的教育干预可以减少不适当的求医行为和不必要的感冒医疗服务利用。
Objective. Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds. Parental misconceptions about the cause and appropriate treatment of colds may contribute to unnecessary health service utilization. The objective of this study was to determine predictors of reported ED use and ambulatory care use for colds among families with young children.Methods. This study was an observational, prospective cohort study to determine attack rates for respiratory illnesses within families that have at least 1 child who is 6 months to 5 years of age and enrolled in out-of-home child care. Families were randomly selected from 5 pediatric practices in Massachusetts and were considered eligible when the child was enrolled in child care with at least 5 other children for greater than or equal to 10 hours per week. Enrolled families were asked to complete a survey that assessed knowledge about colds, antibiotic indications, and frequency of health service utilization. Predictors of self-reported use of health care services were assessed in multivariate logistic regression models.Results. Of the 261 families enrolled in the study, 197 families (75%) returned completed surveys. Although 93% of parents understood that viruses caused colds, 66% of parents also believed that colds were caused by bacteria. Fifty-three percent believed that antibiotics were needed to treat colds. Parents reported that they would visit the ED (23%) or their doctor's office (60%) when their child had a cold. Predictors of ED use on multivariate analysis included Medicaid insurance (odds ratio [OR]: 17.6 [2.2-139.3]), history of wheezing (OR: 18.3 [4.4-75.8]), and belief that antibiotics treat colds (OR: 4.2 [1.4-12.9]). Predictors of ambulatory care use included parent younger than 30 years (OR: 10.0 [1.6-64.3]), history of wheezing (OR: 5.6 [1.1-29.7]), and belief that antibiotics treat colds (OR: 3.8 [1.7-8.5]).Conclusions. Misconceptions about the appropriate treatment of colds are predictive of increased health service utilization. Targeted educational interventions for families may reduce inappropriate antibiotic-seeking behavior and unnecessary health service utilization for colds.