Shared Decision-Making in Pediatrics: A National Perspective
Shared Decision-Making in Pediatrics: A National Perspective
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DOI：
10.1542/peds.2010-0526
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发表时间：
2010-08-01
期刊：
影响因子：
8
通讯作者：
Guevara, James P.
中科院分区：
文献类型：
--
作者：
Fiks, Alexander G.;Localio, A. Russell;Guevara, James P.
目的：确定具有全国代表性的美国注意力缺陷/多动障碍 (ADHD) 或哮喘儿童样本中的共同决策 (SDM) 模式，并确定人口统计、健康状况或获得护理的机会是否与 SDM 相关。 患者和方法：我们对 2002-2006 年医疗支出小组调查进行了一项横断面研究，该调查代表了 200 万患有 ADHD 的儿童和 400 万患有 ADHD 的儿童。哮喘。结果是高 SDM，是通过使用基于涉及 SDM 方面的 7 个医疗支出小组调查项目的潜在类别模型来定义的。我们将可能与 SDM 相关的因素输入到逻辑回归模型中，并以高 SDM 作为结果。然后边际标准化描述了每个因素中具有高 SDM 的儿童家庭的标准化比例。结果：对于 ADHD 和哮喘，65% 的儿童家庭具有高 SDM。调整其他因素后，那些自称孩子总体健康状况不佳的人，患有 ADHD 的高 SDM 的可能性要低 13%（64% vs 77%），患哮喘的可能性要低 8%（62% vs 70%）。行为障碍的结果相似。受访者的人口统计特征与 SDM 无关。那些通过电话联系临床医生有困难的人，与没有困难的人相比，患高 SDM 的可能性分别为 26%（多动症：55 比 81%）和 29%（哮喘：48 比 77%）。结论：这些发现表明，报告有更严重障碍或通过电话联系临床医生有困难的儿童家庭完全参与 SDM 的可能性较小。未来的研究应该探讨促进家庭和临床医生之间持续沟通的策略如何影响 SDM。儿科 2010；126：306-314
OBJECTIVES: To identify patterns of shared decision-making (SDM) among a nationally representative sample of US children with attention-deficit/hyperactivity disorder (ADHD) or asthma and determine if demographics, health status, or access to care are associated with SDM.PATIENTS AND METHODS: We performed a cross-sectional study of the 2002-2006 Medical Expenditure Panel Survey, which represents 2 million children with ADHD and 4 million children with asthma. The outcome, high SDM, was defined by using latent class models based on 7 Medical Expenditure Panel Survey items addressing aspects of SDM. We entered factors potentially associated with SDM into logistic regression models with high SDM as the outcome. Marginal standardization then described the standardized proportion of children's households with high SDM for each factor.RESULTS: For both ADHD and asthma, 65% of children's households had high SDM. Those who reported poor general health for their children were 13% less likely to have high SDM for ADHD (64 vs 77%) and 8% less likely for asthma (62 vs 70%) when adjusting for other factors. Results for behavioral impairment were similar. Respondent demographic characteristics were not associated with SDM. Those with difficulty contacting their clinician by telephone were 26% (ADHD: 55 vs 81%) and 29% (asthma: 48 vs 77%) less likely to have high SDM than those without difficulty.CONCLUSIONS: These findings indicate that households of children who report greater impairment or difficulty contacting their clinician by telephone are less likely to fully participate in SDM. Future research should examine how strategies to foster ongoing communication between families and clinicians affect SDM. Pediatrics 2010;126:306-314