Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants 英文参考文献.docVIP

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Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants 英文参考文献.doc

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Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants 英文参考文献

VanBerckelaeretal.BMCPediatrics2011,11:36 /1471-2431/11/36 RESEARCH ARTICLE OpenAccess Predictorsofwellchildcareadherenceovertime inacohortofurbanMedicaid-eligibleinfants AnjeCVanBerckelaer1,2*,NanditaMitra3andSusmitaPati2,3,4 Abstract Background:Changesinwellchildcare(WCC)adherenceovertimehavenotpreviouslybeenexamined.Our objectiveistodescribeadherenceratestoWCCovertimeinalow-incomeurbanpopulationofinfants0-24 monthsofage,andtoidentifypredictorsofWCCadherenceinthispopulation. Methods:ThisisasecondaryanalysisofacohortofMedicaid-eligiblechildrenfollowedfrombirthto2years between2005and2008withstructuredtelephonesurveystoassessmaternalwell-being,socialsupport,and householdanddemographicinformation.Forthe260childrenattending4urbanpediatricpractices,WCC adherencewasassessedbasedonvisitdataabstractedfromelectronicmedicalrecords.Arandom-interceptmixed effectslogitmodelclusteredonsubjectwasused. Results:92%ofthemotherswereAfrican-American,27%hadnotfinishedhighschool,87%weresingle,and43% earned$500/month;meanagewas23.WCCadherencedecreasedfrom88%at6monthsto47%(12mo),44% (18mo),and67%(24mo).Thedifferenceacrosstimeperiodswasstatisticallysignificant(p0.001).Married(OR 1.71,p=0.02)andprimiparous(OR1.89,p0.001)mothershadsignificantlygreateroddsofadherence,along withwomenwhoreportedhavingbeenadherenttoprenatalcarevisits(OR1.49,p=0.03)andthosewiththe lowesthouseholdincome(OR1.40,p=0.03). Conclusions:MaternaleducationeffortsshouldemphasizetheimportanceofestablishingWCC,especiallyfor mothersofmorethanonechild.Furtherstudiesusinglarger,morebroadlydefinedpopulationsareneededto confirmourfindingsthateffortstoincreaseWCCadherenceshouldbeintensifiedafter6monthsofage, particularlyforchildrenathigherrisk. Background standards,whichhaveformedpartoftherequiredMed- Almost30millionchildrenwerecoveredbyMedicaidin icaid benefit since 1966, are a cornerstone of pediatric 2008[1].Though20%ofthesechildrenareatsignificant care,mandatingtheprovisionofscreeningandpreven- risk for developm