predictors of well child care adherence over time in a cohort of urban medicaid-eligible infants预测的儿童保健依从性随着时间的推移,在一群城市medicaid-eligible婴儿.pdfVIP

Van Berckelaer et al. BMC Pediatrics 2011, 11:36 /1471-2431/11/36 RESEARCH ARTICLE Open Access Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants Anje C Van Berckelaer1,2*, Nandita Mitra3 and Susmita Pati2,3,4 Abstract Background: Changes in well child care (WCC) adherence over time have not previously been examined. Our objective is to describe adherence rates to WCC over time in a low-income urban population of infants 0-24 months of age, and to identify predictors of WCC adherence in this population. Methods: This is a secondary analysis of a cohort of Medicaid-eligible children followed from birth to 2 years between 2005 and 2008 with structured telephone surveys to assess maternal well-being, social support, and household and demographic information. For the 260 children attending 4 urban pediatric practices, WCC adherence was assessed based on visit data abstracted from electronic medical records. A random-intercept mixed effects logit model clustered on subject was used. Results: 92% of the mothers were African-American, 27% had not finished high school, 87% were single, and 43% earned $500/month; mean age was 23. WCC adherence decreased from 88% at 6 months to 47% (12 mo), 44% (18 mo), and 67% (24 mo). The difference across time periods was statistically significant (p 0.001). Married (OR 1.71, p = 0.02) and primiparous (OR 1.89, p 0.001) mothers had significantly greater odds of adherence, along with women who reported having been adherent to prenatal care visits (OR 1.49, p = 0.03) and those with the lowest household income (OR 1.40, p = 0.03). Conclusions: Maternal education efforts should emphasize the importance of establishing WCC, especially for mothers of more than one child. Further studies using larger, more broadly defined populations are nee