Nonfinancial Barriers to Care for Children and Youth

Halfon, Neal; Inkelas, Moira; Wood, David L.

doi:10.1146/annurev.pu.16.050195.002311

Cited by 65 publications

(34 citation statements)

References 51 publications

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“…14,15 This study adds to the growing literature that demonstrates that there are more than just financial barriers to access to primary care that need to be evaluated. [16][17][18] …”

Section: Discussionmentioning

confidence: 99%

Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in Children

Ludwick

Warden

et al. 2009

Academic Emergency Medicine

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Objectives: Patients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital.Methods: This historical cohort study included 26,038 children age 18 and under, assigned to 332 primary care practices affiliated with a Medicaid health maintenance organization (HMO). Predictor variables were distance from the child's home to his or her PCP site, distance from home to the nearest ED, and distance from home to the nearest children's hospital. The outcome variable was each child's ED use. A negative binomial model was used to determine the association between distance variables and ED use, adjusted for age, sex, and race, plus medical and primary care site characteristics previously found to influence ED use. Distance variables were divided into quartiles to test for nonlinear associations.Results: On average, children made 0.31 ED visits ⁄ person ⁄ year. In the multivariable model, children living greater than 1.19 miles from the nearest ED had 11% lower ED use than those living within 0.5 miles of the nearest ED (risk ratio [RR] = 0.89, 95% CI = 0.81 to 0.99). Children living between 1.54 and 3.13 miles from their PCPs had 13% greater ED use (RR = 1.13, 95% CI = 1.03 to 1.24) than those who lived within 0.7 miles of their PCP.Conclusions: Geographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care.ACADEMIC EMERGENCY MEDICINE 2009; 16:411-417 ª

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“…14,15 This study adds to the growing literature that demonstrates that there are more than just financial barriers to access to primary care that need to be evaluated. [16][17][18] …”

Section: Discussionmentioning

confidence: 99%

Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in Children

Ludwick

Warden

et al. 2009

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…[1][2][3][4][5][6][7][8] We examined disparities in primary care among those with concordant relationships and then among discordant groups. If race/ethnicity concordance would reduce disparities in primary care, we hypothesized that the size of disparities between minority groups and whites would be smaller in concordant relationships than for those in discordant groups.…”

Section: Discussionmentioning

confidence: 99%

“…A lthough racial and ethnic disparities in children' s primary care experiences have been documented in the literature, [1][2][3][4][5][6][7][8] differences in socioeconomic status, insurance coverage, and language contribute to, but do not completely explain, these disparities in health care. A recent report by the Institute of Medicine describing racial gaps in the delivery of health care suggests that, in addition to these factors, components of the patient-provider relationship might also be contributing factors.…”

Section: Introductionmentioning

confidence: 99%

Patient-Provider Racial and Ethnic Concordance and Parent Reports of the Primary Care Experiences of Children

Stevens¹

2003

The Annals of Family Medicine

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PURPOSE Studies among adults suggest that patient-provider racial concordance is associated with higher satisfaction and partnership with physicians. It remains unknown whether similar findings are true for children. This study examines the association of race/ethnicity concordance with parent reports of children's primary care experiences. METHODSWe completed telephone interviews with a random, cross-sectional sample of 413 parents of elementary school children, aged 5 to 12 years, enrolled in a single large school district serving 3 cities in San Bernardino, Calif. Parents reported on their children's primary care experiences, and the responses were compared between children in race concordant and discordant patientprovider relationships. RESULTSWe assessed parent reports of 6 structure and process features of primary care: first-contact care (accessibility, utilization), longitudinality (strength of affiliation, interpersonal relationship), and comprehensiveness (services offered, received). Before and after controlling for demographics, socioeconomic status, and health system factors, race/ethnicity concordance was not associated with children's primary care experiences. Minority parents generally reported poorer experiences than whites in several domains of primary care, but the only significant effect of race/ethnicity concordance was slightly better primary care utilization for whites in concordant relationships, which did not hold after adjustment. CONCLUSIONIn contrast with studies among adults, patient-provider race/ethnicity concordance was not associated with parent reports of primary care experiences in our sample of children. It is possible that provider biases or patient expectations that contribute to disparities in care for adults are attenuated in relationships involving children. INTRODUCTIONA lthough racial and ethnic disparities in children' s primary care experiences have been documented in the literature, 1-8 differences in socioeconomic status, insurance coverage, and language contribute to, but do not completely explain, these disparities in health care. A recent report by the Institute of Medicine describing racial gaps in the delivery of health care suggests that, in addition to these factors, components of the patient-provider relationship might also be contributing factors. Patient-provider relationship factors, such as interpersonal communication, trust, and mutual understanding of cultural differences in health needs and expectations might, in fact, be affected by the race and eth-

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“…18 The same forces that limit access may also be limiting the quality of care. Parents of children who usually receive care from the same clinician appear to be getting more anticipatory guidance.…”

Section: Commentmentioning

confidence: 99%