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Primary Care Accessibility Effects on Health Care Utilization Among Urban Children.
Mudd, Abigail E; Michael, Yvonne L; Diez-Roux, Ana V; Maltenfort, Mitchell; Moore, Kari; Melly, Steve; Lê-Scherban, Félice; Forrest, Christopher B.
Afiliação
  • Mudd AE; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa.
  • Michael YL; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa. Electronic address: ylm23@drexel.edu.
  • Diez-Roux AV; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa.
  • Maltenfort M; Applied Clinical Research Center, Children's Hospital of Philadelphia (M Maltenfort and CB Forrest), Philadelphia, Pa.
  • Moore K; The Urban Health Collaborative, Dornsife School of Public Health, Drexel University (K Moore and S Melly), Philadelphia, Pa.
  • Melly S; The Urban Health Collaborative, Dornsife School of Public Health, Drexel University (K Moore and S Melly), Philadelphia, Pa.
  • Lê-Scherban F; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa.
  • Forrest CB; Applied Clinical Research Center, Children's Hospital of Philadelphia (M Maltenfort and CB Forrest), Philadelphia, Pa.
Acad Pediatr ; 20(6): 871-878, 2020 08.
Article em En | MEDLINE | ID: mdl-32492576
OBJECTIVE: Evidence suggests that spatial accessibility to primary care is a contributing factor to appropriate health care utilization, with limited primary care access resulting in avoidable hospitalizations and emergency department visits which are burdensome on individuals and our health care system. Limited research, however, has examined the effects on children. METHODS: We evaluated associations of spatial accessibility to primary care on health care utilization among a sample of 16,709 children aged 0 to 3 years in Philadelphia who were primarily non-White and publicly insured. Log-Poisson models with generalized estimating equations were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI), while accounting for 3 levels of clustering (within individual, within primary care practice, within neighborhood). RESULTS: In age-adjusted models, the lowest level of spatial accessibility was associated with 7% fewer primary care visits (RR 0.93, 95% CI 0.91, 0.95), 15% more emergency department visits (RR 1.15, 95% CI 1.09, 1.22), and 18% more avoidable hospitalizations (RR 1.18, 95% CI 1.01, 1.37). After adjustment for individual- (race/ethnicity, sex, number of chronic conditions, insurance status) and neighborhood-level (racial composition and proportion of housing units with no vehicle), spatial accessibility was not significantly associated with rate of health care utilization. CONCLUSIONS: Individual-level predisposing factors, such as age, race, and need, attenuate the association between accessibility to primary care and use of primary care, emergency department visits, and avoidable hospitalization. Given the possibility of modifying access to primary care unlike immutable individual factors, a focus on spatial accessibility to primary care may promote appropriate health care utilization.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Atenção Primária à Saúde / Aceitação pelo Paciente de Cuidados de Saúde / Acessibilidade aos Serviços de Saúde Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Implementation_research Limite: Child, preschool / Female / Humans / Infant / Male / Newborn País/Região como assunto: America do norte Idioma: En Revista: Acad Pediatr Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Atenção Primária à Saúde / Aceitação pelo Paciente de Cuidados de Saúde / Acessibilidade aos Serviços de Saúde Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Implementation_research Limite: Child, preschool / Female / Humans / Infant / Male / Newborn País/Região como assunto: America do norte Idioma: En Revista: Acad Pediatr Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos