Factors associated with not having a personal health care provider for children in Florida
ABSTRACT National recommendations by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners promote that all children obtain quality primary care through a consistent medical provider who can better assess, diagnose, and monitor a child's health. The purpose of this article was to identify characteristics of children in Florida without a personal health care provider.
Florida data (N = 2116) from the 2003 National Survey of Children's Health were analyzed by using bivariate and multivariate methods. The dependent, or outcome, variable was a personal health care provider, defined in the National Survey of Children's Health as a personal doctor or nurse.
In Florida, 20.1% of children (0-17 years of age) do not have a personal health care provider compared with 16.7% in the United States. Children at greatest risk are those without health insurance. Other significant risk factors include family poverty up to 100% of federal poverty level, poverty level 100% to 199%, poverty level unknown, poverty level 200% to 399%, children aged 5 to 12 years, children aged 13 to 17 years, and Hispanic ethnicity. All the factors in the Florida model were also significant in the national model.
Lack of a personal health care provider is driven by larger community issues of health insurance, socioeconomic status, and ethnicity, including race, on a national level. To achieve the goal of a personal health care provider for children, a multifaceted approach needs to be considered. Knowing which children are without a personal health care provider provides valuable information for state policy-makers, program planners, and evaluators.
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ABSTRACT: To determine if insurance type is associated with differences in the management of children presenting to the emergency department (ED) with bronchiolitis We analyzed data from a 30-center, prospective cohort study of children younger than 2 years with bronchiolitis presenting to the ED. Insurance status was defined as private, public, and no insurance. Of 1450 patients, 473 (33%) had private, 928 (64%) had public, and 49 (3%) had no insurance. Multivariable analysis found that children with public insurance were less likely to receive inhaled β-agonists (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92) or antibiotics (OR, 0.61; 95% CI, 0.42-0.89) the week before the ED visit. Children without insurance were less likely to have a primary care provider (OR, 0.15; 95% CI, 0.04-0.57) or receive laboratory testing in the ED (OR, 0.41; 95% CI, 0.19-0.88). The children's clinical presentation (eg, respiratory rate, oxygen saturation, and retractions) and ED treatments (eg, inhaled β-agonists, inhaled racemic epinephrine, systemic corticosteroids, and antibiotics) were similar. Likewise, hospital admission (multivariable OR 1.04; 95% CI, 0.45-2.42) was similar between insurance groups. We noted some pre-ED and ED management differences across insurance types for children presenting to the ED with bronchiolitis. Although these variations may reflect treatments with unproven benefits, all children regardless of insurance should receive similar care. Despite these management variations, there were no differences in medications delivered in the ED or admission rate.Pediatric emergency care 09/2010; 26(10):716-21. DOI:10.1097/PEC.0b013e3181f39861 · 0.92 Impact Factor
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ABSTRACT: The outcomes of 113 children with autoimmune hepatitis (AIH), registered with Studies of Pediatric Liver Transplantation and who underwent transplantation between 1995 and 2006, were compared with those who underwent transplantation for other diagnoses (non-AIH). A total of 4.9% of liver transplants were for AIH; 81% of these patients had AIH type 1 and most underwent transplantation for complications of chronic disease (60%), the majority in females (72%). Transplantation for fulminant AIH was more common in males (52.5% versus 47.5% chronic; P = 0.042). Patients with AIH differed from non-AIH patients by: age (13.0 ± 0.4 versus 4.6 ± 0.1 years; P < 0.0001), sex (64.6% female versus 52.9%; P = 0.016), ethnicity (48.7% white versus 58.2%; P < 0.0001), initial immunosuppression (tacrolimus-based: 72.6% versus 62.6%; P = 0.045; mycophenolate mofetil use: 31.0% versus 21.6%; P = 0.02), and immunosuppression at 2 years after transplant (monotherapy: 51.9% versus 17.3%; P < 0.0001). Late (>3 months), but not steroid-resistant or chronic, rejection was more common in AIH (log-rank P = 0.0015). The 5-year posttransplant survival for AIH was 86% (95% confidence interval: 73-93). Patient and graft survival, infectious and metabolic complications, and retransplantation rates did not differ between AIH and non-AIH groups. In conclusion, the higher risk for late acute rejection and greater degree of immunosuppression does not compromise outcomes of liver transplantation for AIH. Children who undergo transplantation for AIH in North America are typically female adolescents with complications of chronic AIH type 1 and include more children of African American or Latino American origin compared to the overall liver transplant population. These observations may inform detection, treatment, and surveillance strategies designed to reduce the progression of autoimmune hepatitis and subsequently, the need for transplantation.Liver Transplantation 04/2011; 17(4):393-401. DOI:10.1002/lt.22244 · 3.79 Impact Factor