To examine racial and ethnic differences in unmet need for vision care among children with special health care needs.
Cross-sectional data from the National Survey of Children with Special Health Care Needs were analyzed. The analytic sample was 14,070 children with special health care needs who needed eyeglasses or vision care in the previous year. Children who did not receive all the eyeglasses or vision care they needed were considered to have unmet need for vision care.
Of the sample, 5.8%, representing approximately 198,600 children with special health care needs in the United States, had unmet need for vision care. Rates of unmet need ranged from 2.5% to 14.3% across the 7 racial and ethnic groups studied. Relative to whites, children of African American, Latino, and multiracial backgrounds had approximately twice the adjusted risk of unmet need, whereas American Indian or Alaskan Native children had a lower adjusted risk. Health care providers, school personnel, insurance coverage, and other factors also contributed to differences in the risk of unmet need, independently of child race/ethnicity.
Further research is needed to explain and address the causes of racial and ethnic differences in unmet need for vision care among children with special health care needs.
[Show abstract][Hide abstract] ABSTRACT: Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care.
The purpose of this work was to examine racial/ethnic disparities in medical and oral health, access to care, and use of services in a national sample.
The National Survey of Children's Health was a telephone survey in 2003-2004 of a national random sample of parents and guardians of 102,353 children 0 to 17 years old. Disparities in selected medical and oral health and health care measures were examined for white, African American, Latino, Asian/Pacific Islander, Native American, and multiracial children. Multivariate analyses were performed to adjust for primary language at home, age, insurance coverage, income, parental education and employment, and number of children and adults in the household. Forty measures of medical and oral health status, access to care, and use of services were analyzed.
Many significant disparities were noted; for example, uninsurance rates were 6% for whites, 21% for Latinos, 15% for Native Americans, 7% for African Americans, and 4% for Asians or Pacific Islanders, and the proportions with a usual source of care were as follows: whites, 90%; Native Americans, 61%; Latinos, 68%; African Americans, 77%; and Asians or Pacific Islanders, 87%. Many disparities persisted for > or = 1 minority group in multivariate analyses, including increased odds of suboptimal health status, overweight, asthma, activity limitations, behavioral and speech problems, emotional difficulties, uninsurance, suboptimal dental health, no usual source of care, unmet medical and dental needs, transportation barriers to care, problems getting specialty care, no medical or dental visit in the past year, emergency department visits, not receiving mental health care, and not receiving prescription medications. Certain disparities were particularly marked for specific racial/ethnic groups: for Latinos, suboptimal health status and teeth condition, uninsurance, and problems getting specialty care; for African Americans, asthma, behavior problems, skin allergies, speech problems, and unmet prescription needs; for Native Americans, hearing or vision problems, no usual source of care, emergency department visits, and unmet medical and dental needs; and for Asians or Pacific Islanders, problems getting specialty care and not seeing a doctor in the past year. Multiracial children also experienced many disparities. CONCLUSIONS; Minority children experience multiple disparities in medical and oral health, access to care, and use of services. Certain disparities are particularly marked for specific racial/ethnic groups, and multiracial children experience many disparities.
[Show abstract][Hide abstract] ABSTRACT: The receipt of health care in a medical home is increasingly touted as a fundamental basis for improved care for persons with chronic conditions, yet the evidence for this claim has not been systematically assessed.
Our goal was to determine the evidence for the federal Maternal and Child Health Bureau recommendation that children with special health care needs receive ongoing comprehensive care within a medical home.
We searched the nursing and medical literature, references of selected articles, and requested expert recommendations. Search terms included children with special health care needs, medical home-related interventions, and health-related outcomes. Articles that met defined criteria (eg, children with special health care needs, United States-based, quantitative) were selected. We extracted data, including design, population characteristics, sample size, intervention, and findings from each article.
We selected 33 articles that reported on 30 distinct studies, 10 of which were comparison-group studies. None of the studies examined the medical home in its entirety. Although tempered by weak designs, inconsistent definitions and extent of medical home attributes, and inconsistent outcome measures, the preponderance of evidence supported a positive relationship between the medical home and desired outcomes, such as better health status, timeliness of care, family centeredness, and improved family functioning.
The evidence provides moderate support for the hypothesis that medical homes provide improved health-related outcomes for children with special health care needs. Additional studies with comparison groups encompassing all or most of the attributes of the medical home need to be undertaken.
[Show abstract][Hide abstract] ABSTRACT: Community health centers (CHCs) are nonprofit community-based providers of primary and preventive health care for medically underserved populations. At the same time, nationally, racial/ethnic minorities and low-income populations are disproportionately affected by poor access to comprehensive eye and vision care and are more likely to experience adverse outcomes.
This report describes the fundamentals of CHCs, including mission, their patients, the types of health care and enabling services that they provide, the quality and cost-effectiveness of their care, and how they are funded. This report also reviews the demographics of vision disparities among at-risk populations, the economic impact of undiagnosed and untreated vision problems, and the similarities between those at risk for vision problems and the patients targeted by CHCs.
Aimed at responding to disparities in access to health care services and health status outcomes, CHCs are optimally positioned to contribute to improved access to comprehensive eye and vision care as well as to the reduction of disparities in visual health status. There is need for extensive research in further defining and addressing disparities in access to optometric care in medically underserved populations and the potential role that CHCs can play in meeting those needs.
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