1
|
Gazzaz AZ, Carpiano RM, Laronde DM, Aleksejuniene J. Parental psychosocial factors, unmet dental needs and preventive dental care in children and adolescents with special health care needs: A stress process model. BMC Oral Health 2022; 22:282. [PMID: 35818050 PMCID: PMC9275152 DOI: 10.1186/s12903-022-02314-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Children and adolescents with special health care needs (SHCN) have higher unmet dental needs, but the potential mechanisms by which parental factors can influence dental care use have not been determined. Parenting a child with SHCN can present special demands that affect parents’ well-being and, in turn, their caregiving. Hence, the study's overall aim was to apply the stress process model to examine the role of parental psychosocial factors in the association between child SHCN and dental care. Specifically, the study tested hypotheses regarding how (a) children’s SHCN status is associated with child dental care (unmet dental needs and lack of preventive dental visits), both directly and indirectly via parental psychosocial factors (parenting stress, instrumental, and emotional social support) and (b) parental social support buffers the association between parenting stress and child dental care. Methods A secondary data analysis of the 2011–2012 US National Survey of Children’s Health was performed for 6- to 11-year-old children (n = 27,874) and 12- to 17-year-old adolescents (n = 31,328). Our age-stratified models estimated associations between child SHCN status and parental psychosocial factors with two child dental care outcomes: parent-reported unmet child dental needs and lack of preventive dental care. Results Parents of children with (vs without) SHCN reported higher unmet child dental needs, higher parenting stress, and lower social support (instrumental and emotional). Instrumental, but not emotional, parental support was associated with lower odds of their child unmet dental needs in both age groups. The association between parenting stress and child dental care outcomes was modified by parental social support. Conclusion Differences existed in child unmet dental needs based on SHCN status, even after adjusting for parental psychosocial factors. SHCN status was indirectly associated with unmet dental needs via parental instrumental support among adolescents, and parental instrumental support buffered the negative association between parenting stress and both child dental care outcomes. Hence, parental social support was an important determinant of child dental care and partially explained the dental care disparities in adolescents with SHCN. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02314-y.
Collapse
Affiliation(s)
- Arwa Z Gazzaz
- Department of Oral Health Science, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada. .,Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| | | | - Denise M Laronde
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Jolanta Aleksejuniene
- Department of Oral Health Science, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Obeidat R, Noureldin A, Bitouni A, Abdellatif H, Lewis-Miranda S, Liu S, Badner V, Timothé P. Oral health needs of U.S. children with developmental disorders: a population-based study. BMC Public Health 2022; 22:861. [PMID: 35488224 PMCID: PMC9055681 DOI: 10.1186/s12889-022-13237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Children with Special Health Care Needs (CSHCN) have higher rates of oral diseases and tooth decay compared with the general population. Children with developmental disorders/ disabilities (DD) are a subset of CSHCN whose oral health has not been specifically addressed. Therefore, this study had two objectives: to describe the oral health needs (OHN) of children with DD compared with children without DD; and to assess barriers to access to care, utilization of dental services, and their association with oral health needs for children with DD. Methods This cross-sectional study utilized a sample of 30,530 noninstitutionalized children from the 2018 National Survey of Children’s Health (NSCH). Analysis was conducted using descriptive and inferential statistics. Results The analysis identified 6501 children with DD and 24,029 children without DD. Children with DD had significantly higher prevalence of OHN (20.3% vs. 12.2%, respectively), unmet dental needs (3.5% vs 1.2%), and utilization of any dental visits (86.1% vs 76.1%), (P-value < . 001). The adjusted logistic model identified four factors that contributed to the higher odds of OHN among children with DD: poverty (< 100% of the Federal Poverty Level (AOR = 2.27, CI: 1.46–3.51), being uninsured (AOR = 2.12, 95% CI: 1.14–3.95), a high level of disability (AOR = 1.89, CI: 1.23–2.78), and living in the western United States (AOR = 1.61, CI: 1.09–2.37. Conclusion Despite higher utilization of dental services, children with DD had poorer oral health and more unmet dental needs than children without DD. Advocacy efforts and policy changes are needed to develop affordable access that assesses, as early as possible, children with DD whose conditions impact their ability a great deal so that their potential OHN may be alleviated more effectively.
Collapse
Affiliation(s)
- Raghad Obeidat
- Public Health Sciences Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA.
| | - Amal Noureldin
- Public Health Sciences Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Anneta Bitouni
- Department of Comprehensive Dentistry, Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Hoda Abdellatif
- Princess Nourah Bint, Abdulrahman University, Riyadh, Saudi Arabia
| | - Shirley Lewis-Miranda
- Department of Comprehensive Dentistry, Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Shuling Liu
- Statistical Collaboration Center, Texas A&M University, 155 Ireland Street, College Station, TX, 77843, USA
| | - Victor Badner
- Depts. of Dentistry and Epidemiology and Population Health, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, New York City, NY, 10461, USA
| | - Peggy Timothé
- Public Health Sciences Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| |
Collapse
|
3
|
Parmar A, Shannon K, Casas M, Orkin J. Dental care in children with medical complexity: A retrospective study. Paediatr Child Health 2022; 27:141-146. [PMID: 35712035 PMCID: PMC9191913 DOI: 10.1093/pch/pxab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Children with medical complexity (CMC) are defined by complex, chronic multi-system disease with significant medical fragility. Limited research exists on dental care in CMC, which is an important part of oral health and overall health. Objectives of this study were to (1) determine the frequency and type of dental visits at a tertiary paediatric hospital of all CMC between 2015 and 2020 and (2) identify the factors associated with dental visits. Methods A retrospective chart review of the electronic records of CMC who were seen at a paediatric hospital from 2015 to 2020 was completed. The number and type of dental visits, demographic and clinical information were reviewed. Poisson regression models were used to test the association between the outcome (number of dental visits) and potential factors associated with receiving dental care. Results Four hundred and eighty-seven CMC (mean age=7.3 ± 4.6 years, 43.7% female) were included in this study. CMC were seen by dentists at the hospital 4.4 ± 3.8 times since 2015, which is approximately once per year over a 5-year period. Dental visits were mostly preventative (66.4% of all visits). CMC had more dental visits if they had dental care funding compared to no funding if they were living in a community with a population >100,000 people and if they were being followed by a greater number of sub-specialists. Conclusions This study highlights the importance of funding, access to paediatric dental specialists, and care coordination support to improve access to dental care for CMC to optimize oral health.
Collapse
Affiliation(s)
- Arpita Parmar
- Department of Paediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kelsey Shannon
- Department of Paediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael Casas
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Department of Dentistry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Correspondence: Julia Orkin, Medical Director, Complex Care Program, Staff Paediatrician, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada. Telephone 416-813-7654, fax (416)-813-5663, e-mail:
| |
Collapse
|
4
|
Van Cleave J, Stille C, Hall DE. Child Health, Vulnerability, and Complexity: Use of Telehealth to Enhance Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S34-S40. [PMID: 35248246 DOI: 10.1016/j.acap.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/14/2022]
Abstract
Telehealth, or the use of telecommunications technology and infrastructure to deliver health-related services and information that support patient care, has the potential to improve the quality of care, particularly deficiencies related to access and patient experience of care. Telehealth may also reduce disparities for children and youth with special health care needs (CYSHCN) with barriers to accessing in-person care, for example, those residing in rural areas and children with medical complexity who are particularly fragile. While important foundational work has been done to study telehealth's effectiveness and implementation, key gaps remain regarding its use for CYSHCN. The CYSHCNet national research agenda development process, described in a companion article, identified as key priority areas for future research telehealth as an innovative care delivery model for all CYSHCN and as a mechanism to address rural-urban disparities in health care access. Here, we review the current knowledge around telehealth, identify populations for whom telehealth could be especially beneficial, discuss the important gaps identified, and make recommendations for specific studies that will move the field forward. There are ample opportunities for telehealth to improve health and patient/family experience of care and quality of life for CYSHCN while requiring less time and resources from families accessing this care. Innovative research to inform best practices around incorporation and implementation of telehealth will improve its efficiency and effectiveness and achieve optimal outcomes.
Collapse
Affiliation(s)
- Jeanne Van Cleave
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado (J Van Cleave and C Stille), Aurora, Colo.
| | - Christopher Stille
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado (J Van Cleave and C Stille), Aurora, Colo
| | - David E Hall
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt (DE Hall), Nashville, Tenn
| |
Collapse
|
5
|
Positive Parenting Styles Tied to Less Unmet Dental Needs in Children with Developmental Disabilities. J Autism Dev Disord 2022; 52:5395-5402. [PMID: 35037185 DOI: 10.1007/s10803-021-05351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to identify factors, particularly positive parenting styles, associated with unmet dental needs, defined as no dental visit for the past 12 months, in children with developmental disabilities (DD). Participants included 263 primary caregivers of children with DD. Children exposed to less positive parenting styles were more than two times (aOR, 2.19, 95%CI, 1.12-4.32) more likely to have unmet dental needs. Children who were male (aOR, 1.88, 95%CI, 1.04-3.41), aged < 4 years (aOR, 2.95, 95%CI, 1.2-7.27) or aged ≥ 11 years (aOR, 2.65, 95%CI, 1.25-5.64), had higher illness severity (aOR, 2.04, 95%CI, 1.09-3.81), had primary caregivers with less than or equal to high school education (aOR, 2.45, 95%CI, 1.13-5.30) were also more likely to have unmet dental needs.
Collapse
|
6
|
Alrayyes SM, Capezio N, Kratunova E, LeHew CW, Alapati S. Factors associated with moderate sedation attendance at a university-based pediatric dental clinic. J Dent Educ 2021; 85:1821-1827. [PMID: 34309855 DOI: 10.1002/jdd.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/20/2021] [Accepted: 07/15/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate patient attendance for moderate sedation (MS) at a university-based pediatric dental clinic; to identify factors with negative impact on MS being completed and to assess for associations between no-show appointments and patient variables METHODS: The electronic health records of patients scheduled for MS appointments in a 22-month period were assessed by a single investigator. Demographic and clinical data related to appointment attendance and MS procedure performance were collected and statistically analyzed using chi-square, Spearman's rho correlation tests, and logistic regression (p < 0.05) RESULTS: A total of 618 scheduled MS appointments were included. The MS appointment no-show-rate was 17.1 percent. Appointment confirmation (p = 0.001) and dmft score ≥ 9 (p = 0.039) had positive correlation with attendance, while "no-shows" history (p = 0.024) and longer waiting time (p = 0.040) had negative impact on attendance. About 20% of attended MS were not completed, with main reasons of airway risk (32.3%), ongoing illness (28.4%), and violation of NPO guidelines (21.5%). Race, ethnicity, language spoken, child's behavior, and distance traveled had no significant impact on attendance CONCLUSION: Interventions to decrease non-attendance rates should target patients who are unconfirmed, have a history of no-show appointments, and are scheduled well before the sedation appointment.
Collapse
Affiliation(s)
- Sahar M Alrayyes
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nicholas Capezio
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Evelina Kratunova
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Charles W LeHew
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Satish Alapati
- Department of Endodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
7
|
McBain RK, Kareddy V, Cantor JH, Stein BD, Yu H. Systematic Review: United States Workforce for Autism-Related Child Healthcare Services. J Am Acad Child Adolesc Psychiatry 2020; 59:113-139. [PMID: 31150751 PMCID: PMC6883168 DOI: 10.1016/j.jaac.2019.04.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/11/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, distribution, and competencies of the US workforce for autism-related child health care services, and assess studies' strength of evidence. METHOD We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research. RESULTS Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples. CONCLUSION There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.
Collapse
Affiliation(s)
| | | | | | | | - Hao Yu
- RAND Corporation, Pittsburgh, PA
| |
Collapse
|
8
|
Walker A, Peden JG, Emter M, Colquitt G. Predictors of Coordinated and Comprehensive Care Within a Medical Home for Children With Special Healthcare (CHSCN) Needs. Front Public Health 2018; 6:170. [PMID: 29930936 PMCID: PMC6000754 DOI: 10.3389/fpubh.2018.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/21/2018] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.
Collapse
Affiliation(s)
- Ashley Walker
- Department of Community Health Education and Behavior, Georgia Southern University, Statesboro, GA, United States
| | - John G. Peden
- School of Human Ecology, Georgia Southern University, Statesboro, GA, United States
| | - Morgan Emter
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, United States
| | - Gavin Colquitt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, United States
| |
Collapse
|
9
|
Schaible BJ, Colquitt G, Li L, Caciula M, Moreau NG. Urban vs. rural differences in insurance coverage and impact on employment among families caring for a child with cerebral palsy. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1321159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Braydon J. Schaible
- Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Gavin Colquitt
- School of Health and Kinesiology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA
| | - Li Li
- School of Health and Kinesiology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA
| | - Manuela Caciula
- School of Health and Kinesiology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA
| | - Noelle G. Moreau
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
10
|
Kim N, Kim CY, Shin H. Inequality in unmet dental care needs among South Korean adults. BMC Oral Health 2017; 17:80. [PMID: 28446178 PMCID: PMC5406911 DOI: 10.1186/s12903-017-0370-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 04/20/2017] [Indexed: 12/29/2022] Open
Abstract
Background The current public health research agenda was to identify the means to reduce oral health inequalities internationally. The objectives of this study were to provide evidence of inequality in unmet dental needs and to find influencing factors attributable to those among South Korean adults. Methods Pooled cross-sectional data from the fourth Korean National Health and Nutrition Examination Survey (2007–2009) on 17,141 Korean adults were used. Demographic factors (sex, age, and marital status), socioeconomic factors (education level, employment status, and income level), need factors (normative dental needs and self-perceived oral health status), and oral health-related factors (the number of decayed teeth, the presence of periodontitis, and the number of missing teeth) were included. Multiple logistic regression analysis was performed. Results Of South Korean adults, 43.9% had perceived unmet dental needs, with the most common reason being financial difficulties. The disparities in unmet dental care needs were strongly associated with income level, normative treatment needs, and self-perceived oral health status. The low-income group, people with normative dental treatment needs, and those with perceived poor oral health status were more likely to have unmet dental needs. There was considerable inequality in unmet dental care needs due to economic reasons according to such socioeconomic factors as income and education level. Conclusions Public health policies with the expansion of dental insurance coverage are needed to reduce inequalities in unmet dental care needs and improve the accessibility of dental care services to vulnerable groups who are experiencing unmet dental care needs due to socioeconomic factors despite having normative and self-perceived needs for dental treatment.
Collapse
Affiliation(s)
- Nayoung Kim
- Department of Postanesthetic Care Unit, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang-Yup Kim
- Department of Health Policy and Management, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, 151-742, Seoul, Korea.
| | - Hosung Shin
- Department of Social and Humanity in Dentistry, College of Dentistry, Wonkwang University, Iksan, Jeolabuk-do, Korea
| |
Collapse
|
11
|
Wilson K, Hirschi M, Comeau M, Bronheim S, Bachman SS. Disparities in insurance coverage among children with special health care needs: how social workers can promote social and economic justice. HEALTH & SOCIAL WORK 2014; 39:121-127. [PMID: 24946429 DOI: 10.1093/hsw/hlu015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
12
|
Fulda KG, Johnson KL, Hahn K, Lykens K. Do unmet needs differ geographically for children with special health care needs? Matern Child Health J 2013; 17:505-11. [PMID: 22535217 DOI: 10.1007/s10995-012-1029-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.
Collapse
Affiliation(s)
- Kimberly G Fulda
- Primary Care Research Center/Texas Prevention Institute, University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
| | | | | | | |
Collapse
|
13
|
Fulkerson ND, Haff DR, Chino M. Health care access disparities among children entering kindergarten in Nevada. J Child Health Care 2013; 17:253-63. [PMID: 23435166 DOI: 10.1177/1367493512461570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to advance our understanding and appreciation of the health status of young children in the state of Nevada in addition to their discrepancies in accessing health care. This study used the 2008-2009 Nevada Kindergarten Health Survey data of 11,073 children to assess both independent and combined effects of annual household income, race/ethnicity, primary language spoken in the family, rural/urban residence, and existing medical condition on access to health care. Annual household income was a significant predictor of access to health care, with middle and high income respondents having regular access to care compared to low income counterparts. Further, English proficiency was associated with access to health care, with English-speaking Hispanics over 2.5 times more likely to have regular access to care than Spanish-speaking Hispanics. Rural residents had decreased odds of access to preventive care and having a primary care provider, but unexpectedly, had increased odds of having access to dental care compared to urban residents. Finally, parents of children with no medical conditions were more likely to have access to care than those with a medical condition. The consequences for not addressing health care access issues include deteriorating health and well-being for vulnerable socio-demographic groups in the state. Altogether these findings suggest that programs and policies within the state must be sensitive to the specific needs of at risk groups, including minorities, those with low income, and regionally and linguistically isolated residents.
Collapse
|
14
|
Hoogsteen L, Woodgate RL. Centering autism within the family: a qualitative approach to autism and the family. J Pediatr Nurs 2013; 28:135-40. [PMID: 22819746 DOI: 10.1016/j.pedn.2012.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/13/2012] [Accepted: 06/15/2012] [Indexed: 11/30/2022]
Abstract
The lived experience of parents of children with autism living in a rural area was explored through a phenomenological approach. Twenty-eight parents from multiple rural communities participated in semi-structured interviews. Van Manen's (1990) selective highlighting approach was used to isolate thematic statements of the experience. Findings revealed that autism became centered within the family thereby affecting how parents parented. Parenting now included: (a) multiple roles; (b) an intense focus on their child's needs; and (c) finding a balance. Although parents acquired multiple roles and faced many unmet needs, parents were determined to strive for balance within the family.
Collapse
Affiliation(s)
- Lindsey Hoogsteen
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | |
Collapse
|
15
|
Park KT, Bensen R, Lu B, Nanda P, Esquivel C, Cox K. Geographical rural status and health outcomes in pediatric liver transplantation: an analysis of 6 years of national United Network of Organ Sharing Data. J Pediatr 2013; 162:313-8.e1. [PMID: 22914224 DOI: 10.1016/j.jpeds.2012.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/11/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine whether children in rural areas have worse health than children in urban areas after liver transplantation (LT). STUDY DESIGN We used urban influence codes published by the US Department of Agriculture to categorize 3307 pediatric patients undergoing LT in the United Network of Organ Sharing database between 2004 and 2009 as urban or rural. Allograft rejection, patient death, and graft failure were used as primary outcome measures of post-LT health. Pediatric end-stage liver disease/model of end-stage liver disease scores >20 was used to measure worse pre-LT health. RESULTS In a multivariate analysis, we found greater rates of allograft rejection within 6 months of LT (OR 1.27; 95% CI 1.05-1.53) and a lower occurrence of posttransplantation lymphoproliferative disorder (OR 0.64; 95% CI 0.41-0.99) in patients in rural areas. The difference in allograft rejection was eliminated at 1 year of LT (OR 1.18; 95% CI 0.98-1.42). Rural location did not impact other outcome measures. CONCLUSION We conclude that rural location makes a negative impact on patient health within the first 6 months of LT by increasing the risk for allograft rejection, although patients in rural areas may have lower rates of developing posttransplantation lymphoproliferative disorder. Long-term adverse health effects were not seen.
Collapse
Affiliation(s)
- K T Park
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA 94304, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Creating a regional dental center serving six rural county health districts. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:325-8. [PMID: 20520371 DOI: 10.1097/phh.0b013e3181947258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People with Medicaid or no dental insurance have a difficult time accessing dentists in private practice. The problem of access is more profound in rural than urban areas. Safety net dental clinics operated by small rural local health districts are difficult to start up, operate, and maintain. The number of these facilities in the United States is small and not evenly distributed to meet needs. This article describes how a full-service dental clinic was established to serve six rural county health districts in Northwest Ohio. Retired volunteer dentists were instrumental in the success of creating the clinic, starting with a field-type operation in 2001 serving 316 persons and building into a full-time regional dental center that served 1,306 individuals in 2007.
Collapse
|
17
|
Cassell CH, Mendez DD, Strauss RP. Maternal Perspectives: Qualitative Responses about Perceived Barriers to Care among Children with Orofacial Clefts in North Carolina. Cleft Palate Craniofac J 2012; 49:262-9. [DOI: 10.1597/09-235] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To examine maternal perceptions of barriers to care of children with orofacial clefts (OFC) in a population-based survey that solicited open-ended qualitative responses. Design and Setting In 2006, a combination mail/phone survey was sent to all mothers of children with OFC. The questionnaire included 76 items. A final open-ended question was included for additional information about cleft-related care. The analysis included responses to the open-ended question and sociodemographic characteristics of the respondents. Qualitative responses were transcribed and entered into a qualitative software package for analysis, and common themes were elucidated. Participants/Patients The North Carolina Birth Defects Monitoring Program was used to identify all resident infants born with OFC from 2001 to 2004. Of 478 eligible mothers, 52.9% (n = 248) responded to the survey, and 39.5% (n = 98) responded to the final open-ended question. Main Outcome Measures Percentage reporting problems accessing care, frequency of positive and negative comments, and indicators of financial, personal, and structural barriers to care. Results Of the 98 respondents, the majority (n = 95, 96.99%) were the biological mother. Almost 40% of mothers indicated that accessing primary craniofacial care was a problem. Of those citing perceived barriers to care, the major issues cited were financial, structural, and personal barriers. Conclusions Collaborative efforts between craniofacial centers and teams, health care systems, and birth defects registries are warranted to reduce perceived barriers to care among families of children with OFC. Further exploration of the themes and factors associated with barriers to care and services is needed.
Collapse
Affiliation(s)
- Cynthia H. Cassell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Dara D. Mendez
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ronald P. Strauss
- Departments of Dental Ecology, Epidemiology, and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
18
|
Park KT, Nanda P, Bensen R, Strichartz D, Esquivel C, Cox K. Effects of rural status on health outcomes in pediatric liver transplantation: a single center analysis of 388 patients. Pediatr Transplant 2011; 15:300-5. [PMID: 21450010 DOI: 10.1111/j.1399-3046.2010.01452.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rural status of patients may impact health before and after pediatric LT. We used UI codes published by the USDA to stratify patients as urban or rural depending county residence. A total of 388 patients who had LT and who met criteria were included. Rejection, PTLD, and survival were used as primary outcome measures of post-LT health. UNOS Status 1 and PELD/MELD scores >20 were used as secondary outcome measures of poorer pre-LT health. Logistic regression models were run to determine associations. We did not find any statistically significant differences in pre- or post-LT outcomes with respect to rurality. Among rural patients, there was a general trend for decreased incidence of rejection (25.0% vs. 33.4%; OR 0.64, 95% CI 0.29-1.44), increased risk of PTLD (5.6% vs. 3.4%; OR 1.86, 95% CI 0.36-3.31), and decreased survival (OR 0.85, 95% CI 0.34-2.13) after LT. Rural patients also tended to be sicker at the time of LT than patients from urban areas, with increased proportion of Status 1 (OR 1.17, 95% CI 0.51-2.70) and PELD/MELD scores >20 (OR 1.20, 95% CI 0.59-2.45). From a single center experience, we conclude that rurality did not significantly affect health outcomes after LT, although a larger study may validate the general trends that rural patients may have decreased rejection, increased PTLD, and mortality, and be in poorer health at the time of LT.
Collapse
Affiliation(s)
- K T Park
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University Medical Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Martin AB, Vyavaharkar M, Veschusio C, Kirby H. Rural–Urban Differences in Dental Service Utilization Among an Early Childhood Population Enrolled in South Carolina Medicaid. Matern Child Health J 2010; 16:203-11. [DOI: 10.1007/s10995-010-0725-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
20
|
Waldman HB, Perlman SP, Rader R. Hardships of raising children with special health care needs (a commentary). SOCIAL WORK IN HEALTH CARE 2010; 49:618-629. [PMID: 20711942 DOI: 10.1080/00981381003635189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Providing health care services for youngsters with special health care needs (SHCN) requires understanding of the medical circumstances that impact on the particular youngster, as well as an increased awareness and sensitivity to their particular family setting, and the issues that impact on the child, his/her parents, and siblings. To this end a review was carried out regarding the variable affects on these youngsters, such as poverty, parental, and family issues, as well as considerations of who is at risk for SHCN and demographics of individuals with SHCN who have unmet health needs. The particular need for dental services, the health service most commonly reported as needed, but not received, is highlighted.
Collapse
Affiliation(s)
- H Barry Waldman
- Department of General Dentistry, Stony Brook University, Stony Brook, New York, USA.
| | | | | |
Collapse
|
21
|
Abstract
Oral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the population's oral health literacy.
Collapse
Affiliation(s)
- Clemencia M Vargas
- Department of Health Promotion and Policy, University of Maryland, Dental School, 650 W. Baltimore Street, Baltimore, MD 21201, USA.
| | | |
Collapse
|
22
|
Effect of Having a Personal Healthcare Provider on Access to Dental Care Among Children. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2009; 15:191-9. [PMID: 19363398 DOI: 10.1097/phh.0b013e3181a117c5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Newborn hearing screening: an outpatient model. Int J Pediatr Otorhinolaryngol 2009; 73:1-7. [PMID: 19062110 DOI: 10.1016/j.ijporl.2008.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 08/25/2008] [Accepted: 09/02/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the feasibility of implementing an outpatient model of a newborn hearing screening program with a particular focus on determining how compliance with the follow-up appointment related to specific socio-economic and demographic factors associated with the mother. METHOD Mothers who delivered their babies in public hospitals in Recife, northeast Brazil, were invited to participate in a two-step program. In Step 1 they were interviewed with regard to specific socio-economic and demographic factors, and then scheduled for a hearing screening test for their baby 1 month after discharge. In Step 2, the baby's hearing was screened using transient otoacoustic emissions. RESULTS A total of 1035 mothers consented to participate in Step 1, but only 149 returned to participate in Step 2 (14.3%). Analysis of the socio-economic and demographic factors indicated that mothers who did not comply with the scheduled newborn hearing screening (NHS) test generally had less than a high school education and came from primarily lower income families who lived in rural areas outside of Recife. CONCLUSION The results of this study highlight some socio-economic and demographic factors of the population of northeast Brazil that contribute to a low compliance rate for an outpatient model of a newborn hearing screening program. Possible solutions to the low compliance rate are considered.
Collapse
|
24
|
Cassell CH, Meyer R, Daniels J. Health care expenditures among Medicaid enrolled children with and without orofacial clefts in North Carolina, 1995-2002. ACTA ACUST UNITED AC 2008; 82:785-94. [DOI: 10.1002/bdra.20522] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Wilder RS, O'Donnell JA, Barry JM, Galli DM, Hakim FF, Holyfield LJ, Robbins MR. Is Dentistry at Risk? A Case for Interprofessional Education. J Dent Educ 2008. [DOI: 10.1002/j.0022-0337.2008.72.11.tb04605.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Jean A. O'Donnell
- Department of Restorative Dentistry and Comprehensive Care; University of Pittsburgh School of Dental Medicine
| | | | | | - Foroud F. Hakim
- Department of Restorative Dentistry; University of the Pacific Arthur A. Dugoni School of Dentistry
| | | | - Miriam R. Robbins
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine; New York University College of Dentistry
| |
Collapse
|
26
|
Newacheck PW, Kim SE, Blumberg SJ, Rising JP. Who is at risk for special health care needs: findings from the National Survey of Children's Health. Pediatrics 2008; 122:347-59. [PMID: 18676553 DOI: 10.1542/peds.2007-1406] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A conceptual model of risk factors for special health care needs in childhood was presented previously. This article uses that conceptual model to identify candidate variables for an exploratory empirical examination of the effects of factors that may increase or decrease the risk of developing a special health care need. METHODS The National Survey of Children's Health was used for our analysis (N = 102 353). We used multilevel and multivariate analysis methods. We examined risk factors for special health care needs generally and for specific physical, developmental, behavioral, and emotional conditions cooccurring with special health care needs. Risk factors were grouped into 6 major domains, namely, predisposing characteristics, genetic endowment, physical environment, social environment, health-influencing behavior, and health care system characteristics. We examined preschool-aged and school-aged children separately. RESULTS Significant associations were found in 5 of 6 domains studied (no variables in the health care systems characteristics were significant). Individual variables found to decrease or to increase significantly the odds of experiencing special health care needs were expressed at the child level (eg, age and gender), family level (eg, family structure and family conflict), and neighborhood level (eg, perception of supportiveness of the neighborhood). CONCLUSIONS This analysis is the first to consider empirically a range of risk factors for special health care needs, using a population health model. Although provisional, the results of our analysis can help us to begin thinking about which characteristics of the child, family, and community are worthy of further exploration. Some of the variables we found to be significantly associated with special health care needs, such as age and ethnicity, are immutable. However, we found a number of significant correlates (ie, possible risk factors) that may be amenable to public health interventions, including breastfeeding practices, exposure to secondhand smoke, family closeness, and neighborhood cohesion.
Collapse
Affiliation(s)
- Paul W Newacheck
- Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, Suite 265, San Francisco, CA 94118, USA.
| | | | | | | |
Collapse
|
27
|
Nicopoulos M, Brennan MT, Kent ML, Brickhouse TH, Rogers MK, Fox PC, Lockhart PB. Oral health needs and barriers to dental care in hospitalized children. SPECIAL CARE IN DENTISTRY 2008; 27:206-11. [DOI: 10.1111/j.1754-4505.2007.tb00348.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
28
|
Skinner AC, Slifkin RT. Rural/urban differences in barriers to and burden of care for children with special health care needs. J Rural Health 2007; 23:150-7. [PMID: 17397371 DOI: 10.1111/j.1748-0361.2007.00082.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children. METHODS The National Survey of Children with Special Health Care Needs was used to examine rural-urban differences in types of providers used, reasons CSHCN had unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care. We present both unadjusted and adjusted results to allow consideration of the causes of rural-urban differences. FINDINGS Rural CSHCN are less likely to be seen by a pediatrician than urban children. They are more likely to have unmet health care needs due to transportation difficulties or because care was not available in the area; there were minimal other differences in barriers to care. Families of rural CSHCN are more likely to report financial difficulties associated with their children's medical needs and more likely to provide care at home for their children. CONCLUSIONS Examining results from both unadjusted and adjusted odds ratios shows that the burden of care for families of rural CSHCN stems both from socioeconomic differences and health system differences. Policies aimed at achieving equity for rural children will require focusing on both individual factors and the health care infrastructure, including increasing insurance coverage to lessen financial difficulties and addressing the availability of providers in rural areas.
Collapse
Affiliation(s)
- Asheley Cockrell Skinner
- North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
| | | |
Collapse
|
29
|
Liu J, Probst JC, Martin AB, Wang JY, Salinas CF. Disparities in dental insurance coverage and dental care among US children: the National Survey of Children's Health. Pediatrics 2007; 119 Suppl 1:S12-21. [PMID: 17272579 DOI: 10.1542/peds.2006-2089d] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to understand disparities in dental insurance coverage and dental care among US children by race/ethnicity, urban/rural residence, and socioeconomic status. METHODS Linked data from the National Survey of Children's Health and Area Resource File were analyzed (N = 89 071). Multiple logistic regression analysis was used to adjust for confounders. RESULTS A total of 22.1% of US children lacked parentally reported dental insurance coverage in the preceding year, 26.9% did not have a routine preventive dental visit, and 5.1% had parentally perceived unmet need for preventive dental care. US-born minority children were less likely to lack dental insurance than US-born white children; however, foreign-born Hispanic children were more likely to be uninsured. Rural children were more likely to be uninsured than urban children. Children with health insurance were more likely to have dental coverage. Children who lacked dental insurance were less likely to have received preventive care and more likely to have unmet need for care. Compared with US-born white children, all minority children were less likely to receive preventive care. These disparities were exacerbated among foreign-born children. Fewer race-based disparities were found for unmet need for dental care. Only black children, both US- and foreign-born, had higher odds of unmet need for preventive services than US-born white children. Poor dental health was strongly associated with unmet need. Disparities in dental insurance coverage and dental care are also evident by family socioeconomic status. CONCLUSIONS Poor and minority children were less likely to receive preventive dental care, even when insurance status was considered. Rural children were less likely to have dental insurance than urban children. Foreign birth affected insurance status for Hispanic children and use of preventive services for all minority children.
Collapse
Affiliation(s)
- Jihong Liu
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA.
| | | | | | | | | |
Collapse
|