充分发挥教学医院在妇幼保健专业人才培训中的作用

随着医学模式的改变、卫生事业的快速发展和人民生活水平的提高,对医务人员的要求也日益增高。近20年来,中国妇幼保健网络已成体系,但由于各种原因,基层妇幼保健机构还存在许多不足和挑战,急需建设一支高素质的基层医疗卫生服务队伍。因此,应积极探索行之有效的妇幼保健专业人才培训方法,充分发挥各地医学院校教学医院的优势和作用,培养既懂保健又懂临床的复合型妇幼保健人才,以满足妇女儿童日益增长的健康需要。     

Differences in Child Passenger Safety Counseling Frequency and Attitudes by Health Care Provider Specialty

Many children are not being properly restrained in motor vehicles, resulting in unnecessary injury and fatalities. Health care provider (HCP) education is effective at increasing proper child restraint within vehicles. However, differences exist by HCP specialty in regards to frequency of child passenger safety (CPS) counseling. This study of a sample of 255 HCPs examined differences in CPS counseling by HCP specialty (pediatric vs. non-pediatric). HCPs from several upper Midwest states were surveyed about how frequently they provide CPS counseling in their practice by patient age and their attitudes toward CPS-related issues. Pediatric HCPs were twice as likely as non-pediatric HCPs to always provide CPS counseling to parents/guardians of children aged 5 or older. Non-pediatric HCPs were more likely than pediatric HCPs to feel that counseling is ineffective at increasing child seat/booster (p = 0.001) or seat belt use (p = 0.006). Non-pediatric HCPs were more likely than pediatric HCPs to feel there is inadequate time to provide CPS counseling in their practice setting (p = 0.001), and were less likely to know where to refer patients if they have questions regarding CPS issues (0.0291). The differences in HCP attitudes toward CPS counseling provision and the resulting differences in counseling frequency by patient age may contribute to disparities for patients who have limited or no access to pediatric HCPs. Additional research is needed to investigate the rationale for counseling differences seen by HCP specialty and patient age, and the potential effect on child motor vehicle injuries and fatalities.     

Individual Characteristics and Use of Maternal and Child Health Services by Adolescent Mothers in Niger

Despite high rates of early childbearing, maternal mortality, and under-five mortality, little is known about factors that affect access of teenage mothers to maternal and child health (MCH) services in Niger. This paper explores potential factors associated with the utilization of MCH care services by adolescent mothers. Using the third wave of the Niger demographic and health survey (NDHS) 2006, we estimate three multivariate logistic regression models to assess individual characteristics associated with the utilization of antenatal care (ANC) and safe delivery care services among adolescent women, as well as full immunization received by children born to adolescent mothers. The analytical sample includes 934 adolescent mothers out of 1,835 respondents aged 15–19, and within this group, 493 mother–child dyads for children aged 12–59 months. Possessing any level of education was found associated with the increased use of all three selected MCH services, while urban residence and higher income were associated with the increased use of two of three MCH services studied. Higher birth order plus a birth interval more than 2 years for the most recent birth appeared associated with the lower probability of antenatal care visits and safe delivery care. This study finds that women who attended at least four ANC visits were more likely to experience safe delivery care, and the children whose mothers had safe delivery care were more likely to receive full immunization. Therefore, an effective program should be designed to promote a continuum of MCH care with special attention to adolescent women who are uneducated, poor and residing in rural areas.     

Health care access and support for disabled women in Canada: falling short of the UN Convention on the Rights of Persons with Disabilities: a qualitative study

PurposeThe United Nations Convention on the Rights of Persons with Disabilities and other international human rights conventions guarantee the fundamental human rights to physical, social, and psychological health. The purpose of this study was to examine whether these rights are being upheld in Canada for disabled women.MethodsAn interpretive, qualitative, focus group design was employed. Participants were women 18 to 67 years of age with a self-identified physical, sensory, cognitive, and/or psychiatric impairment. Eleven focus groups were conducted with 74 disabled women from urban and rural settings in Northern Ontario, Manitoba, and Nova Scotia. The data were analyzed for themes using a flexible coding system derived from and consistent with the research objectives and the study’s human rights framework.FindingsParticipants described multiple intersecting factors that impeded or facilitated access to health care. Services included both generic health services and impairment-specific services. Participants experienced a number of barriers accessing professionals, support programs, and services. These are described under three broad themes: 1) Labyrinthine health service ‘systems,’ 2) assumptions, attitudes, and discriminatory practices, and 3) inadequate sexual health or reproductive services and supports.ConclusionThe results suggest that Canada falls significantly short of guaranteeing disabled women’s human rights to access health care supports and services. Access barriers resulted from the inefficiencies and complexities of the multiple agencies and programs that disabled women had to navigate, difficulties accessing information on available services, and negative attitudes of some health and social service providers.     

A Latent Class Analysis of Attitudes Towards Asylum Seeker Access to Health Care

In the past decade there has been an increase in focus on the concept of deservingness and how it plays out in debates around health care for migrant populations with precarious legal status. This study uses latent class analysis to identify subtypes of attitudes regarding asylum seeker access to health care and endorsement of support for asylum seeker access to care among 4066 employees of health care institutions in Montreal and Toronto, Canada. Authors identified four classes of attitudes towards asylum seeker access to care named ‘Favorable,’ ‘Opposed,’ ‘Ambivalent/Reactive,’ and ‘Unconcerned/Status quo’. The odds of endorsing access to health care depended on the individual’s class membership of asylum seeker attitude. Although there are segments of the population that overwhelmingly endorse, or reject, asylum seeker access to care, there are important variants in opinions and beliefs. Interventions are needed to engage professionals more ambivalent or opposed to asylum seeker access to care.

     

The Role of School Health Centers in Health Care Access and Client Outcomes

Objectives. We describe the impact of school health centers in Alameda County, California, on adolescents'' access to care and their mental and physical health outcomes.Methods. We used a multimethod evaluation of 12 school health centers to track data on clients (n = 7410), services, and provider-reported outcomes; client pre–post surveys (n = 286); and student focus groups (n = 105 participants).Results. School health centers were the most commonly reported source of medical (30%), family planning (63%), and counseling (31%) services for clients. Mental health providers reported significant improvements (P < .05) from baseline to follow-up in clients'' presenting concerns and resiliency factors. Medical providers and clients also reported general improvements in reproductive health, particularly in the use of birth control other than condoms. Student focus group participants noted that school health centers helped improve access to services students might not seek out otherwise, particularly counseling and family planning services. Furthermore, students noted that they liked school health centers because of their confidentiality, free services, convenience, and youth-friendly staff.Conclusions. School health centers increase access to care and improve mental health, resiliency, and contraceptive use.School-based and school-linked health centers (hereafter “school health centers”) represent a model of care that responds to the unique physical and mental health issues of adolescents by offering care in an accessible, youth-friendly environment. Studies have found that access to school health centers increases use of primary care, reduces use of emergency rooms, and results in fewer hospitalizations.^1–3 School health centers also expand access to and quality of care for underserved adolescents; one study found that school health center users were more likely than were traditional outpatient clients to have received primary and preventive care services despite the fact that they were less likely to be insured.⁴ Furthermore, adolescents with alternate forms of health care report high degrees of comfort-seeking care at school health centers.⁵Adolescent mental health outcomes have also improved because of school health centers. Studies have shown a significant decline in depression among students who received school health center mental health services⁶ and a reduced likelihood of suicide ideation among students attending schools with school health centers.⁷ Studies have also documented the positive impact of school health centers on reproductive health outcomes,⁸ including improved contraceptive use.⁹Although research has demonstrated how the school health center model of care can affect health access and outcomes, many studies have been limited by relatively small sample sizes. Collecting uniform outcome data from larger coalitions of school health centers is challenging, given the obstacles of different school districts, community health providers, service structures, and data confidentiality regulations. Our aim was to demonstrate the impact of 12 school health centers on clients'' access to care, satisfaction, and reproductive and mental health outcomes. We incorporated data collection from both client and provider perspectives through a standardized evaluation process that documents services provided, as well as provider assessments of 2 outcome measures that school health centers have been known to affect: reproductive health and mental health.     

Interprofessional Collaboration in Finnish Residential Child Care: Challenges in Incorporating and Sharing Expertise Between the Child Protection and Health Care Systems

Many children taken into care tend to be in need of psychiatric treatment as well as child protection services, and thus the professional expertise of both systems must be coordinated in their care. However, it is widely known across Europe that collaboration between child protection services and mental health services is not working well and the outcomes for looked-after children are poor. In spite of drastic need for knowledge, interprofessional collaboration between residential workers and mental health practitioners is poorly explored in international research. Most importantly, very little is known about shared expertise in multi-agency teams between these systems. Based on the analysis of interprofessional focus group interviews (eight interviews with 17 practitioners) in Finland, it is claimed that both sides have unrealistic expectations and perceptions of the other professional grouping and its facilities to help high-need children. The study also indicates that the collaboration assumes an equality of status and responsibilities between the professionals that does not always exist amongst residential child care practitioners and mental health professionals. The analysis suggests that the concept of residential child care work itself needs more empirical research to strengthen the interprofessional competencies and enhance child-centred integrated care.     

Access to Oral Health Care: The Role of Federally Qualified Health Centers in Addressing Disparities and Expanding Access

Objectives. We examined utilization, unmet need, and satisfaction with oral health services among Federally Qualified Health Center patients. We examined correlates of unmet need to guide efforts to increase access to oral health services among underserved populations.Methods. Using the 2009 Health Center Patient Survey, we performed multivariate logistic regressions to examine factors associated with access to dental care at health centers, unmet need, and patient experience.Results. We found no racial or ethnic disparities in access to timely oral health care among health center patients; however, uninsured patients and those whose insurance does not provide dental coverage experienced restricted access and greater unmet need. Slightly more than half of health center patients had a dental visit in the past year, but 1 in 7 reported that their most recent visit was at least 5 years ago. Among health center patients who accessed dental care at their health center, satisfaction was high.Conclusions. These results underscore the critical role that health centers play in national efforts to improve oral health status and eliminate disparities in access to timely and appropriate dental services.The “silent epidemic” of poor oral health in America was highlighted by the US Surgeon General’s 2000 report, Oral Health in America, which also called attention to the disparities that persist in oral health status, access to care, and unmet need for dental care.1A Government Accountability Office report from the same year echoed the need to address oral health disparities, noting that oral health problems are the most prevalent chronic disease suffered by children despite being largely preventable.2 As with medical care, numerous studies also have found that both disease burden and access to oral health care are associated with income,3 race and ethnicity,4 language,5 and insurance status and type.6 These factors are associated with barriers to access in underserved communities such as affordability, lack of provider availability, inadequate transportation, and low health literacy around the need for oral health care. Whereas nationally almost 60% of individuals with high incomes had a dental visit in the past year, less than 30% of low-income patients (those with incomes below 200% of the federal poverty level) had a dental visit in the past year.7In the 2011 brief Advancing Oral Health in America, the Institute of Medicine (IOM) offered recommendations for improving access to oral health prevention and treatment services through a variety of mechanisms, including expanding the focus on oral health in primary care settings. Components of the strategy included training primary care providers to screen patients for emergent oral health issues, to assess patient risk for oral health problems, and to refer patients to dental professionals when appropriate. The IOM also called for improving oral health literacy through education efforts aimed at individuals, communities, and health care professionals. For example, community-wide public education campaigns were recommended to enhance awareness and knowledge about the causes and implications of oral disease and the importance of preventive oral health services. Building the health literacy of patients and promoting healthy behaviors may increase patient activation around these issues, especially when coupled with guidance on how to access oral health services in the community.8A subsequent IOM report, Improving Access to Oral Health Care for Vulnerable and Underserved Populations, suggested ways to narrow or eliminate disparities and improve the oral health status of vulnerable populations, guided by the principles that (1) oral health is essential to overall health and, thus, is an important part of comprehensive health care, and (2) any broad strategy to increase access to care should include components aimed at oral health promotion and disease prevention.9 Building on the existing literature, recommendations for improving access to oral health services for underserved individuals included expanding oral health care capacity by encouraging the integration of oral health services into overall health care.10 Improving dental education and training for nondental primary care providers may facilitate such integration.11 Financial and administrative barriers such as the lack of coverage for dental care need to be addressed, while supporting policies that encourage all professionals to practice to the full extent of their training and licensure.12Federally Qualified Health Centers (health centers) play a key role in these strategies as they are uniquely positioned to increase access to oral health services in the communities experiencing the most acute access problems. Health centers provided comprehensive primary care to 19.5 million patients in 2010, while also serving as an affordable and convenient access point to oral health services for underserved communities and populations. More than 3.8 million patients received dental services at health centers in 2010, and there were more than 9.2 million visits to dental providers employed in health centers.13All health centers are required to provide preventive dental services either on site or by referral, and 4 out of 5 health center grantee organizations provided dental services in at least 1 of their sites in 2010, and 62.0% provided emergency dental services on site.14 By enhancing affordability for needy patients and providing other services such as transportation, translation, and case management, health centers address barriers to access for the most vulnerable and underserved patients in the nation. In the report on underserved populations,9 the IOM specifically calls for health centers to utilize a variety of oral health care professionals in addition to dentists, to educate health center providers about best practices in oral health care, and to provide oral health services as part of outreach efforts beyond the walls of the health center.The oral health objectives in Healthy People 2020 are the guideposts for evaluating efforts to improve access to timely dental care and, ultimately, oral health status.15 The oral health goals in Healthy People 2020 seek to reduce the incidence and prevalence of dental problems by reducing delays and barriers to timely prevention and treatment, and 2 of the 17 oral health objectives specifically call for health centers to expand their role as a source of access to dental services. The first objective seeks to increase the proportion of health centers with on-site oral health care programs from 75% in 2007 to 83% by 2020. The second objective seeks to increase the proportion of health center patients that receive oral health services at their health center from 17.5% in 2007 to 33.3% by 2020.16 By 2010, 80% of grantees offered on-site oral health services in at least 1 site14 and 19.5% of health center patients received oral health services at their health center,13 demonstrating progress toward these goals.We examined data from the 2009 Health Center Patient Survey regarding access to oral health services among health center patients. We examined utilization and unmet need for oral health care, along with satisfaction with oral health care among health center patients.     

Health Department Services for Preschools and Day Care Centers

The DuPage County Health Department developed a program for preschool and day care centers that would assist in the early identification of health problems and provide educational resources and programs for children, parents and staff. The program is based on the premise that the earlier the recognition and treatment of health problems, the greater the child's wellness and ability to learn. The program is carried out by public health nurses who provide services to the preschools and day care centers in accordance with a written agreement. The agreement defines services offered and provisions for delivering them.     

Unmet Health Care Needs Among Children with Special Health Care Needs Enrolled in Tricare

TRICARE provides health care benefits to nearly two million children of active duty, retired, National Guard, and reserve service members. Child health advocates and congressional reports have raised questions regarding the adequacy access to care for children with military health benefits, particularly children with special health care needs (CSHCN). The objective of this study was to compare the health care experiences of CSHCN in TRICARE with those of CSHCN with other sources of health insurance. A cross-sectional analysis comparing unmet health care needs among CSHCN with TRICARE versus CSHCN with other sources of health insurance using nationally representative data from three years of the National Survey of Children’s Health (NSCH), 2016-2018. The NSCH includes a broad range of questions related to child health and health care to provide national level estimates, and the data allow for comparisons between insurance coverage groups and TRICARE. The survey data contain responses from over 100,000 parents or primary caregivers (parents) of children, representative of over 73 million children annually. This includes 804 children who were representative of approximately 367,000 CSHCN covered by TRICARE annually. Children with special health care needs. Overall, 21 percent (95% CI 19-24 percent) of parents of children covered by TRICARE reported their child had a special health care need, compared to 16 percent of children with commercial insurance (95% CI 15-16 percent) and 24 percent of children with public insurance (95% CI 23-25 percent). Eight percent of parents of CSHCN covered by TRICARE (95% CI 4-16 percent) reported any unmet health care needs in the prior 12 months, compared to 4 percent of CSHCN with private insurance (95% CI 4-5 percent) and 9 percent of CSHCN with public insurance (95% CI 8-11 percent). Among specific needs, 3 percent or fewer CSHCN covered by TRICARE had unmet needs for medical, dental, vision, hearing, or mental health care. Similarly, 5 percent or fewer reported difficulty or delays in getting services because of eligibility for coverage of the service, availability in the area, difficulty in getting an appointment, or cost. About 11 percent of parents of CSHCN covered by TRICARE reported usually or always being frustrated in getting needed services for their child during the prior 12 months, compared to 4 percent of those with private insurance and 9 percent of those with public insurance. About 12 percent of parents of CSHCN covered by TRICARE reported problems with paying for their child’s health care needs in the prior 12 months, compared to 23 percent of those with private insurance and 8 percent of those with public insurance. TRICARE is largely meeting the needs of the CSHCN for whom it provides benefits, but there are opportunities for improvement. CSHCN in TRICARE face higher rates of unmet needs than privately insured children, and their parents face higher levels of frustration in getting needed services. TRICARE should continue to work with families of CSHCN to identify specific unmet needs and sources of frustration with getting needed services.     

Dual Loyalty in Prison Health Care

Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities.Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services.Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners.DUAL LOYALTY IS AN ETHICAL dilemma commonly encountered by health care professionals caring for persons in custody.1,2 Dual loyalty may be defined as clinical role conflict between professional duties to a patient and obligations, express or implied, to the interests of a third party such as an employer, an insurer, or the state.1 The dual loyalty practitioners most commonly face in prison is between their patients and the prison administration or the state authority.1 We aim to shed light on the problem of dual loyalty in prison health care and to identify measures to reduce and solve the problem.     

The therapeutic value of fees: What do practitioners believe?

Theorists have proposed that out-of-ocket fee payment helps clients benefit from psychotherapy. 159 staff members of a public mental health agency completed a fee attitude survey. Aggregate results indicated neutral beliefs. Significant differences appeared by gender, population served, and organizational role. Women were less likely than men to endorse TVF beliefs. Addiction services staff held strongest TVF beliefs, child and adult mental health staffs were neutral, and victim services staff rejected TVF beliefs. Clinical service providers were less likely to endorse TVF concepts than were clinicians in management roles, and non-clinical support staff held the strongest TVF beliefs. By understanding the relationships between fee attitudes, organizational role, and populations served, mental health administrators may be better able to manage changes in fee procedures.     

山西省县级妇幼保健机构卫生人力资源现状分析及对策

目的了解山西省县级妇幼保健机构卫生人力资源发展现状,探讨县级妇幼卫生人力资源发展存在的主要问题,为合理配置妇幼卫生人力资源提供依据。方法借助国家妇幼保健中心机构监测信息网络直报系统,对全省2009年度119所县(市、区)级妇幼保健机构妇幼卫生人力资源进行描述性分析。结果卫生技术人员达标率低,分布不平衡;人员学历结构不合理,职称结构欠佳;继续教育和经费投入各地相差较大。结论科学配置人才队伍,加强培训力度,增加继续教育经费,提高妇幼卫生技术人员素质。     

Unmet Need and Problems Accessing Specialty Medical and Related Services Among Children with Special Health Care Needs

OBJECTIVES: To extend what is known about parent reports of their child's need for specialty medical and related services, unmet need, and specific types of access problems among children with special health care needs (CSHCN). METHODS: Using data from a 1998-1999 20-state survey of families of CSHCN, we examined differences in parent report of need for services by child characteristics, investigated parent report of unmet need and access problems by service area and number of services needed, and estimated the likelihood of four access problems and unmet need by child, family, and health insurance characteristics. RESULTS: Overall, the sample children had numerous service needs, although the prevalence of need varied by service type and child characteristics. Reports of unmet need were greater for older children and for children with multiple service needs, unstable health care needs or a behavioral health condition, parents who were in poor health or had more than a high school education, and families whose insurance coverage was inconsistent or lacked a secondary plan. Reports of access problems were greatest for mental health and home health services. The two most prevalent access problems were finding a skilled provider and getting enough visits. CONCLUSIONS: The results underscore the importance of finding new ways to link children with behavioral health problems to mental health services, implementing coordinated care and the other core dimensions of the medical home concept, increasing the number of specialty pediatricians and home health providers, and expanding coverage for a wider range of mental health services.     

Maternal Care Coordination for Migrant Farmworker Women: Program Structure and Evaluation of Effects on Use of Prenatal Care and Birth Outcome

Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant-specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first-trimester entry into prenatal care and number of prenatal visits increased over a five-year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period. The results of this study suggest that migrant health centers should focus on employing public health-oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard-to-reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant farmworkers.     

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes.Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique.Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English.Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings.Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient–provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient–provider interactions and health outcomes than treatment processes.Conclusions. Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color.PLAIN-LANGUAGE SUMMARY: Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. Negative implicit attitudes about people of color may contribute to racial/ethnic disparities in health and health care. We systematically reviewed evidence on implicit racial/ethnic bias among health care professionals and on the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Fifteen relevant studies were identified through searches of bibliographic databases and reference lists of studies that met inclusion criteria. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient–provider interactions, treatment decisions, treatment adherence, and patient health outcomes.In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes.1–3 Compared with Whites, people of color face more barriers to accessing care, which includes preventive services, acute treatment, and chronic disease management.4 People of color are also generally less satisfied with their interactions with health care providers. The National Healthcare Disparities Report showed that White patients received better quality of care than Black American, Hispanic, American Indian, and Asian patients.4 Dominant communication styles, fewer demonstrated positive emotions, infrequent requests for input about treatment decisions, and less patient-centered care seem to characterize patient–provider interactions involving people of color.4–6People of color also face disparities in terms of morbidity, mortality, and health status. Black Americans, Hispanic Americans, and American Indians have higher infant mortality rates than White and Asian Americans.1 The premature death rate from heart disease and stroke is highest among Black Americans. In addition, numerous disparities in health conditions and risk behaviors exist among people of color, including asthma, cigarette smoking, diabetes, early childbearing, HIV/AIDS, hypertension, low birth weight, obesity, periodontitis, preterm births, and tuberculosis.1,4 Black Americans, Hispanic Americans, and American Indians were more likely to rate their health as fair or poor, and reported more days of feeling unwell in the past month, compared with White and Asian Americans.1 Despite all of the advancements in health care in the past century, disparities based on race and ethnicity persist in access to health care, quality of care received, disease incidence and prevalence, life expectancy, and mortality.     

The Health Attitudes of Young Hispanic Women and the Health Status of Their Children on the Texas-Mexico Border

In this paper our objective was to identify child health problems as observed by young Hispanic mothers living along the Texas-Mexico border. Samples of 300 young Hispanic women living in each of the twin cities of El Paso and Juarez were interviewed regarding their knowledge, attitudes, and experiences with respect to birth control, pregnancy, maternal and child health, and health care services. Only 35 women in El Paso and 50 in Juarez were ever pregnant and their attitudes toward health issues were compared to the never pregnant women. Those with living children were also asked about the health problems they had observed in their children. The results indicate that the ever pregnant women were more positive toward both family planning and child bearing than were their never-pregnant peers. The ever-pregnant women were also less confident in family planning techniques. The mothers in Juarez generally reported more observed illness symptoms in their children than did the El Paso mothers.     

Care Coordination Impacts on Access to Care for Children with Special Health Care Needs Enrolled in Medicaid and CHIP

Children with special health care needs (CSHCN) often require services from multiple health care providers. This study’s objective is to evaluate whether CSHCN, enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) and receiving care coordination services, experience improved access to mental and specialty health care services. Using data from the 2009–2010 National Survey of Children with Special Health Care Needs, two separate outcomes are used to evaluate children’s access to care: receipt of needed mental and specialty care and timely access to services. Using propensity score matching, CSHCN propensity for receiving care coordination services is derived and an assessment is made of care coordination’s impact on the receipt of health care and whether care is delayed. Results demonstrate that care coordination is positively associated with whether a child receives the mental and specialty care that they need, regardless of whether or not that coordination is perceived to be adequate by parents. However, receiving care coordination services that parents perceive to be adequate has a larger impact on the timeliness in which care is received. This study indicates that care coordination is associated with an increased ability for CSHCN to access needed mental and specialty care. States should consider offering care coordination services that support provider communication and fulfill families’ coordination needs to the CSHCN enrolled in their Medicaid and CHIP programs.     

Future issues in Children's Health Care: Addressing Psychosocial Concerns

A panel of experts, participating in a Delphi poll, identified significant issues facing psychosocial aspects of health care for children in the future In three rounds of feedback and evaluation, ten top future issues were composited in rank order chronic illness and complex health care needs, sociogenic problems, unequal access to health care, lack of financial resources for psychosocial services, increased focus on prevention, children without primary caregivers, complex ethical questions, family-centered care, training of health care professionals, and interdisciplinary integration Implications of these issues are discussed.