Hospital and emergency department use by young low-income children

BACKGROUND

Limited data are available concerning determinants of health care service usage by low-income young children.

OBJECTIVES

To explore predictors of hospitalization and emergency department (ED) use by young children of low-income families by using the Aday and Andersen Access Framework.

METHODS

Low-income women (n = 474) with a child younger than 6 years completed a structured face-to-face interview at human service offices or Women, Infants, and Children (WIC) clinics in four central Ohio counties. Women were considered low-income if they or their child were Medicaid eligible or uninsured. Data were collected for both the mother and the index child on sociodemographic status, health services use, health status, and access to care.

RESULTS

Fifteen percent of the children had been hospitalized the previous year, and half had an ED visit. Hospitalization was significantly related to maternal hospitalization the previous year (OR = 2.5), child age younger than 1 year old (OR = 2.1) and more than two chronic conditions (OR = 2.2). Maternal ED usage in the last year (OR = 2.2), Medicaid fee for service plan (OR = 1.7), and rural residence (OR = 2.0) were predictive of ED use.

CONCLUSIONS

Predisposing characteristics (maternal hospital/ED use) were predictive of both hospitalization and ED use by the index child. Enabling characteristics (fee-for-service Medicaid plan, rurality) were only predictive of ED use, and need characteristics (child's health) were only predictive of hospitalization. Further research to explore linkages between maternal and child use of health care services as well as the effect of changes in health care access, managed care, and other innovations on hospitalization and ED use in young, low-income children is recommended.

Self-reported health status of low-income mothers

PURPOSE

To determine the self-reported health status of low-income mothers before major health and welfare policy reform in the state of Ohio, to compare the health status of this group with the general population age-based norms, and to examine differences in health status among insurance and racial subgroups. Policy makers and others have a need for key health-status information about low-income mothers, a topic for which little empirical data currently exist.

DESIGN

Descriptive using a cross-sectional survey with convenience sampling; 502 women were interviewed at intake sites in four countries in central Ohio, 1995 to 1996.

METHODS

Health status was measured using the general health status index developed by J. E. Ware and colleagues (1995). Two summary measures, one indicating physical health and one indicating mental health, were used and compared with published norms. Multivariate logistic models were examined for depression and physical health status.

FINDINGS

A significant level of depression in the population of low-income mothers was found as were differences in physical health scores by insurance group. People insured privately had the highest physical health scores, while those enrolled in fee-for-service Medicaid had scores indicating the poorest health. No significant difference was found between racial groups in self-reported health status.

CONCLUSIONS

Self-reported mental health status is low among some low-income female populations. Physical health is worse for the Medicaid-enrolled group compared to both uninsured and privately insured groups. This poor state of health will likely diminish the success of welfare reform to improve the economic self-sufficiency of these women unless comprehensive health services are available.

Preventive health counseling reported by uninsured women with limited access to care

Low-income women in the childbearing years are at an increasing risk of becoming uninsured as welfare reforms are enacted and women enter minimum-wage jobs without insurance benefits. This study contrasts preventive counseling reported by low-income uninsured mothers and mothers insured through Medicaid. Low-income women attending Women, Infant, and Children (WIC) clinics and human services offices who had received health care during the previous 12 months (N = 406) were asked if they had received counseling from a health provider regarding any of seven types of preventive health behaviors. Uninsured women were less than half as likely to receive counseling on three or more preventive topics (OR = 0.42) as were mothers on Medicaid. Risk estimates were stable on bivariate analyses and logistic regression models. Findings indicate that opportunities for preventive health counseling need to be maximized for this group already experiencing compromised access to care.

Dental utilization by low-income mothers

OBJECTIVE

This study examines the influence of predisposing, enabling, and need variables on whether low-income mothers sought dental care during the past year. This report is a substudy of mothers and children on their self-reported health status, utilization, access, and satisfaction with health care in general.

METHODS

A convenience sample of 502 mothers and youngest child younger than 6 years old was administered a face-to-face questionnaire in four Ohio counties. Information was collected at county human services offices and WIC clinics between November 1995 and July 1996. Using whether or not the mother sought dental care as the dependent variable, logistic regression models were created for the variables within the predisposing, enabling, and need characteristics separately and together.

RESULTS

Fewer than one-half of the mothers sought dental care during the past year. Variables associated with the predisposing characteristic explained little about who sought care. Those mothers who have Medicaid coverage are 2.7 times more likely to have a dental visit than those without insurance. Moreover, those mothers who perceive any dental need are several times less likely to have received dental care than those who have no perceived need.

CONCLUSIONS

Even among a somewhat homogeneous population of low-income women, source of payment for dental services and perceived need for dental care are discriminating variables in determining who seeks dental care.

Sexual activity and knowledge of safe sex reported by HIV-infected persons receiving home care

Sexual activity and knowledge of safe sex were assessed for 57 human immunodeficiency virus (HIV)-infected persons on admission to home care. More than one third of the individuals providing information were sexually active; 72% of the sexually active persons reported that they practiced safe sex. Definitions of safe sex were inconsistent, particularly regarding safety of oral sex. Needs for counseling on safe sex of HIV-infected persons receiving home care practices were clearly evident.

Quality of life in nurse case management of persons with AIDS receiving home care

Effects of case management on quality of life were tested with 57 home care patients with AIDS, randomly assigning individuals to either usual care or case-managed care over the duration of home services (ranging from 5 days to over 2 years). Participants were primarily male (93%), white (79%), and never married (82%). Quality of life was measured monthly using the quality of Well-Being Index (QWB). Case-managed patients showed advantages over the usual care group in descriptive analyses of quality of life and survival. Large standard deviations in the QWB scores resulting from high fatality among subjects impeded statistical analyses of effects.

Missed opportunities to immunize preschoolers

Local health departments (n = 122) and private physician offices (n = 90) responded to a mailed survey assessing practices of immunizing children presenting with any of 17 conditions identified in the literature as invalid contraindications to immunizations. More than 30% of both provider groups withheld immunizations in the presence of six conditions identified as invalid, specifically tuberculosis, current antimicrobial therapy, recent exposure to infectious disease, mild diarrheal illness in an otherwise well child, any convalescent phase of an illness, and current or recent mild illness. These findings document provider contributions to the problem of inadequate childhood immunizations and underscore the importance of improved provider education on immunization practices.

Inadequate immunization among 2-year-old children: a profile of children at risk

A community survey was conducted to assess the immunization status of 2-year-old children and barriers to immunization. The 299 respondents were more affluent and well-educated than the general population. Eighty-three percent of the respondents received immunizations from private physicians. Only 31.1% of the children were age-appropriately immunized with deficiencies primarily in receiving the 18-month dosages of diphtheria-tetanus-pertussis (DTP) and polio. Parents reported multiple barriers and beliefs about immunization amenable to change by health providers. A profile of risk factors differentiating nonimmunized from immunized children was developed.

Immunization status of 2-year-olds in middle/upper- and lower-income populations: a community survey

Immunization rates of preschool children in the United States are well below recommended levels. Whereas low-income and minority groups have been targeted as at risk for inadequate immunization, the assumption is generally made that middle/upper-income children are adequately immunized through the private sector. We conducted a community-based survey that refutes this assumption. Only 31% of the 302 parents surveyed reported full immunization of their 2-year-olds. No significant differences were found in the immunization rates for middle/upper-income (34% immunized) versus lower-income children (28% immunized). Failure to receive the 18-month doses of DTP and polio was the most frequent cause of inadequate coverage for both groups. Barriers to immunization reported by middle/upper- and lower-income parents were similar, with over one-third of the parents identifying cost and lack of insurance coverage as problems. Additional barriers related to methods of operations of providers. Findings have immediate implications for public health nurses in terms of assessing coverage of their own preschool populations and introducing corrective actions to improve levels of immunization.

Why aren't preschoolers immunized? A comparison of parents' and providers' perceptions of the barriers to immunizations

A community-wide survey of 302 parents of 2-year-old children and 90 private medical practitioners in a large midwestern city revealed low immunization rates (31%) and differences in parent and provider perceptions of barriers to preschool immunizations. Parents most frequently identified barriers of system factors such as cost, lack of insurance coverage, and long office waits. System barriers were reported across differing sources of immunizations (private physician as well as public clinics) and were pervasive across income groups. Providers were more likely to report barriers of parental difficulties with forgetting immunizations or not knowing when the immunizations were due. Even though providers identified parental shortcomings with scheduling as problematic, only one fifth employed tracking and reminder systems. Implications of findings for modifications of the delivery of immunization services and for parent education are discussed.

Assuming responsibility for one's health: an analysis of a key assumption in Nursing's Agenda for Health Care Reform

Nursing's proposal for health care reform includes an expanded role for the consumer of health care and an emphasis on personal responsibility for health. This shift in the philosophic underpinnings of the health care delivery system is a significant change from our current system. The impact and importance of this shift should not be underestimated. This article has begun an analysis of this shift by addressing three questions--why include these responsibility tenets now, what does personal responsibility in the context of health mean, and what are the consequences of including personal responsibility in a health care reform package? Nursing's Agenda for Health Care Reform is an important step forward in suggesting changes to our present health care delivery system. It broadens the scope of reform to include the consumer of health care as a major component of this reform. But the profession has to be clear on what the role of the individual is. While the individual is key to any successful change, nursing must be ever vigilant that the reform proposal is not used to justify unintended and harmful consequences.

Home health care services for AIDS patients: one community's response

The AIDS epidemic has challenged communities to develop and mobilize care networks for persons infected with the human immunodeficiency virus (HIV). A major part of that mobilization has been a push toward community- and home-based services. The movement of HIV care to the home/community setting is occurring, however, without investigation of either the problems that this change engenders for agencies providing care or the agencies' responses to these problems. This article from one health care market suggests that home care agencies may not be well positioned to meet the cyclical needs of HIV patients, that care is becoming increasingly fragmented with multiple agencies seeking to patch together a program of comprehensive services, and that agency policies may be limiting the numbers of community-based HIV patients eligible for home care.

AIDS research in the community: a case study in collaboration between researchers and clinicians

This paper presents a practical guide for researchers-academicians and clinicians who are considering the development of a collaborative community-based project. It reports on a federally funded project developed by nurse-researchers at a large midwestern university and the nurse clinician directing home care services at the city health department. The focus of this study is to determine the service needs and to evaluate the effectiveness of a case management protocol for persons who are positive for the human immunodeficiency virus and in need of home care.