Disparities in Primary Care Access for Infants: Implications for Medical Home Development for Infants
DOI:
https://doi.org/10.12974/2311-8687.2016.04.01.3Keywords:
Maternal and infant health, disparities, medical home, PRAMS.Abstract
Background: Medical homes are proposed to provide a new standard of primary care that is comprehensive, family centered, and coordinated. Disparities in access to medical homes may affect healthcare outcomes among populations that include infants, children, and caregivers. This study examined disparities among pregnant mothers in a Midwestern state in the United States of America (USA) with regard to self-reported medical home access for their infants.
Method: Data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of maternal behaviors, were analyzed. Medical home access was determined by the respondents answering a question about whether their child had a personal doctor or nurse familiar with their medical history.
Results: A series of Cochran-Mantel-Haenszel Chi-Square (?2) tests revealed that medical home access differed significantly across race, marital status, education, age, income, insurance status of infant, and prenatal care transportation availability. Multiple logistic regression results showed that mothers who had education higher than a high school diploma, mothers with an annual household income of $50,000 or more and mothers whose infants had health insurance were more likely to report access to a medical home for their infant. Mothers with an annual income of less than $20,000 and no transportation were less likely to report access to a medical home.
Conclusion: Similar to other disparity research, our analyses highlighted that pregnant mothers with less education, less income, mothers without insurance for their infants, and pregnant mothers without transportation reported less access to a medical home. The present study indicates a need to continue to examine implications of medical home access for pregnant mothers.
References
Disabilities C. o. C. W. Care Coordination: Integrating Health and Related Systems of Care for Children With Special Health Care Needs. Pediatrics 1999; 104(4): 978-981. http://dx.doi.org/10.1542/peds.104.4.978 DOI: https://doi.org/10.1542/peds.104.4.978
Committee M. H. I. f. C. W. S. N. P. A. The Medical Home. Pediatrics 2002; 110(1): 184-186. http://dx.doi.org/10.1542/peds.110.1.184 DOI: https://doi.org/10.1542/peds.110.1.184
Starfield B and Shi L. The Medical Home, Access to Care, and Insurance: A Review of Evidence. Pediatrics 2004: 113(Supplement 4); 1493-1498. DOI: https://doi.org/10.1542/peds.113.S4.1493
Beal A, Doty M, Hernandez S, SheaK and Davis K. Closing the Divide: How Medical Homes Promote Equitable Care: Results from the Commonwealth Fund 2006 Health Quality Survey: Commonwealth Fund 2007.
Phares TM, Morrow B, Lansky A, Barfield WD, Prince CB, Marchi KS and Kinniburgh B. (2004). Surveillance for disparities in maternal health-related behaviors-selected states, Pregnancy Risk Assessment Monitoring System (PRAMS). MMWR Surveill Summ 2000-2001; 53(4): 1-13. DOI: https://doi.org/10.1037/e307152005-001
Hayes DK, Ta VM, Hurwitz EL, Mitchell-Box KM and Fuddy LJ. Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander Women in Hawaii: Pregnancy Risk assessment monitoring system (PRAMS), 2004-2007. Maternal and Child Health Journal 2010; 14(5): 765-773. http://dx.doi.org/10.1007/s10995-009-0504-z DOI: https://doi.org/10.1007/s10995-009-0504-z
Carr SC and Sloan TS. Poverty and psychology: From global perspective to local practice: Springer Science and Business Media 2003. http://dx.doi.org/10.1007/978-1-4615-0029-2 DOI: https://doi.org/10.1007/978-1-4615-0029-2
Mullins LL, Wolfe-Christensen C, Chaney JM, Elkin TD, Wiener L, Hullmann SE, et al. The relationship between single-parent status and parenting capacities in mothers of youth with chronic health conditions: The mediating role of income. Journal of Pediatric Psychology 2011; 36(3): 249-257. http://dx.doi.org/10.1093/jpepsy/jsq080 DOI: https://doi.org/10.1093/jpepsy/jsq080
Smith L. Psychotherapy, classism, and the poor: conspicuous by their absence. American Psychologist 2005; 60(7): 687. http://dx.doi.org/10.1037/0003-066X.60.7.687 DOI: https://doi.org/10.1037/0003-066X.60.7.687
The Child and Adolescent Health Measurement Initiative; Oregon Health and Science University. (2009). Measuring Medical Home for Children and Youth: Methods and findings from the National Survey of Children with Special Health Care needs and the National Survey of Children's Health. CDK PO#300614801-01. Retrieved August 31, 2015, from: https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent /Managed%20Care%20Organization/OBMH/OBMHome.htm. spage.
Centers for Disease Control and Prevention. PRAMS model protocol, 2009 Version. Retrieved September 20, 2013, from www.cdc.gov/prams/Methodology.
Shulman H, Colley Gilbert B and Lansky A. The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluations of 2001 response rates. Public Health Rep 2006; 121: 74-83. DOI: https://doi.org/10.1177/003335490612100114
Strickland BB, Jones JR, Ghandour RM, Kogan MD and Newacheck PW. The Medical Home: Health Care Access and Impact for Children and Youth in the United States. Pediatrics 2011; 127(4): 604-611. http://dx.doi.org/10.1542/peds.2009-3555 DOI: https://doi.org/10.1542/peds.2009-3555
Raphael JL, Guadagnolo BA, Beal AC and Giardino AP. Racial and Ethnic Disparities in Indicators of a Primary Care Medical Home for Children. Academic Pediatrics 2009; 9(4): 221-227. http://dx.doi.org/10.1016/j.acap.2009.01.011 DOI: https://doi.org/10.1016/j.acap.2009.01.011
Fedele DA, Molzon ES, Eddington AR, Hullmann SE, Mullins LL and Gillaspy SG. Perceived barriers to care in a pediatric medical home: the moderating role of caregiver minority status. Clin Pediatr 2014; 53(4): 351-355. http://dx.doi.org/10.1177/0009922813507994 DOI: https://doi.org/10.1177/0009922813507994
Oklahoma Health Care Authority (2009). Annual Report: 825,000 Oklahomans are counting on us. Retrieved October 18, 2011, from www.okhca.org.
