Różnice między miastem a wsią w dostępie do opieki zdrowotnej u dzieci z epilepsją: identyfikacja czynników związanych z odpowiednią opieką medyczną
Urban-rural differences in healthcare access among children with epilepsy: identifying factors associated with adequate care using the National Survey of Children's health
W skrócie
Badanie wykazało, że dzieci z epilepsją mają trudności w dostępie do opieki lekarskiej oraz gorszą komunikację z lekarzami w porównaniu z dziećmi zdrowymi, głównie ze względu na brak uważnego słuchania przez personel medyczny i niedostateczne wyjaśnianie informacji. Nie stwierdzono większych różnic w dostępie do opieki między dzieć z epilepsją mieszkającymi na wsi a tymi z miast. Badacze rekomendują poprawę komunikacji między lekarzami a rodzicami oraz usprawnienie procesu dostępu do usług medycznych.
Oryginalny abstract (angielski)
BACKGROUND: Epilepsy, affecting approximately 470,000 U.S. children, is associated with higher comorbidities, increased mortality, and limited access to specialized care. This study identifies gaps in access and quality of care between rural and urban children with epilepsy (CWE) using the National Survey of Children's Health. We evaluated differences in care between children with and without epilepsy, and between rural and urban CWE, aiming to clarify the factors linked to adequate care. METHODS: We conducted a cross-sectional analysis of 2021-2023 National Survey of Children's Health (NSCH) data, representative of U.S. children aged 0-17 years. Children were classified by parental report of an epilepsy diagnosis. Outcomes included healthcare access (insurance, personal doctor, specialist visits, referral difficulty) and patient- and family-centered care (PFCC) measures. Survey weights and design-based χ2 tests compared children with and without epilepsy, and rural-urban differences among CWE. RESULTS: Of 145,720 children, 888 (0.6%) had epilepsy; 11.6% resided in rural areas. CWE were more likely to have a personal doctor, but parents more often reported frustration accessing services. PFCC ratings were lower for CWE, including statements of 'providers who always listened carefully', 'showed sensitivity to family values', and 'provided needed information'. No significant rural-urban differences were found among CWE. CONCLUSION: Caregivers of CWE reported lower PFCC in listening, cultural sensitivity, and provision of information, alongside greater frustration accessing services. Improving provider-caregiver communication and streamlining service access may enhance satisfaction and continuity of care. Limitations include a lack of epilepsy severity data and a small epilepsy subsample. Future research should incorporate standardized satisfaction measures and detailed clinical data to guide interventions.