Researchers in Milwaukee at the Medical College of Wisconsin and Children's Hospital of Wisconsin Center for Advancement of Underserved Children studied outcomes data on 38,886 children with special healthcare needs (CSHCN) in the National Survey of CSHCN. They found that 13 percent of black parents and 17 percent of Hispanic parents were dissatisfied with their child's care, in contrast to only seven percent of white parents. They also found that over one-third of black or Hispanic parents reported problems with ease of using health care services, compared to less than one-fourth of white parents.
The team identified parental interview language as the key factor in Hispanic parents' dissatisfaction with care and ease of use of services. Hispanic/white disparities in both satisfaction with care and ease of use disappeared when a statistical adjustment was made for interview language. Similarly, they found inadequacy of family-centered care the key factor in black /white disparities in satisfaction with care. However, black/white disparities in ease of use persisted.
"Our results underscore the importance of providing adequate medical interpreter services for Latino families of CSHCN, and the significance of providing adequate family-centered care and making services easier to use for black families," says principal investigator Emmanuel M. Ngui, Dr.PH.
Dr. Ngui is an assistant professor of pediatrics, epidemiology, and health policy in the Center. The Center's director, Glenn Flores, M.D., FAAP, associate professor of pediatrics, co-authored the study.
"Previous studies have linked family-centered care factors such as adequate listening, respect, trust and participatory decision-making to greater satisfaction with care among black adults, compared to other racial/ethnic groups," says Dr. Ngui "However, it is not clear why black/white disparities in ease of using healthcare services persist after adjusting for this and other factors studied, such as socio-demographics, insurance, the child's condition severity/stability and having a personal doctor or nurse. It may be that other, unmeasured factors, such as attitudes, discrimination, transportation barriers, waiting times and limited availability of specialized providers or services in minority communities contribute to this disparity."
For all parents, difficulty in using services was three times more likely to be associated with dissatisfaction with care, and lack of insurance coverage was associated with twice the odds of dissatisfaction with care. However, public insurance was the only factor that seemed to protect against reported difficulty in using health care services. Compared with parents of CSHCN with private insurance, parents of publicly-insured CSHCN had significantly lower odds of reporting problems in ease of use of services.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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