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J Nurs Scholarsh. 2019 Jul 8. doi: 10.1111/jnu.12499. [Epub ahead of print]

Socioeconomic Status and Health Services Utilization for Children With Complex Chronic Conditions Liable to Receive Nurse-Led Services: A Cross-Sectional Study.

Author information

1
Faculty of Health Sciences, Department of Nursing, Universidad de Granada, Spain.
2
Faculty of Health Sciences, Department of Nursing Spain, Instituto de Investigación Biomédica de Málaga, Spain.
3
Hospital Materno-Infantil, Málaga, Spain; Clinical lecturer, Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain.
4
Distrito Sanitario Málaga-Valle del Guadalhorce, Universidad de Málaga, Clinical lecturer, Faculty of Health Sciences, Department of Nursing, Spain, Instituto de Investigación Biomédica de Málaga, Spain.
5
Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain.
6
Universidad de Málaga, Faculty of Health Sciences, Department of Nursing Spain;, Instituto de Investigación Biomédica de Málaga, Spain.

Abstract

AIM:

To analyze the use of health services for children with severe chronic diseases, seeking to identify patterns of use according to sociodemographic and clinical conditions, and to identify unmet needs of care coordination that could benefit from nursing case management services.

DESIGN:

Cross-sectional study.

METHODS:

Children treated in ambulatory and hospital care in Granada, Spain, with complex chronic diseases in 2016 were analyzed to determine their use of healthcare resources. Socioeconomic variables were evaluated, along with clinical status and duration of their conditions.

RESULTS:

In total, 265 children were analyzed (mean age 7.3 years, SD 4.63; 56.6% male). The average duration of the disease was 63.26 months (SD 54.09). The most common types of disease were neurological (35.80%), congenital (23.90%), and oncological (18.90%). Multivariate analysis showed that children in need of advanced care (β = 0.71), with a relatively recent diagnosis (β = -0.11), with criteria for palliative care 1 (β = -0.26), and whose mothers were older (β = 0.36) and had a higher educational level (β = 0.19) made greater use of healthcare resources during the preceding 12 months, whether urgent or scheduled (r2 = 78.0%, p < .001).

CONCLUSIONS:

Children with higher needs for advanced care have a heterogeneous use of healthcare resources depending on certain clinical and sociodemographic determinants. This finding highlights the importance of the identification of profiles of children and families for care coordination. The presence of sociodemographic determinants may need individualized approaches to assure a timely health care utilization.

CLINICAL RELEVANCE:

A significant proportion of the children used multiple health services, being treated at several centers simultaneously, and producing up to 139 total yearly contacts with the health system. Policymakers, healthcare providers, and patients' families should engage in a redesign of healthcare services for these children, providing comprehensive and coordinated systems of care for this population.

KEYWORDS:

Case management; child health services; chronic disease; healthcare disparities; hospice and palliative care nursing; multimorbidity; pediatric nursing; socioeconomic factors

PMID:
31282095
DOI:
10.1111/jnu.12499

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