188宝金博页面版

Parental Information, Motivation, and Adherence BehaviorsAmong Children with Sickle Cell DiseaseJean L. Raphael, MD, MPH a , Ashley M. Butler, PhD c , Tiffany L. Rattler, BS a , Marc A.Kowalkowski, MS b , Brigitta U. Mueller, MD, MHCM a , and Thomas P. Giordano, MD, MPH ba Department of Pediatrics, Baylor College of Medicine, Hematology/Oncology, Houston, TXb Department of Medicine, Baylor College of Medicine, Houston, TXc Department of Pediatrics, Baylor College of Medicine, Psychology, Houston, TXAbstractBackground—Identification of psychosocial correlates of health care utilization has become animportant strategy in improving clinical care. The objective of the study was to examine the fit ofthe Information-Motivation-Behavioral Skills (IMB) model, applied to health care utilizationamong children with sickle cell disease (SCD).Procedure—Participants were parents of 150 children, ages 1 to 17 years, receiving care in asickle cell center. Parents completed questionnaires assessing information, motivation, adherencebehaviors, and other factors with respect to SCD management. Data regarding health careutilization in the previous 12 months were obtained from parent report and electronic medicalrecords. Stepwise multiple regression analysis was conducted to determine associations betweenIMB factors and health care use.Results—Parents rated highly in the domains of information, motivation, and adherencebehaviors for managing their child’s SCD. Children of parents reporting higher satisfaction withsocial supports had higher odds (OR 1.49, 95% CI 1.03–2.15) of 2 or more routine hematologyvisits in the previous 12 months. Neither information nor adherence behavior was associated withurgent or routine care use. Among other variables measured, high parental illness-related stressand child health status reported as fair/poor were the strongest predictors of urgent care use whileprivate insurance type was the strongest predictor of routine care use.Conclusions—Among IMB factors, social support was associated with routine health careutilization. Social support and parental illness-related stress may serve as important, modifiabletargets in interventions to allocate needed resources to families and reduce unnecessary medicalcare.KeywordsSickle cell disease; Epidemiology; Outcomes research; Health Care UtilizationContact: Jean L. Raphael, MD, MPH, Suite D.1540.00, Texas, Children's Hospital, 6701 Fannin Street Houston, TX 77030, Phone:(832) 822-1791, Fax #: (832) 825-3435, Raphael@bcm.edu.Conflict of Interest StatementThe authors declared no financial interests related to this work.NIH Public AccessAuthor ManuscriptPediatr Blood Cancer . Author manuscript; available in PMC 2014 July 01.Published in final edited form as:Pediatr Blood Cancer . 2013 July ; 60(7): 1204–1210. doi:10.1002/pbc.24466.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript