Disparities in pediatric psychosocial oncology utilization

被引:4
作者
Zheng, Daniel J. [1 ,2 ,10 ]
Umaretiya, Puja J. [3 ,4 ,5 ,6 ]
Schwartz, Emily R. [6 ,7 ]
Al-Sayegh, Hasan [1 ,3 ,4 ]
Raphael, Jean L. [8 ]
van Litsenburg, Raphaele R. L. [9 ]
Ma, Clement [1 ,3 ,4 ,6 ,11 ]
Muriel, Anna C. [5 ,6 ]
Bona, Kira [1 ,3 ,4 ,6 ]
机构
[1] Boston Childrens Hosp, Dept Pediat, Boston, MA USA
[2] Boston Med Ctr, Dept Pediat, Boston, MA USA
[3] Dana Farber Canc Inst, Dept Pediat Oncol, Boston, MA 02115 USA
[4] Dana Farber Canc Inst, Div Populat Sci, Boston, MA 02115 USA
[5] Dana Farber Canc Inst, Dept Psychosocial Oncol & Palliat Care, Boston, MA 02115 USA
[6] Harvard Med Sch, Boston, MA 02115 USA
[7] Vrije Univ Amsterdam, Emma Childrens Hosp, Canc Ctr Amsterdam, Amsterdam UMC,Dept Pediat Oncol, Amsterdam, Netherlands
[8] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
[9] Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands
[10] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
[11] Ctr Addict & Mental Hlth, Toronto, ON, Canada
基金
美国国家卫生研究院;
关键词
health care disparities; health services research; mental health; minority health; pediatric oncology; psychiatry; MENTAL-HEALTH; ETHNIC DISPARITIES; CHILDREN; FAMILIES;
D O I
10.1002/pbc.29342
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Integratedbehavioral health models have been proposed as care delivery approaches to mitigate mental health disparities in primary care settings. However, these models have not yet been widely adopted or evaluated in pediatric oncology medical homes. Methods We conducted a retrospective cohort study of 394 children with newly diagnosed cancer at Dana-Farber/Boston Children's Cancer and Blood Disorders Center (DF/BCH) from April 2013 to January 2017. Baseline sociodemographic characteristics and psychiatry utilization outcomes at 12 months following diagnosis were abstracted from the medical record. The severity of household material hardship (HMH), a concrete poverty exposure, at diagnosis and race/ethnicity were characterized by parent report using the Psychosocial Assessment Tool 2.0 (PAT). Associations between sociodemographic characteristics and receipt of psychiatry consultation were assessed with multivariable logistic regression models. Results Among 394 children, 29% received a psychiatric consultation within 12 months postdiagnosis. Of these, 88% received a new psychiatric diagnosis, 76% received a psychopharmacologic recommendation, and 62% received a new behavioral intervention recommendation. In multivariable logistic regression adjusting for age, cancer diagnosis, and PAT total score, there was no statistically significant association between HMH severity or household income and psychiatry utilization. Children who identified as racial/ethnic minorities were significantly less likely to receive a psychiatry consultation (OR = 0.48, 95% CI = 0.27-0.84). Conclusions In a pediatric oncology medical home with an integrated behavioral health model, socioeconomic status was not associated with disparate psychiatry utilization. However, there remained a profound racial/ethnic disparity in psychiatry utilization, highlighting the need for additional research and care delivery intervention.
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页数:7
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