Biomedical subjects

M P Hurtado

Publications and source records attributed to M P Hurtado.

3 recordsLinked to original sources

PubMed2000

Measuring consumer experiences with primary care.

OBJECTIVE: To assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) for evaluating the attainment of the key characteristics of primary care services for children and youth. DESIGN: Community-based telephone survey. SETTING: Specific political subdivision in Washington, DC. PARTICIPANTS: Four hundred fifty parents/guardians of offspring 18 years of age or less. MEASURES: Reliability, validity and principal component analysis of 5 scales representing key aspects of the 4 cardinal domains of primary care included in the PCAT-CE. In addition, 2 subdomains (first contact use and extent of affiliation with a primary care source) were included as indices to describe overall patterns of use and affiliation with the particular source of care. RESULTS: Most scales had adequate internal consistency, test-retest reliability, and construct validity. The principal components factor analysis yielded 5 separate factors. These corresponded to the subdomains of first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; and comprehensiveness (both services available and indicated services received). CONCLUSIONS: Psychometric assessment supported the integrity and general adequacy of the PCAT-CE for assessing the characteristics and quality of primary care for children and youth. Testing of revised versions in a variety of different settings is underway. A major component of this testing is to explore the possibility of reducing the number of items while retaining sufficient detail about each component of primary care to make judgements about people's experiences with that care.

Child↗

PubMed1996

School-based health centers. Students' access, knowledge, and use of services.

OBJECTIVE: To examine students' knowledge, barriers to access, and use of services at two school-based health centers. DESIGN: In-person survey. SETTINGS: Two urban public schools in Baltimore, Md. PARTICIPANTS: One hundred forty-nine middle school and 131 high school African-American students. The response rate was 84%. MAIN OUTCOME MEASURES: Knowledge about center operations and services, reported barriers to access to the center, and reported use of the center. RESULTS: Knowledge about center operations and services was generally high. However, knowledge was low with respect to the need for an appointment for non-emergency visits (40% correct) and the availability of dental service referrals (51% correct). One fifth of students incorrectly reported their enrollment status. Boys were more likely to report that they knew about the availability of sports physical examinations (odds ratio, 3.7), and girls were more likely to report that they knew about reproductive services (odds ratio, 3.0). The most frequently identified barriers to access were difficulty in obtaining a teacher's permission to leave class (55%), requiring parental permission for enrollment (31%), and concern about confidentiality (26%). Barriers to access were reported more frequently by students in the middle school than by students in the high school. Seven eighths of enrolled students reported that they had used the center in the past year, but only a third would use it if they woke up on a Monday with a bad cough and needed to see a physician or nurse. CONCLUSIONS: Despite increasing the availability of primary care services by locating health centers in schools, some barriers to access remain. School-based health centers could more actively promote awareness of their operation and services among students and their parents.

Black or African American↗

PubMed1996

Managed care, primary care, and quality for children.

In an effort to provide medical care that is both more effective and less costly, the new variants of managed care organizations have instituted a variety of incentives and administrative controls that impact on the types and quantity of care provided to patients. Evidence suggests that the early forms of managed care, namely prepaid group practices, showed particular promise in improving the primary care delivered to children, ie, care that is accessible, person-focused in the long term, comprehensive, coordinated, and oriented toward achieving better outcomes. However, recent evidence concerning the quality of care delivered to children in the newer variants of managed care is mixed and scant; the newer organizational forms may not facilitate and may even have a negative impact on the attainment of primary care. Managed care can have a positive effect on first contact care, because it contractually defines a primary care provider and reduces use of the emergency room as a source of care. It may, however, have mixed effects on other aspects of access and use, depending on the plan's particular characteristics. Longitudinality is threatened by the disruption of prior relationships with out-of-plan providers and by the instability of both enrollees and providers in managed care plans. Children's benefits in managed care arrangements tend to include more preventive services, but access to specialty services has generally been found to be more restrictive. Coordination of care is not inherent to managed care, and many plans are no more likely to foster communication than are traditional indemnity plans. Evidence for the superior clinical quality afforded to children by new variants of managed care is lacking. Because managed care arrangements are proliferating rapidly, better studies are needed to prove or refute the contention that managed care has a significant positive effect on quality of care.

Child↗