Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #101861

Emmanuel M. Ngui, DrPH, Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, (414) 456-4302, engui@mail.mcw.edu and Glenn Flores, MD, Center for the Advancement of Underserved Children, Medical College of Wisconsin/Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226.

OBJECTIVE: To examine whether racial/ethnic disparities exist in parental satisfaction with care among CSHCN and to identify factors associated with these disparities.

METHODS: Analyses of data on 38,886 CSHCN <18 years old participating in the National Survey of Children with Special Health Care Needs (CSHCN). Covariates included sociodemographic and access factors, condition severity and stability, ease of using services, and provider-patient communication factors (PPC). PPC measures included parental ratings of the provider as never or sometimes: spending adequate time with the child (inadequate time), listening carefully (inadequate listening), sensitive to the family's values/customs (cultural insensitivity), providing needed information (inadequate information), and helping parents feel like partners in care (inadequate partnership).

RESULTS: Nationally, 8% of parents of CSHCN were dissatisfied or somewhat dissatisfied with their children's healthcare, with Hispanic (16%) and black (13%) parents more dissatisfied than white parents (7%). Dissatisfaction was associated with poverty, lack of insurance, public insurance, lack of a personal doctor/nurse, non-English interview language, maternal education, PPC, ease of service use and having an unstable condition. Black and Hispanic parents were significantly more likely than white parents to be dissatisfied (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.6-3.3; OR, 2.6; 1.8-3.8, respectively), but these disparities disappeared after adjustments. Among all parents of CSHCN, inadequate listening (OR, 2.4; 1.6-3.5), information (OR, 1.8; 1.3-2.6), time (OR, 1.7; 1.2-2.4), partnership (OR, 1.6; 1.1-2.3), difficulty using services (OR, 3.4; 2.5-4.8), language barriers (OR, 2.1; 1.1-4.4), and condition severity (OR, 1.1; 1.06 -1.2) were significantly associated with dissatisfaction. Within racial/ethnic groups, dissatisfaction was associated with cultural insensitivity among blacks (OR, 2.7; 1.2-5.9), language barriers (OR, 2.7; 1.2-6.2) and inadequate partnership (OR, 5.2; 2.2-12.4) among Hispanics, and lack of insurance (OR, 1.8; 1.1-3.1), inadequate time (OR, 1.7; 1.1-2.6) and inadequate partnership (OR, 1.7; 1.1-2.6) among whites.

CONCLUSIONS: Racial/ethnic disparities exist in satisfaction with care among parents of CSHCN, but disappear after adjustments. Across racial/ethnic groups, key factors associated with dissatisfaction included inadequate listening and information, condition severity, and difficulty using services. For Hispanic parents, satisfaction with care can be greatly enhanced by improving partnership with families and reducing language barriers through adequate interpreter services and bilingual staff. For all CSHCN, and particularly minority CSHCN, overall satisfaction with care can be improved by implementing more family-centered healthcare that incorporates fewer language barriers, enhanced provider listening and cultural sensitivity skills, adequate information and time with patients/families, and easier access to healthcare services.

Learning Objectives:

• Examine ethnic disparities in satisfaction with care
• Identify factors contributing to ethnic disparities in satisfaction with care among CSHCN

Keywords: Children With Special Needs, Ethnic Minorities

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.