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. 1996 Jan-Feb;111(1):71–77.

Barriers to the use of preventive health care services for children.

R Riportella-Muller 1, M L Selby-Harrington 1, L A Richardson 1, P L Donat 1, K J Luchok 1, D Quade 1
PMCID: PMC1381746  PMID: 8610196

Abstract

This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid's Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bates A. S., Fitzgerald J. F., Dittus R. S., Wolinsky F. D. Risk factors for underimmunization in poor urban infants. JAMA. 1994 Oct 12;272(14):1105–1110. [PubMed] [Google Scholar]
  2. Bobo J. K., Gale J. L., Thapa P. B., Wassilak S. G. Risk factors for delayed immunization in a random sample of 1163 children from Oregon and Washington. Pediatrics. 1993 Feb;91(2):308–314. [PubMed] [Google Scholar]
  3. Colle A. D., Grossman M. Determinants of pediatric care utilization. J Hum Resour. 1978;13 (Suppl):115–158. [PubMed] [Google Scholar]
  4. Cornelius L. J. Barriers to medical care for white, black, and Hispanic American children. J Natl Med Assoc. 1993 Apr;85(4):281–288. [PMC free article] [PubMed] [Google Scholar]
  5. Currier R. Is early and periodic screening, diagnosis and treatment (EPSDT) worthwhile? Int J Rehabil Res. 1979 Dec;2(4):508–509. doi: 10.1097/00004356-197912000-00007. [DOI] [PubMed] [Google Scholar]
  6. Friedman E. Money isn't everything. Nonfinancial barriers to access. JAMA. 1994 May 18;271(19):1535–1538. [PubMed] [Google Scholar]
  7. Irwin R. H., Conroy-Hughes R. EPSDT impact on health status: estimates based on secondary analysis of administratively generated data. Med Care. 1982 Feb;20(2):216–234. doi: 10.1097/00005650-198202000-00008. [DOI] [PubMed] [Google Scholar]
  8. Keller W. J. Study of selected outcomes of the Early and Periodic Screening, Diagnosis, and Treatment program in Michigan. Public Health Rep. 1983 Mar-Apr;98(2):110–119. [PMC free article] [PubMed] [Google Scholar]
  9. Manning W. L. The EPSDT program: a progress report. Indiana Med. 1985 Apr;78(4):320–322. [PubMed] [Google Scholar]
  10. Marcus A. C., Crane L. A., Kaplan C. P., Reading A. E., Savage E., Gunning J., Bernstein G., Berek J. S. Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies. Med Care. 1992 Mar;30(3):216–230. doi: 10.1097/00005650-199203000-00004. [DOI] [PubMed] [Google Scholar]
  11. Melnyk K. A. Barriers to care: operationalizing the variable. Nurs Res. 1990 Mar-Apr;39(2):108–112. [PubMed] [Google Scholar]
  12. Melnyk K. A. Barriers: a critical review of recent literature. Nurs Res. 1988 Jul-Aug;37(4):196–201. [PubMed] [Google Scholar]
  13. Miller L. A., Hoffman R. E., Barón A. E., Marine W. M., Melinkovich P. Risk factors for delayed immunization against measles, mumps, and rubella in Colorado two-year-olds. Pediatrics. 1994 Aug;94(2 Pt 1):213–219. [PubMed] [Google Scholar]
  14. Orr S. T., Charney E., Straus J. Use of health services by black children according to payment mechanism. Med Care. 1988 Oct;26(10):939–947. doi: 10.1097/00005650-198810000-00002. [DOI] [PubMed] [Google Scholar]
  15. Patton R. D., Harvill L. M., Michal M. L. Attitudes of single parents toward health issues. J Am Med Womens Assoc. 1981 Nov;36(11):340–348. [PubMed] [Google Scholar]
  16. Reis J. S., Pliska S. R., Hughes E. F. A synopsis of federal-state sponsored preventive child health. J Community Health. 1984 Spring;9(3):222–239. doi: 10.1007/BF01326703. [DOI] [PubMed] [Google Scholar]
  17. Salsberry P. J., Nickel J. T., Mitch R. Why aren't preschoolers immunized? A comparison of parents' and providers' perceptions of the barriers to immunizations. J Community Health Nurs. 1993;10(4):213–224. doi: 10.1207/s15327655jchn1004_2. [DOI] [PubMed] [Google Scholar]
  18. Selby-Harrington M. L., Riportella-Muller R. Easing the burden on health departments: a cost-effective method for public health nurses to increase private sector participation in the early and periodic screening, diagnosis, and treatment program. Public Health Nurs. 1993 Jun;10(2):114–121. doi: 10.1111/j.1525-1446.1993.tb00034.x. [DOI] [PubMed] [Google Scholar]
  19. Selby M. L., Riportella-Muller R., Sorenson J. R., Quade D., Luchok K. J. Increasing participation by private physicians in the EPSDT Program in rural North Carolina. Public Health Rep. 1992 Sep-Oct;107(5):561–568. [PMC free article] [PubMed] [Google Scholar]
  20. Selby M. L., Riportella-Muller R., Sorenson J. R., Quade D., Sappenfield M. M., Potter H. B., Farel A. M. Public health nursing interventions to improve the use of a health service: using a pilot study to guide research. Public Health Nurs. 1990 Mar;7(1):3–12. doi: 10.1111/j.1525-1446.1990.tb00603.x. [DOI] [PubMed] [Google Scholar]
  21. Selby M. L., Riportella-Muller R., Sorenson J. R., Walters C. R. Improving EPSDT use: development and application of a practice-based model for public health nursing research. Public Health Nurs. 1989 Dec;6(4):174–181. doi: 10.1111/j.1525-1446.1989.tb00594.x. [DOI] [PubMed] [Google Scholar]
  22. Short P. F., Lefkowitz D. C. Encouraging preventive services for low-income children. The effect of expanding Medicaid. Med Care. 1992 Sep;30(9):766–780. doi: 10.1097/00005650-199209000-00002. [DOI] [PubMed] [Google Scholar]
  23. Tollestrup K., Hubbard B. B. Evaluation of a follow-up system in a county health department's immunization clinic. Am J Prev Med. 1991 Jan-Feb;7(1):24–28. [PubMed] [Google Scholar]

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