title: Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants.
abstract: BACKGROUND
  Changes in well child care (WCC) adherence over time have not previously been examined. Our objective is to describe adherence rates to WCC over time in a low-income urban population of infants 0-24 months of age, and to identify predictors of WCC adherence in this population.
  
  
  METHODS
  This is a secondary analysis of a cohort of Medicaid-eligible children followed from birth to 2 years between 2005 and 2008 with structured telephone surveys to assess maternal well-being, social support, and household and demographic information. For the 260 children attending 4 urban pediatric practices, WCC adherence was assessed based on visit data abstracted from electronic medical records. A random-intercept mixed effects logit model clustered on subject was used.
  
  
  RESULTS
  92% of the mothers were African-American, 27% had not finished high school, 87% were single, and 43% earned<$500/month; mean age was 23. WCC adherence decreased from 88% at 6 months to 47% (12 mo), 44% (18 mo), and 67% (24 mo). The difference across time periods was statistically significant (p<0.001). Married (OR 1.71, p=0.02) and primiparous (OR 1.89, p<0.001) mothers had significantly greater odds of adherence, along with women who reported having been adherent to prenatal care visits (OR 1.49, p=0.03) and those with the lowest household income (OR 1.40, p=0.03).
  
  
  CONCLUSIONS
  Maternal education efforts should emphasize the importance of establishing WCC, especially for mothers of more than one child. Further studies using larger, more broadly defined populations are needed to confirm our findings that efforts to increase WCC adherence should be intensified after 6 months of age, particularly for children at higher risk.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars, University of Pennsylvania, Philadelphia, PA, USA. anje@upenn.edu
authors.forename: Anje C
authors.initials: AC
authors.lastname: Van Berckelaer
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
mesh_terms: D000293:Adolescent; D000328:Adult; D002662:Child Health Services; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008484:Medicaid; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011203:Poverty; D011322:Primary Prevention; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014505:Urban Population; D055815:Young Adult