Heslin K C, Cunningham W E, Marcus M, Coulter I, Freed J, Der-Martirosian C, Bozzette S A, Shapiro M F, Morton S C, Andersen R M
Department of Health Services, UCLA School of Public Health, Room 31-254A, Center for Health Sciences (CHS), 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
J Public Health Dent. 2001 Winter;61(1):14-21. doi: 10.1111/j.1752-7325.2001.tb03350.x.
Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care important. Using the domains specified in the Behavioral Model of Health Services Use, this paper examines the correlates of unmet needs for dental and medical care in a nationally representative sample of patients with HIV.
This investigation is a cross-sectional study using baseline data from the HIV Cost and Services Utilization Study (HCSUS), the first nationally representative study of persons in care for HIV. Using probability-based techniques, 4,042 people were randomly selected in January 1996, and 2,864 (71%) completed a structured interview that included questions on unmet needs for dental and medical care. Regression analysis was used to identify variables associated with having unmet needs for dental care only, medical care only, and both medical and dental care.
Of the estimated 230,900 people in treatment for HIV in the United States, approximately 58,000 had unmet medical or dental needs based on self-reported data. Unmet dental needs were more than twice as prevalent as unmet medical needs (32,900 vs 14,300), and 11,600 people were estimated to have both types of unmet needs. Multinomial logit regression showed that persons with low income had increased odds of reporting unmet needs for both dental and medical care. The uninsured and those insured by Medicaid without dental benefits had more than three times the odds of having unmet needs for both types of care than did the privately insured.
To serve both the dental and medical needs of diverse populations affected by HIV disease, greater coordination of services is needed. In addition, state insurance programs for people with HIV should consider the feasibility of expanding their benefit structure to include dental care benefits.
与艾滋病相关的口腔健康状况通常比普通人群更为严重，因此获得牙科和医疗护理都很重要。本文利用卫生服务利用行为模型中规定的领域，研究了全国具有代表性的艾滋病患者样本中未满足的牙科和医疗护理需求的相关因素。
本调查是一项横断面研究，使用了艾滋病成本与服务利用研究（HCSUS）的基线数据，这是第一项关于接受艾滋病护理人群的全国性代表性研究。1996年1月，采用基于概率的技术随机抽取了4042人，其中2864人（71%）完成了结构化访谈，访谈内容包括有关未满足的牙科和医疗护理需求的问题。回归分析用于确定仅存在未满足的牙科护理需求、仅存在未满足的医疗护理需求以及同时存在未满足的医疗和牙科护理需求的相关变量。
在美国估计接受艾滋病治疗的230900人中，根据自我报告数据，约58000人存在未满足的医疗或牙科需求。未满足的牙科需求的普遍程度是未满足的医疗需求的两倍多（32900对14300），估计有11600人同时存在这两种未满足的需求。多项logit回归显示，低收入人群报告未满足牙科和医疗护理需求的几率增加。未参保者以及参加医疗补助但无牙科福利的参保者存在这两种未满足需求的几率是私人参保者的三倍多。
为满足受艾滋病影响的不同人群的牙科和医疗需求，需要加强服务协调。此外，针对艾滋病患者的州保险计划应考虑扩大福利结构以包括牙科护理福利的可行性。
