Wagner T H, Greenlick M R
VA HSR&D Health Economics Resource Center, Center for Primary Care and Outcomes Research, and Center for Health Policy, Stanford University, CA, USA.
Med Care. 2001 Aug;39(8):848-55. doi: 10.1097/00005650-200108000-00010.
Most studies assessing the effects of consumer health information on medical utilization have used randomized controlled clinical trials with the chronically ill. In this paper, we analyze the effect of the Healthwise Communities Project, a natural experiment that provided free self-care resources, on reported pediatric utilization.
Random household surveys were collected before and after the intervention in Boise, Idaho and in two control communities.
A total of 5,909 surveys were completed, representing an overall response rate of 54%. Of these, 1,812 respondents were between 18 and 55 years of age and had children under 18 years of age living in the home. All analyses were restricted to these 1,812 persons.
Parents were asked how many times their children visited a physician in the last year. Responses were gathered with a categorical response scale, which was then transformed into a continuous variable (number of pediatric visits).
The intervention was associated with a decrease in reported pediatric utilization rates. The decrease in visits ranged from -0.72 to -0.66 (P approximately 0.05), depending on the statistical model used. Further analyses of 423 families followed over time found a more modest decrease (-0.19) that was not statistically significant.
This study found that increasing access to self-care books, telephone advice nurses, and Internet-based health information is associated with decreases in reported pediatric utilization. However, the significance of the results was sensitive to the statistical model. More research is needed to understand the average and marginal costs of providing health information to consumers.
大多数评估消费者健康信息对医疗利用影响的研究都采用了针对慢性病患者的随机对照临床试验。在本文中，我们分析了“健康社区项目”这一自然实验对报告的儿科医疗利用的影响，该项目提供了免费的自我护理资源。
在爱达荷州博伊西市以及两个对照社区进行干预前后分别收集随机的家庭调查。
总共完成了5909份调查，总体回复率为54%。其中，1812名受访者年龄在18至55岁之间，家中有18岁以下的子女。所有分析都局限于这1812人。
询问家长他们的孩子在过去一年中看医生的次数。通过分类反应量表收集回答，然后将其转换为连续变量（儿科就诊次数）。
干预与报告的儿科利用率下降有关。就诊次数的下降幅度在-0.72至-0.66之间（P约为0.05），具体取决于所使用的统计模型。对423个家庭进行的长期跟踪进一步分析发现下降幅度较小（-0.19），且无统计学意义。
本研究发现，增加获取自我护理书籍、电话咨询护士和基于互联网的健康信息的机会与报告的儿科利用率下降有关。然而，结果的显著性对统计模型敏感。需要更多研究来了解向消费者提供健康信息的平均成本和边际成本。
