Box Tamara L, Olsen Maren, Oddone Eugene Z, Keitz Sheri A
Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
J Womens Health (Larchmt). 2003 May;12(4):391-7. doi: 10.1089/154099903765448907.
To examine access to and utilization of primary healthcare services with respect to gender. Greater family and child-rearing responsibilities are possible barriers to healthcare access and utilization for women with HIV infection.
This study was part of a prospective, randomized, controlled trial evaluating primary care for HIV-infected patients at Duke University Medical Center (DUMC), a tertiary care medical center. Subjects were 214 HIV-infected, uninsured or publicly insured participants. Ambulatory care visits, emergency room utilization, hospitalization rates, length of stay, preventive and screening measures, and antiretroviral use were the outcome measures.
Women (n = 83) and men (n = 131) enrolled in the study were similar with respect to race, educational level, marital status, and employment status. Women with HIV were more likely than men to have children (80% vs. 25%, p = 0.001) and spend their time as primary caregivers for their children (22% vs. 0.8%, p = 0.001). Women had higher CD4(+) cell counts (378 +/- 287 vs. 243 +/- 252 cells/microl, p = 0.0002), and a smaller proportion of women than men had AIDS at baseline (41% vs. 62%, p = 0.002). Women and men had similar numbers of primary care visits, emergency room visits, annual admission rates, and lengths of stay for hospitalizations. Pneumocystis carinii pneumonia prophylaxis, pneumococcal vaccination, and tuberculosis screening were also similar between women and men. Women were more likely than men to have ever been prescribed an antiretroviral agent (88.0% vs. 71.8%, p = 0.005).
Women had greater familial responsibilities than men, but this was not a barrier to access or utilization of healthcare services. Despite less advanced HIV disease, women received similar care and had similar utilization of health services.
研究初级医疗服务在性别方面的可及性和利用情况。对于感染艾滋病毒的女性而言，更多的家庭和育儿责任可能是获取和利用医疗服务的障碍。
本研究是一项前瞻性、随机、对照试验的一部分，该试验在三级医疗中心杜克大学医学中心（DUMC）评估对艾滋病毒感染患者的初级护理。研究对象为214名未参保或参加公共保险的艾滋病毒感染参与者。门诊就诊、急诊室利用情况、住院率、住院时间、预防和筛查措施以及抗逆转录病毒药物使用情况为观察指标。
参与研究的女性（n = 83）和男性（n = 131）在种族、教育水平、婚姻状况和就业状况方面相似。感染艾滋病毒 的女性比男性更有可能育有子女（80% 对 25%，p = 0.001），且花费更多时间担任子女的主要照顾者（22% 对 0.8%，p = 0.001）。女性的 CD4(+) 细胞计数较高（378 ± 287 对 243 ± 252 个/微升，p = 0.0002），且基线时患艾滋病的女性比例低于男性（41% 对 62%，p = 0.002）。女性和男性的初级护理就诊次数、急诊就诊次数、年住院率以及住院时间相似。卡氏肺孢子虫肺炎预防、肺炎球菌疫苗接种和结核病筛查在女性和男性中也相似。女性比男性更有可能曾被开具抗逆转录病毒药物（88.0% 对 71.8%，p = 0.005）。
女性承担的家庭责任比男性更大，但这并非获取或利用医疗服务的障碍。尽管艾滋病毒疾病进展程度较低，但女性接受的护理相似，且医疗服务利用情况也相似。
