Dobie Dorcas J, Maynard Charles, Kivlahan Daniel R, Johnson Kay M, Simpson Tracy, David Andrew C, Bradley Katharine
Mental Illness Research, Education and Clinical Center, University of Washington School of Medicine, Seattle, WA, USA.
J Gen Intern Med. 2006 Mar;21 Suppl 3(Suppl 3):S58-64. doi: 10.1111/j.1525-1497.2006.00376.x.
Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.
To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.
Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.
Women receiving care at an urban VA medical center between October 1996 and January 2000.
Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.
Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD-) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.
Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.
患有创伤后应激障碍（PTSD）的女性报告称健康状况不佳，但与医疗保健利用之间的关联研究较少。
确定女性退伍军人事务部（VA）患者中医疗/外科利用与PTSD之间的关联。
对通过邮寄调查筛查PTSD呈阳性或阴性的女性的利用率进行前瞻性比较。
1996年10月至2000年1月期间在城市VA医疗中心接受治疗的女性。
调查回复，包括经过验证的PTSD筛查（PCL-C），以及截至2002年9月的VA利用数据。
2578名（78%的符合条件者）女性完成了PCL-C；其中858名（33%）筛查出PTSD呈阳性（PTSD+）。在未调整的模型中，PTSD+女性的医疗/外科住院率和外科住院手术率较高。在年龄35至49岁的女性中，PTSD+女性每年每100名患者的平均住院天数为43.4天（95%可信区间26至61天），而PTSD阴性（PTSD-）女性为17.0天（16至18天）。更多PTSD+女性接受了外科手术（P<0.001）。PTSD+女性的年均门诊就诊次数显著更高，包括：急诊科（1.1次[1.0至1.2次]对0.6次[0.5至0.6次]）、初级保健（3.2次[3.0至3.4次]对2.2次[2.1至2.3次]）、医疗/外科专科医生（2.1次[1.9至2.3次]对1.5次[1.4至1.6次]）、辅助服务（4.1次[3.7至4.5次]对2.4次[2.2至2.6次]）以及诊断检查（5.6次[5.1至6.1次]对3.7次[3.4至4.0次]）。在针对人口统计学、吸烟、服务获取和医疗合并症进行调整的多变量模型中，PTSD+女性进行医疗/外科住院的可能性更大（比值比=1.37[1.04至1.79]），并且在急诊科、初级保健、辅助服务和诊断检查就诊患者中处于前四分位数的可能性更大。
筛查出PTSD+的女性退伍军人接受了更多的VA医疗/外科服务。该护理的适宜性值得进一步研究。
