Staton Forrest S, Bhosle Monali J, Camacho Fabian T, Feldman Steven R, Balkrishnan Rajesh
Departmetn of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
JAAPA. 2007 Jun;20(6):32, 34, 36 passim. doi: 10.1097/01720610-200706000-00008.
Increasing health care costs and inaccessibility to care create barriers to physicians' services. The physician assistant (PA) profession developed in part to help care for underserved populations. The objective of this study was to test the hypothesis that poorer patients in outpatient clinics are more likely to see PAs than physicians.
A retrospective analysis of National Ambulatory Medical Care Survey data (1997-2003) on outpatient physicians and their office staff was carried out. Weighted logistic regression analysis was used.
After adjusting for covariates such as patient age, gender, race, year of visit, and region, patients covered by Medicare insurance had lower odds of visiting PAs compared to patients possessing private insurance (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81). Further, patients who paid out-of-pocket had higher odds of visiting PAs compared to patients with private insurance, after adjusting for potential confounders (OR: 1.37; CI: 1.18-1.77). Patients in rural areas were more likely to visit PAs than were patients in urban areas (OR: 2.02; CI: 1.31-3.14).
Considerable use is made of PAs in all settings, and they tend to be utilized in otherwise underserved, rural populations who do not have health insurance.
医疗保健成本的增加以及医疗服务的不可及性给医生服务造成了障碍。医师助理（PA）这一职业的发展部分是为了帮助照顾医疗服务不足的人群。本研究的目的是检验以下假设：门诊诊所中较贫困的患者比医生更有可能看医师助理。
对1997 - 2003年全国门诊医疗护理调查数据中关于门诊医生及其办公室工作人员进行回顾性分析。采用加权逻辑回归分析。
在对患者年龄、性别、种族、就诊年份和地区等协变量进行调整后，与拥有私人保险的患者相比，医疗保险覆盖的患者看医师助理的几率较低（优势比[OR]：0.48；95%置信区间[CI]：0.29 - 0.81）。此外，在调整潜在混杂因素后，与有私人保险的患者相比，自掏腰包的患者看医师助理的几率更高（OR：1.37；CI：1.18 - 1.77）。农村地区的患者比城市地区的患者更有可能看医师助理（OR：2.02；CI：1.31 - 3.14）。
在所有环境中，医师助理都得到了大量使用，并且他们往往被用于那些没有医疗保险、医疗服务原本不足的农村人群。
