Von Lengerke Thomas, John Jürgen
Hannover Medical School, Medical Psychology Unit, Hannover, Germany.
Psychol Health Med. 2007 Oct;12(5):536-44. doi: 10.1080/13548500701203425.
As general practitioners (GP) are seeing, and are likely to continue to see, increasing numbers of obese patients in their practices, it is relevant to know with which needs these patients enter general practice. The present study aims to determine whether besides physical comorbidities, health-related quality of life (HRQOL) accounts for associations of obesity with GP use. In a general population survey in Augsburg, Germany (KORA-Survey S4 1999/2001), anthropometric body mass (BMI in kg/(m(2))), physical comorbidities, HRQOL (the 12-item Short Form; SF-12), and visits to GP were assessed, and analyzed by logistic and zero-truncated negative binomial regressions (two-part model). Gender, age, socio-economic status, marital status, health insurance, and place of residence were adjusted for. The sample consisted of N = 942 residents aged 25 - 74, who had been randomly sampled from 17 cluster-sampled communities, and were either normal-weight, overweight, moderately obese, or severely obese. The moderately obese group had higher odds than the normal-weight to report any GP use; however, while being predictive, neither physical comorbidity nor HRQOL mediated this. In contrast, with regard to number of GP visits among users, the severely obese group (BMI >/= 35) reported significantly more visits than the normal-weight group, and both physical comorbidity and physical (but not mental) HRQOL accounted for this. In conclusion, physical comorbidity and HRQOL mediate excess use of GP by severely obese users in terms of number of visits. Thus, for this group, subjective physical health seems to be important besides physical comorbidities, suggesting for general practice to focus both on evaluated and perceived needs of these patients.
由于全科医生在其诊疗过程中见到且可能会继续见到越来越多的肥胖患者，了解这些患者带着哪些需求进入全科医疗是很有必要的。本研究旨在确定除身体合并症外，健康相关生活质量（HRQOL）是否能解释肥胖与全科医生诊疗利用之间的关联。在德国奥格斯堡的一项普通人群调查（KORA调查S4 1999/2001）中，评估了人体测量的体重指数（BMI，单位为kg/(m²)）、身体合并症、HRQOL（12项简短健康调查；SF - 12）以及全科医生诊疗次数，并通过逻辑回归和零截断负二项回归（两部分模型）进行分析。对性别、年龄、社会经济地位、婚姻状况、健康保险和居住地点进行了校正。样本包括从17个整群抽样社区中随机抽取的942名年龄在25 - 74岁的居民，他们的体重状况分别为正常体重、超重、中度肥胖或重度肥胖。中度肥胖组报告使用任何全科医生诊疗服务的几率高于正常体重组；然而，虽然具有预测性，但身体合并症和HRQOL均未介导这种关联。相比之下，就使用者的全科医生诊疗次数而言，重度肥胖组（BMI≥35）报告的诊疗次数显著多于正常体重组，身体合并症和身体（而非心理）HRQOL均可解释这一现象。总之，身体合并症和HRQOL在诊疗次数方面介导了重度肥胖使用者对全科医生的过度利用。因此，对于这一群体，除身体合并症外，主观身体健康似乎也很重要，这表明全科医疗应关注这些患者已评估的需求和感知到的需求。
