Blewett Lynn A, Johnson Pamela Jo, Lee Brian, Scal Peter B
School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, USA.
J Gen Intern Med. 2008 Sep;23(9):1354-60. doi: 10.1007/s11606-008-0659-0. Epub 2008 May 28.
To examine whether the usual source of preventive care, (having a usual place for care only or the combination of a usual place and provider compared with no usual source of preventive care) is associated with adults receiving recommended screening and prevention services.
Using cross-sectional survey data for 24,138 adults (ages 18-64) from the 1999 National Health Interview Survey (NHIS), we estimated adjusted odds ratios using separate logistic regression models for receipt of five preventive services: influenza vaccine, Pap smear, mammogram, clinical breast exam, and prostate specific antigen.
Having both a usual place and a usual provider was consistently associated with increased odds for receiving preventive care/screening services compared to having a place only or neither. Adults ages 50-64 with a usual place/provider had 2.8 times greater odds of receiving a past year flu shot compared with those who had neither. Men ages 50-64 with a usual place/provider had nearly 10 times higher odds of receiving a PSA test compared with men who had neither. Having a usual place/provider compared with having neither was associated with 3.9 times higher odds of clinical breast exam among women ages 20-64, 4.1 times higher odds of Pap testing among women ages 21-64, and 4.8 times higher odds of mammogram among women ages 40-64.
Having both a usual place and usual provider is a key variable in determining whether adults receive recommended screening and prevention services and should be considered a fundamental component of any medical home model for adults.
探讨预防保健的常规来源（仅拥有常规的就医地点，或常规就医地点与医疗服务提供者的组合，与无预防保健常规来源相比）是否与成年人接受推荐的筛查和预防服务相关。
利用1999年国家健康访谈调查（NHIS）中24138名18至64岁成年人的横断面调查数据，我们针对五项预防服务的接受情况，使用单独的逻辑回归模型估计调整后的比值比，这五项预防服务为：流感疫苗、巴氏涂片检查、乳房X光检查、临床乳房检查和前列腺特异性抗原检测。
与仅拥有就医地点或两者皆无相比，同时拥有常规就医地点和常规医疗服务提供者始终与接受预防保健/筛查服务的几率增加相关。50至64岁拥有常规就医地点/医疗服务提供者的成年人接受过去一年流感疫苗接种的几率是两者皆无者的2.8倍。50至64岁拥有常规就医地点/医疗服务提供者的男性接受前列腺特异性抗原检测的几率比两者皆无的男性高近10倍。与两者皆无相比，拥有常规就医地点/医疗服务提供者与20至64岁女性进行临床乳房检查的几率高3.9倍、21至64岁女性进行巴氏检查的几率高4.1倍以及40至64岁女性进行乳房X光检查的几率高4.8倍相关。
拥有常规就医地点和常规医疗服务提供者是决定成年人是否接受推荐的筛查和预防服务的关键变量，应被视为任何成人医疗之家模式的基本组成部分。
