超越保险覆盖范围：高血压和高胆固醇血症治疗中的常规医疗服务提供方。来自 2003-2006 年全国健康和营养调查的数据。
Beyond insurance coverage: usual source of care in the treatment of hypertension and hypercholesterolemia. Data from the 2003-2006 National Health and Nutrition Examination Survey.
机构信息
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT 06520-8088, USA.
出版信息
Am Heart J. 2010 Jul;160(1):115-21. doi: 10.1016/j.ahj.2010.04.013.
BACKGROUND
Expanding insurance coverage, while necessary, may not be sufficient to ensure high-quality care for adults with cardiovascular disease. We sought to examine the association between having a usual source of care (USOC) and receiving medication treatment of hypertension and hypercholesterolemia.
METHODS
Using the 2003-2006 National Health and Nutrition Examination Survey, we categorized USOC (a place to go when sick or need medical advice) and insurance status in adults >or=35 years old with an indication for medication treatment of hypertension (n = 3,142) and hypercholesterolemia (n = 1,134), determined using the Joint National Committee 7 and Adult Treatment Panel III recommendations, respectively. Multivariable logistic regression modeling was used to determine the independent effect of USOC on receiving treatment of hypertension and hypercholesterolemia, controlling for age, sex, race/ethnicity, insurance status, and comorbidities. Separate multivariable models were examined stratified by insurance status.
RESULTS
Among subjects with an indication for treatment of hypertension and hypercholesterolemia, 32.4% and 42.0% were untreated, respectively. When compared with adults with a USOC, adults without a USOC were more likely to be untreated for hypertension (adjusted prevalence ratio [aPR] 2.43, 95% CI 1.88-2.85) and hypercholesterolemia (aPR 1.79, 95% CI 1.31-2.13). In stratified analyses among subjects with insurance, no USOC remained associated with being untreated (hypertension, aPR 2.58, 95% CI 1.88-3.08; hypercholesterolemia, aPR 1.65, 95% CI 0.97-2.18).
CONCLUSIONS
Absence of a USOC was associated with being untreated for hypertension and hypercholesterolemia, even among individuals with insurance, suggesting that efforts to improve chronic disease management should also facilitate access to a regular source of care.
背景
扩大保险覆盖范围虽然是必要的，但可能不足以确保心血管疾病成年患者获得高质量的护理。我们试图研究通常的医疗服务提供者（USOC）和接受高血压和高胆固醇血症药物治疗之间的关系。
方法
使用 2003-2006 年全国健康和营养调查，我们将 USOC（生病或需要医疗建议时去的地方）和保险状况分类为有药物治疗高血压（n=3142）和高胆固醇血症（n=1134）指征的>或=35 岁成年人，分别使用联合国家委员会 7 和成人治疗小组 III 建议确定。多变量逻辑回归模型用于确定 USOC 对接受高血压和高胆固醇血症治疗的独立影响，控制年龄、性别、种族/族裔、保险状况和合并症。分别检查了按保险状况分层的多变量模型。
结果
在有治疗高血压和高胆固醇血症指征的患者中，分别有 32.4%和 42.0%未接受治疗。与有 USOC 的成年人相比，没有 USOC 的成年人更有可能未接受高血压（调整后的患病率比[aPR]2.43，95%CI 1.88-2.85）和高胆固醇血症（aPR 1.79，95%CI 1.31-2.13）治疗。在有保险的患者的分层分析中，没有 USOC 仍然与未接受治疗相关（高血压，aPR 2.58，95%CI 1.88-3.08；高胆固醇血症，aPR 1.65，95%CI 0.97-2.18）。
结论
即使在有保险的人群中，没有 USOC 与高血压和高胆固醇血症未治疗相关，这表明改善慢性病管理的努力也应促进获得常规医疗服务提供者的机会。
Zotero 插件