Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, 4770 Buford Highway NE, Atlanta, GA, USA.
Health Serv Res. 2011 Aug;46(4):1059-81. doi: 10.1111/j.1475-6773.2011.01240.x. Epub 2011 Feb 9.
To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly.
The 2001-2003 Medicare Current Beneficiaries Survey and 2002 Area Resource File.
Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question "Is there a particular medical person or a clinic you usually go to when you are sick or for advice about your health?" Ambulatory care use (ACU) was defined by having at least one physician office visit and/or hospital outpatient visit using Medicare claims. Depression was identified by a two-item screen (sadness and/or anhedonia). All measures were for the past 12 months. A simultaneous-equations (trivariate probit) model was estimated, adjusted for sampling weights and study design effects.
Based on the simultaneous-equations model, USOC is associated with 3.8 percent lower probability of having depression symptoms (p=.03). Also, it had a positive effect on having any ACU (p<.001). Having any ACU had no statistically significant effect on depression (p=.96).
USOC was associated with lower depression prevalence and higher realized access (ACU) among community-dwelling Medicare beneficiaries.
探讨是否存在常规医疗服务提供者（USOC）会降低老年人的抑郁患病率。
2001-2003 年医疗保险当前受益人调查和 2002 年区域资源文件。
确定了 2455 名年龄在 65 岁以上的社区居住者的 2 万 455 人年，这些人在医疗保险费用服务中同时享受医疗保险 A 部分和 B 部分的覆盖，并在一整年中都有 Medicare 报销的门诊服务。USOC 通过问题“当你生病或需要健康建议时，是否有特定的医疗人员或诊所可供你去？”来定义。门诊服务利用（ACU）通过至少一次医生办公室就诊和/或使用医疗保险报销的医院门诊就诊来定义。抑郁通过两项指标（悲伤和/或快感缺失）来确定。所有措施都是针对过去 12 个月。使用联立方程（三变量概率单位）模型进行估计，并调整了抽样权重和研究设计效果。
根据联立方程模型，USOC 与抑郁症状的发生概率降低 3.8%（p=.03）相关。此外，它对任何 ACU 的利用都有积极影响（p<.001）。任何 ACU 的利用对抑郁没有统计学上的显著影响（p=.96）。
USOC 与社区居住的医疗保险受益人的抑郁患病率降低和实际利用（ACU）增加相关。
