University of Michigan, Ann Arbor, MI 48109, USA.
Public Health. 2012 Nov;126(11):920-7. doi: 10.1016/j.puhe.2012.08.003. Epub 2012 Sep 5.
To quantify the extent to which adults with chronic health conditions or impairments in Great Britain experience barriers to accessing health services in comparison to adults without impairments.
Secondary analysis of cross-sectional population-based survey data from the Life Opportunities Survey.
The Life Opportunities Survey interviewed a nationally representative sample of 37,513 individuals age 16 or older from 19,951 households. A subset of questions addressed disability status, health conditions and impairments, and participation restrictions in accessing public services. Simple bivariate and multivariate logistic regression (controlling for age, gender, and ethnicity) analyses were undertaken to estimate the risk that specific condition/impairment types were associated with barriers to accessing health care.
Individuals with chronic health conditions or impairments were significantly more likely to report difficulties accessing health care services. Additionally, individuals in each condition/impairment group had significantly higher odds of experiencing a variety of barriers, including discrimination by healthcare staff, inexperienced or unhelpful staff, lack of help with communication, lack of information, problems with transportation, difficulty getting into buildings, difficulty using facilities, and lack of confidence or anxiety.
Individuals with chronic health conditions or impairments are significantly more likely than their non-impaired peers to experience barriers in accessing health care. These barriers are likely to exacerbate disability and may increase the likelihood of developing additional preventable health conditions. As a result, they may contribute towards the health inequalities experienced by disabled people. The existence of these barriers also suggests that health care provision in Great Britain is failing to meet its statutory requirement to provide 'reasonable adjustments' to ensure equality of access for disabled adults.
定量比较英国患有慢性疾病或身体损伤的成年人与无损伤成年人在获取医疗服务方面所面临的障碍程度。
对来自生活机遇调查的横断面基于人群的调查数据进行二次分析。
生活机遇调查对来自 19951 户家庭的 37513 名 16 岁或以上的具有代表性的个体进行了访谈。其中一部分问题涉及残疾状况、健康状况和损伤以及在获取公共服务方面的参与限制。采用简单的二变量和多变量逻辑回归（控制年龄、性别和种族）分析来估计特定疾病/损伤类型与获取医疗保健障碍之间的关联风险。
患有慢性疾病或损伤的个体更有可能报告在获取医疗保健服务方面存在困难。此外，每个疾病/损伤组的个体都有更高的几率经历各种障碍，包括医护人员的歧视、医护人员缺乏经验或不帮忙、缺乏沟通帮助、信息缺乏、交通问题、难以进入建筑物、难以使用设施以及缺乏信心或焦虑。
患有慢性疾病或损伤的个体比没有损伤的同龄人更有可能在获取医疗保健方面遇到障碍。这些障碍可能会加重残疾，并可能增加出现其他可预防健康状况的可能性。因此，它们可能会导致残疾人士面临的健康不平等。这些障碍的存在还表明，英国的医疗保健服务未能满足其提供“合理调整”以确保残疾成年人平等获得服务的法定要求。
