超重和肥胖患者的“医生购物”与医疗保健利用的增加有关。
Doctor shopping by overweight and obese patients is associated with increased healthcare utilization.
机构信息
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Obesity (Silver Spring). 2013 Jul;21(7):1328-34. doi: 10.1002/oby.20189. Epub 2013 May 13.
OBJECTIVE
Negative interactions with healthcare providers may lead patients to switch physicians or "doctor shop." We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight nonshoppers.
DESIGN AND METHODS
We combined claims data from a health plan in one state with information from beneficiaries' health risk assessments. The primary outcome was "doctor shopping," which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations.
RESULTS
Of the 20,726 beneficiaries, the mean BMI was 26.3 kg m(-2) (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04-1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26-1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37-2.45; IRR 1.83, 95%CI 1.34-2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10-2.03; Obese IRR 1.54, 95%CI 1.12-2.11).
CONCLUSION
Frequently changing PCPs may impair continuity and result in increased healthcare utilization.
目的
与医疗保健提供者的负面互动可能导致患者更换医生或“医生购物”。我们假设超重和肥胖患者更有可能“医生购物”，因此与正常体重非购物者相比，他们急诊就诊和住院的比例会更高。
设计和方法
我们将一个州的健康计划中的索赔数据与受益人的健康风险评估信息相结合。主要结果是“医生购物”，我们将其定义为在 24 个月内有≥5 名不同初级保健医生（PCP）的门诊索赔。自变量是按 BMI 划分的 NIH 标准体重类别。我们进行多变量逻辑回归来评估体重类别与医生购物之间的关联。我们进行了多变量零膨胀负二项回归，以评估体重-医生购物类别与急诊就诊和住院次数的关系。
结果
在 20726 名受益人中，平均 BMI 为 26.3kg/m²（标准差 5.1），平均年龄为 44.4 岁（标准差 11.1），53%为女性。与正常体重的受益相比，超重的受益调整后的医生购物可能性增加了 23%（OR 1.23，95%CI 1.04-1.46），肥胖的受益调整后的医生购物可能性增加了 52%（OR 1.52，95%CI 1.26-1.82）。与正常体重非购物者相比，超重和肥胖购物者的急诊就诊率更高（IRR 1.85，95%CI 1.37-2.45；IRR 1.83，95%CI 1.34-2.50），这在体重组内比较中仍然存在（超重 IRR 1.50，95%CI 1.10-2.03；肥胖 IRR 1.54，95%CI 1.12-2.11）。
结论
经常更换 PCP 可能会损害连续性并导致医疗保健利用率增加。
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