Department of Dermatology, University of California at San Francisco, San Francisco, USA.
JAMA Dermatol. 2013 Jun;149(6):717-21. doi: 10.1001/jamadermatol.2013.133.
This article represents a real-world perspective on access to health care including the number and types of physicians seen by patients with psoriasis. It is important for practicing dermatologists to recognize patients who may be less likely to seek care for this multifaceted systemic disease as well as to be aware of reasons for not seeing physicians.
To examine the relationship between psoriasis patient characteristics and access to health care and to determine out-of-pocket costs for psoriasis care.
Cross-sectional survey.
Patients with psoriasis and psoriatic arthritis in the general community in the United States.
A random sample of patients with psoriasis and psoriatic arthritis from more than 75,000 National Psoriasis Foundation members.
Number and type of physicians seen in the past 2 years and out-of-pocket health care expenses were measured.
Among 5604 patients with psoriasis and psoriatic arthritis, 92.4% had seen at least 1 physician in 2 years. Compared with males, female patients with psoriasis were 1.47 times more likely to seek care (adjusted odds ratio, 1.47; 95% CI, 1.18-1.83). Patients with private insurance and Medicare were more likely to seek care compared with uninsured patients (adjusted odds ratio, 3.02; 95% CI, 2.23-4.08 and 2.85; 1.91-4.24, respectively). Among patients with psoriasis seeking care, 78.3% were seeing specialists; 22% obtained care from primary care physicians. Primary reasons for not seeking treatments included giving up on disease treatment (27.6%) and prohibitive cost (21%). Compared with patients with mild disease, patients with severe psoriasis were more likely to seek a specialist for care (adjusted odds ratio, 1.64; 95% CI, 1.37-1.98). Patients spent an average of $2528 out-of-pocket per year for psoriasis care.
About one-quarter of patients seek psoriasis care from primary care physicians, and insurance status affects care-seeking patterns. Giving up on treatment and prohibitive costs remain primary reasons for not seeking care.
本文从现实角度探讨了银屑病患者的医疗保健可及性，包括患者就诊的医生数量和类型。对于皮肤科医生来说，了解哪些患者不太可能寻求这种多方面的系统性疾病的治疗非常重要，同时也要意识到患者未就诊的原因。
研究银屑病患者特征与医疗保健可及性之间的关系，并确定银屑病治疗的自付费用。
横断面调查。
美国普通社区的银屑病和银屑病关节炎患者。
从美国银屑病基金会的 75000 多名成员中随机抽取的银屑病和银屑病关节炎患者。
在过去 2 年内就诊的医生数量和类型以及自付医疗保健费用。
在 5604 名银屑病和银屑病关节炎患者中，92.4%的患者在过去 2 年内至少看过 1 名医生。与男性相比，女性银屑病患者寻求治疗的可能性高 1.47 倍（调整后的优势比，1.47；95%CI，1.18-1.83）。与未参保患者相比，有私人保险和医疗保险的患者更有可能寻求治疗（调整后的优势比，3.02；95%CI，2.23-4.08 和 2.85；1.91-4.24）。在寻求治疗的银屑病患者中，78.3%的患者就诊于专科医生；22%的患者从初级保健医生处获得治疗。未寻求治疗的主要原因包括放弃疾病治疗（27.6%）和费用过高（21%）。与轻度疾病患者相比，重度银屑病患者更有可能寻求专科医生进行治疗（调整后的优势比，1.64；95%CI，1.37-1.98）。患者每年用于银屑病治疗的自付费用平均为 2528 美元。
约四分之一的患者从初级保健医生处获得银屑病治疗，而保险状况影响了就诊模式。放弃治疗和费用过高仍然是未寻求治疗的主要原因。
