不明原因躯体症状患者的生命质量和医疗费用均较其他患者群体差：一项关于负担的横断面研究。
Patients with unexplained physical symptoms have poorer quality of life and higher costs than other patient groups: a cross-sectional study on burden.
机构信息
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, PO Box 2040, 3000, CA Rotterdam, The Netherlands.
出版信息
BMC Health Serv Res. 2013 Dec 17;13:520. doi: 10.1186/1472-6963-13-520.
BACKGROUND
To determine whether healthcare resources are allocated fairly, it is helpful to have information on the quality of life (QoL) of patients with Unexplained Physical Symptoms (UPS) and on the costs associated with them, and on how these relate to corresponding data in other patient groups. As studies to date have been limited to specific patient populations with UPS, the objective of this study was to assess QoL and costs in a general sample of patients with UPS using generic measures.
METHODS
In a cross-sectional study, 162 patients with UPS reported on their QoL, use of healthcare resources and lost productivity in paid and unpaid work. To assess QoL, the generic SF-36 questionnaire was used, from which multidimensional quality-of-life scores and a one-dimensional score (utility) using the SF-6D scorings algorithm were derived. To assess costs, the TiC-P questionnaire was used.
RESULTS
Patients with UPS reported a poor QoL. Their QoL was mostly decreased by limitations in functioning due to physical health, and the least by limitations in functioning due to emotional problems. The median of utilities was 0.57, and the mean was 0.58 (SD = .09).The cost for the use of healthcare services was estimated to be €3,123 (SD = €2,952) per patient per year. This cost was enlarged by work-related costs: absence from work (absenteeism), lower on-the-job productivity (presenteeism), and paid substitution of domestic tasks. The resulting mean total cost was estimated to be €6,815 per patient per year.
CONCLUSIONS
These findings suggest that patients with UPS have a high burden of disease and use a considerable amount of healthcare resources. In comparison with other patient groups, the QoL values of patients with UPS were among the poorest and their costs were among the highest of all patient groups. The burden for both patients and society helps to justify the allocation of sufficient resources to effective treatment for patients with UPS.
背景
为了确定医疗资源分配是否公平，了解不明原因躯体症状 (UPS) 患者的生活质量 (QoL) 及其相关成本的信息很有帮助，了解这些信息与其他患者群体的相应数据的关系也很有帮助。由于迄今为止的研究仅限于具有 UPS 的特定患者群体，因此本研究的目的是使用通用措施评估一般 UPS 患者的 QoL 和成本。
方法
在一项横断面研究中，162 名 UPS 患者报告了他们的 QoL、医疗资源的使用情况以及在有薪和无薪工作中的生产力损失。为了评估 QoL，使用了通用的 SF-36 问卷，从中得出多维生活质量评分和使用 SF-6D 评分算法的一维评分（效用）。为了评估成本，使用了 TiC-P 问卷。
结果
UPS 患者报告生活质量较差。他们的 QoL 主要因身体健康导致的功能受限而下降，而因情绪问题导致的功能受限最少。效用中位数为 0.57，平均值为 0.58（SD=0.09）。估计每位患者每年因使用医疗服务而产生的费用为 3123 欧元（SD=2952 欧元）。与工作相关的成本（旷工、在职工作生产力下降和支付替代家务劳动）扩大了这一成本。由此产生的平均总成本估计为每位患者每年 6815 欧元。
结论
这些发现表明 UPS 患者疾病负担沉重，使用大量医疗资源。与其他患者群体相比，UPS 患者的 QoL 值是所有患者群体中最差的，而他们的成本是所有患者群体中最高的。无论是对患者还是对社会来说，这一负担都有助于证明为 UPS 患者提供充足资源以进行有效治疗是合理的。
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