School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Graduate School of Business, University of Cape Town, Cape Town, South Africa.
Glob Health Action. 2014 Mar 14;7:23807. doi: 10.3402/gha.v7.23807. eCollection 2014.
Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening.
A cross-sectional study for the period 2007-2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data.
Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR] = 3.2 for HIV screening, confidence interval [CI] = 2.75-3.73). Plan type (full comprehensive plan) was most strongly associated with cholesterol screening (OR = 3.53, CI = 3.27-3.80), and most negatively associated (hospital-only core plan) with cervical cancer screening (OR = 0.44, CI = 0.28-0.70). Gender was a negative predictor for glucose screening (OR = 0.88, CI = 0.82-0.96). Provincial residence was most strongly associated with cervical cancer screening (OR = 1.89, CI = 0.65-5.54).
Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access.
为了降低发病率、死亡率和成本，广泛接受了遵循筛查指南的做法。本研究的目的是在南非一个参加医疗保险的人群中确定与生活方式相关的慢性病、癌症和 HIV 筛查指南的依从性的预测因素，这些人群中有些人自愿选择参加奖励筛查的健康计划。
使用单一保险公司的随机抽样，对 2007 年至 2011 年期间的 170471 名医疗保险成员进行了横断面研究。从医疗索赔数据中计算出筛查指南的依从性。
筛查指南的依从性从结直肠癌的 1.1%到胆固醇筛查的 40.9%不等。参加健康计划的成员筛查疾病的可能性增加了两倍（HIV 筛查的比值比[OR] = 3.2，置信区间[CI] = 2.75-3.73）。计划类型（全面综合计划）与胆固醇筛查的相关性最强（OR = 3.53，CI = 3.27-3.80），与宫颈癌筛查的相关性最弱（仅医院核心计划，OR = 0.44，CI = 0.28-0.70）。性别是葡萄糖筛查的负面预测因素（OR = 0.88，CI = 0.82-0.96）。省级居住与宫颈癌筛查的相关性最强（OR = 1.89，CI = 0.65-5.54）。
对筛查建议的依从性<50%。计划类型、性别、省级居住和参加激励性健康计划与筛查服务的利用不成比例有关，即使支付方式相同也是如此。
