Sanders Scott R, Erickson Lance D, Call Vaughn R A, McKnight Matthew L, Hedges Dawson W
Department of Sociology, Brigham Young University, Provo, Utah.
J Rural Health. 2015 Spring;31(2):146-56. doi: 10.1111/jrh.12093. Epub 2014 Sep 12.
(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass.
Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass.
Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows.
Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior.
（1）评估农村初级保健医生（PCP）绕过行为的发生率，即居民为获得医疗服务而前往比必要距离更远的地方就医的行为；（2）研究社区和非医疗相关特征在绕过行为中的作用；（3）分析空间绕过模式，以确定哪些农村社区受绕过行为影响最大。
数据来自蒙大拿州健康事务调查，该调查收集了蒙大拿州居民关于其医疗服务利用、对医疗服务满意度以及社区和人口特征的自我报告信息。使用逻辑回归和空间分析来研究绕过行为的概率和空间模式。
总体而言，39%的受访者绕过当地医疗服务。与先前的研究相似，对当地医疗服务的不满会增加绕过的可能性。对当地购物的不满也会增加绕过的可能性，而社区中的朋友数量以及与社区的共性会降低绕过的可能性。与绕过相关的其他重要因素包括年龄、收入、健康状况以及生活在高度农村化社区或通勤流量大的社区。
我们的结果表明，患者为了增加便利性而将服务和购物捆绑在一起的外出购物理论也适用于初级医疗保健选择。这意味着农村医疗保健选择是多方面的，除了对当地医疗服务的感知满意度外，当地购物质量和社区依恋程度也会影响绕过行为。
