Bailey Steffani R, O'Malley Jean P, Gold Rachel, Heintzman John, Marino Miguel, DeVoe Jennifer E
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon.
Am J Prev Med. 2015 Feb;48(2):229-233. doi: 10.1016/j.amepre.2014.08.035. Epub 2014 Nov 6.
Lack of insurance is associated with suboptimal receipt of diabetes preventive care. One known reason for this is an access barrier to obtaining healthcare visits; however, little is known about whether insurance status is associated with differential rates of receipt of diabetes care during visits.
To examine the association between health insurance and receipt of diabetes preventive care during an office visit.
This retrospective cohort study used electronic health record and Medicaid data from 38 Oregon community health centers. Logistic regression was used to test the association between insurance and receipt of four diabetes services during an office visit among patients who were continuously uninsured (n=1,117); continuously insured (n=1,466); and discontinuously insured (n=336) in 2006-2007. Generalized estimating equations were used to account for within-patient correlation. Data were analyzed in 2013.
Overall, continuously uninsured patients had lower odds of receiving services at visits when due, compared to those who were continuously insured (AOR=0.73, 95% CI=0.66, 0.80). Among the discontinuously insured, being uninsured at a visit was associated with lower odds of receipt of services due at that visit (AOR=0.77, 95% CI=0.64, 0.92) than being insured at a visit.
Lack of insurance is associated with a lower probability of receiving recommended services that are due during a clinic visit. Thus, the association between being uninsured and receiving fewer preventive services may not be completely mediated by access to clinic visits.
缺乏保险与糖尿病预防保健的接受情况不理想有关。其中一个已知原因是获得医疗就诊存在障碍；然而，关于保险状况是否与就诊期间糖尿病护理的不同接受率相关，人们知之甚少。
研究医疗保险与就诊期间糖尿病预防保健接受情况之间的关联。
这项回顾性队列研究使用了来自俄勒冈州38个社区卫生中心的电子健康记录和医疗补助数据。采用逻辑回归分析，以检验2006 - 2007年间持续未参保患者（n = 1117）、持续参保患者（n = 1466）和间断参保患者（n = 336）在就诊期间保险与接受四项糖尿病服务之间的关联。使用广义估计方程来考虑患者内部的相关性。数据于2013年进行分析。
总体而言，与持续参保患者相比，持续未参保患者在应就诊时接受服务的几率较低（调整后比值比[AOR]=0.73，95%置信区间[CI]=0.66，0.80）。在间断参保患者中，就诊时未参保与就诊时接受应得服务的几率较低相关（AOR = 0.77，95% CI = 0.64，0.92），低于就诊时参保的情况。
缺乏保险与在诊所就诊时接受应得推荐服务的可能性较低相关。因此，未参保与接受较少预防服务之间的关联可能并非完全由获得诊所就诊的机会所介导。
