O'Toole Thomas P, Johnson Erin E, Redihan Stephan, Borgia Matthew, Rose Jennifer
J Health Care Poor Underserved. 2015 Aug;26(3):1019-31. doi: 10.1353/hpu.2015.0077.
We describe data from a multi-center community-based survey of homeless veterans who were not accessing available primary care to identify reasons for not getting this care as well as for not seeking health care when it was needed. Overall, 185 homeless veterans were interviewed: The average age was 48.7 years (SD 10.8), 94.6% were male, 43.2% were from a minority population. The majority identified a recent need for care and interest in having a primary care provider. Reasons for delaying care fell into three domains: 1) trust; 2) stigma; and 3) care processes. Identifying a place for care (OR 3.3; 95% CI: 1.4-7.7), having a medical condition (OR 5.5; 95% CI 1.9-15.4) and having depression (OR 3.4; 95% CI: 1.4-8.7) were associated with receiving care while not being involved in care decisions was associated with no care (OR 0.7; 95% CI 0.5-0.9). Our findings support the importance of considering health access within an expanded framework that includes perceived stigma, inflexible care systems and trust issues.
我们描述了一项基于社区的多中心调查数据，该调查对象为未接受现有初级保健服务的无家可归退伍军人，旨在确定未接受此类保健服务以及在需要时未寻求医疗保健的原因。总体而言，对185名无家可归退伍军人进行了访谈：平均年龄为48.7岁（标准差10.8），94.6%为男性，43.2%来自少数族裔。大多数人表示最近需要保健服务，并希望有一名初级保健提供者。延迟就医的原因分为三个方面：1）信任；2）耻辱感；3）就医流程。确定就医地点（比值比3.3；95%置信区间：1.4 - 7.7）、患有疾病（比值比5.5；95%置信区间1.9 - 15.4）和患有抑郁症（比值比3.4；95%置信区间：1.4 - 8.7）与接受治疗相关，而未参与治疗决策与未接受治疗相关（比值比0.7；95%置信区间0.5 - 0.9）。我们的研究结果支持在一个扩大的框架内考虑医疗保健可及性的重要性，该框架包括感知到的耻辱感、僵化的医疗系统和信任问题。
