横断面研究，旨在考察首次接触初级保健的程度是否会对具有某些性格特征的人群接受预防服务产生不同程度的益处。
Cross-sectional study examining whether the extent of first-contact access to primary care differentially benefits those with certain personalities to receive preventive services.
作者信息
Pandhi Nancy, Schumacher Jessica R, Thorpe Carolyn T, Smith Maureen A
机构信息
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Population Health Sciences, Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
出版信息
BMJ Open. 2016 Mar 7;6(3):e009738. doi: 10.1136/bmjopen-2015-009738.
OBJECTIVE
The extent of first-contact access to primary care (ie, easy availability when needed) is associated with receiving recommended preventive services. Whether this access benefits patients at risk of preventive services underutilisation, such as those with certain personality characteristics, is unclear.
SETTING
Secondary analysis of the 2003-2006 round of the Wisconsin Longitudinal Study.
PARTICIPANTS
6975 respondents who reported a usual provider whose specialty was internal medicine or family medicine. Those reporting not visiting a medical provider in the past 12 months, and those who were uninsured were excluded.
PRIMARY OUTCOME MEASURES
Receiving mammography, cholesterol testing and influenza vaccination. Adjusted predicted probabilities (aPP) of receiving these services were analysed stratified by personality characteristics overall, and if significant, then interacted with first-contact access.
RESULTS
Lower conscientiousness as compared with higher conscientiousness predicted less of all 3 preventive services; mammography (aPP 80%; 95% CI (77% to 83%) vs aPP 85%; (95% CI 82% to 87%)), cholesterol testing (88%; (85% to 90%) vs 93% (91% to 94%), and influenza vaccination (62%; (59% to 64%) vs 66%; (63% to 68%)). Lower agreeableness as compared with higher agreeableness predicted less mammography (77%; (73% to 81%) vs 84%; (82% to 87%)) and less influenza vaccination (59%; (56% to 62%) vs 65%; (63% to 68%)). Lower extraversion predicted less cholesterol testing (88%; (86% to 91%) vs (92%; (90% to 94%)). Lower openness to experience predicted less influenza vaccination (59%; (56% to 63%) vs (68%; (65% to 70%)). For agreeableness, these differences in receiving preventive services did not persist when first-contact access to primary care was present.
CONCLUSIONS
Certain personality characteristics predicted receiving less preventive care services. For those with less agreeableness, improved first-contact access to primary care mitigated this effect. If these results are replicated in other studies, primary care offices seeking to improve population health through receiving preventive services should prioritise increasing their first-contact accessibility.
目的
首次接触初级保健的程度（即在需要时易于获得）与接受推荐的预防服务相关。这种可及性是否对有预防服务利用不足风险的患者有益，比如那些具有某些人格特征的患者，尚不清楚。
背景
对威斯康星纵向研究2003 - 2006年轮次进行二次分析。
参与者
6975名报告有内科或家庭医学专科常规医疗服务提供者的受访者。排除过去12个月未就医者以及未参保者。
主要结局指标
接受乳房X光检查、胆固醇检测和流感疫苗接种。总体上按人格特征分层分析接受这些服务的调整预测概率（aPP），若有显著差异，则与首次接触可及性进行交互分析。
结果
与尽责性较高者相比，尽责性较低者接受所有3项预防服务的比例均较低；乳房X光检查（aPP 80%；95%置信区间（77%至83%）对比aPP 85%；（95%置信区间82%至87%））、胆固醇检测（88%；（85%至90%）对比93%（91%至94%））以及流感疫苗接种（62%；（59%至64%）对比66%；（63%至68%））。与宜人性较高者相比，宜人性较低者接受乳房X光检查的比例较低（77%；（73%至81%）对比84%；（82%至87%））且接受流感疫苗接种的比例较低（59%；（56%至62%）对比65%；（63%至68%））。外向性较低者接受胆固醇检测的比例较低（88%；（86%至91%）对比（92%；（90%至94%））。经验开放性较低者接受流感疫苗接种的比例较低（59%；（56%至63%）对比（68%；（65%至70%））。对于宜人性，当存在首次接触初级保健的可及性时，接受预防服务的这些差异不再持续。
结论
某些人格特征预示接受的预防保健服务较少。对于宜人性较低者，改善首次接触初级保健的可及性减轻了这种影响。如果这些结果能在其他研究中得到重复验证，那么寻求通过接受预防服务来改善人群健康的初级保健机构应优先提高其首次接触的可及性。
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