社区卫生中心获得保险覆盖对戒烟的影响：一项队列研究
Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study.
作者信息
Bailey Steffani R, Hoopes Megan J, Marino Miguel, Heintzman John, O'Malley Jean P, Hatch Brigit, Angier Heather, Fortmann Stephen P, DeVoe Jennifer E
机构信息
Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
OCHIN, Inc., Portland, OR, USA.
出版信息
J Gen Intern Med. 2016 Oct;31(10):1198-205. doi: 10.1007/s11606-016-3781-4. Epub 2016 Jun 21.
BACKGROUND
Community health center (CHC) patients have high rates of smoking. Insurance coverage for smoking cessation assistance, such as that mandated by the Affordable Care Act, may aid in smoking cessation in this vulnerable population.
OBJECTIVE
We aimed to determine if uninsured CHC patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers.
DESIGN
Longitudinal observational cohort study using electronic health record data from a network of Oregon CHCs linked to Oregon Medicaid enrollment data.
PATIENTS
Cohort of patients who smoke and who gained Medicaid coverage in 2008-2011 after ≥ 6 months of being uninsured and with ≥ 1 smoking assessment in the 24-month follow-up period from the baseline smoking status date. This group was propensity score matched to a cohort of continuously uninsured CHC patients who smoke (n = 4140 matched pairs; 8280 patients).
INTERVENTION
Gaining Medicaid after being uninsured for ≥ 6 months.
MAIN MEASURES
'Quit' smoking status (baseline smoking status was 'current every day' or 'some day' and status change to 'former smoker' at a subsequent visit), smoking cessation medication order, and ≥ 6 documented visits (yes/no variables) at ≥ 1 smoking status assessment within the 24-month follow-up period.
KEY RESULTS
The newly insured had 40 % increased odds of quitting smoking (aOR = 1.40, 95 % CI:1.24, 1.58), nearly triple the odds of having a medication ordered (aOR = 2.94, 95 % CI:2.61, 3.32), and over twice the odds of having ≥ 6 follow-up visits (aOR = 2.12, 95 % CI:1.94, 2.32) compared to their uninsured counterparts.
CONCLUSIONS
Newly insured patients had increased odds of quit smoking status over 24 months of follow-up than those who remained uninsured. Providing insurance coverage to vulnerable populations may have a significant impact on smoking cessation.
背景
社区卫生中心（CHC）的患者吸烟率很高。诸如《平价医疗法案》所规定的戒烟援助保险覆盖范围，可能有助于这一弱势群体戒烟。
目的
我们旨在确定，与持续无保险的吸烟者相比，获得医疗补助保险覆盖的无保险社区卫生中心患者是否有更高的初级保健利用率、收到更多的戒烟药物处方且戒烟率更高。
设计
纵向观察性队列研究，使用来自俄勒冈州社区卫生中心网络的电子健康记录数据，并与俄勒冈州医疗补助登记数据相链接。
患者
在2008年至2011年期间，吸烟且在连续无保险≥6个月后获得医疗补助保险覆盖，并且在自基线吸烟状态日期起的24个月随访期内有≥1次吸烟评估的患者队列。该组与连续无保险的吸烟社区卫生中心患者队列进行倾向得分匹配（n = 4140对匹配组；8280名患者）。
干预
在无保险≥6个月后获得医疗补助。
主要测量指标
“戒烟”吸烟状态（基线吸烟状态为“每日吸烟”或“有时吸烟”，且在后续就诊时状态转变为“既往吸烟者”）、戒烟药物处方，以及在24个月随访期内≥1次吸烟状态评估时有≥6次记录就诊（是/否变量）。
关键结果
与无保险的对应患者相比，新参保者戒烟几率增加40%（调整后比值比[aOR]=1.40，95%置信区间[CI]：1.24，1.58），获得药物处方的几率几乎增加两倍（aOR = 2.94，95% CI：2.61，3.32），且有≥6次随访就诊的几率增加超过两倍（aOR = 2.12，95% CI：1.94，2.32）。
结论
在24个月的随访期内，新参保患者的戒烟几率高于仍未参保的患者。为弱势群体提供保险覆盖可能对戒烟有重大影响。
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