Mendez-Luck Carolyn A, Walker Kara O, Luck Jeff
*College of Public Health and Human Sciences, Oregon State University, Corvallis, OR †Department of Family and Community Medicine, University of California, San Francisco, CA.
Med Care. 2016 Dec;54(12):1098-1104. doi: 10.1097/MLR.0000000000000584.
The burden of informal caregiving is significant and well-documented, yet the evidence is mixed as to whether being a caregiver presents an additional barrier to receiving recommended preventive care.
To determine whether (1) caregivers compared with noncaregivers were less likely to receive preventive health services; and (2) higher intensity caregivers were less likely to receive preventive health services than lower intensity caregivers.
RESEARCH DESIGN, SUBJECTS, AND MEASURES: Data were from a telephone survey of Latino and African American adults 50 years or older in South Los Angeles (n=702). Outcomes were flu vaccination, pneumococcal vaccination, and colorectal cancer screening. Logistic regression models adjusted for predisposing, enabling, and need factors according to the Andersen Model of Access to Health Care for Low-income Populations.
Caregiver type (eg, adult child, nonrelated) was associated with varying odds of receiving a preventive service. Caregivers had lower odds than noncaregivers of receiving preventive services although odds of receiving a flu vaccination improved slightly for caregivers of persons with memory loss compared with other caregivers. More weekly caregiving hours was associated with higher odds of receiving flu vaccination (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1) or colorectal cancer screening (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1). Caregivers and noncaregivers age 65 and older or with chronic conditions were more likely to receive vaccinations.
Preventive service use was influenced by characteristics of the caregiving situation. An opportunity may exist to leverage care recipients' ongoing contact with health care providers to increase caregivers' own access to preventive services.
非正式护理的负担很重且有充分记录，但对于护理者是否会成为接受推荐的预防性护理的额外障碍，证据并不一致。
确定（1）与非护理者相比，护理者接受预防性健康服务的可能性是否更低；（2）高强度护理者比低强度护理者接受预防性健康服务的可能性是否更低。
研究设计、研究对象和测量方法：数据来自对南洛杉矶50岁及以上的拉丁裔和非裔美国成年人进行的电话调查（n = 702）。结果指标为流感疫苗接种、肺炎球菌疫苗接种和结直肠癌筛查。根据低收入人群获得医疗保健的安德森模型，对易患因素、促成因素和需求因素进行了逻辑回归模型调整。
护理者类型（如成年子女、非亲属）与接受预防性服务的不同几率相关。护理者接受预防性服务的几率低于非护理者，尽管与其他护理者相比，记忆力丧失者的护理者接受流感疫苗接种的几率略有提高。每周护理时间越长，接受流感疫苗接种（调整后的优势比为1.1；95%置信区间 = 1.0, 1.1）或结直肠癌筛查（调整后的优势比为1.1；95%置信区间 = 1.0, 1.1）的几率越高。65岁及以上或患有慢性病的护理者和非护理者更有可能接种疫苗。
预防性服务的使用受到护理情况特征的影响。可能有机会利用护理接受者与医疗保健提供者的持续接触，增加护理者自身获得预防性服务的机会。
