Kim Minchul, Asche Carl V, Tillis William, Ren Jinma
a Center for Outcomes Research/Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
b Department of Pharmacy Systems, Outcomes and Policy , University of Illinois at Chicago College of Pharmacy , Chicago , IL , USA.
Curr Med Res Opin. 2017 Mar;33(3):479-487. doi: 10.1080/03007995.2016.1264930. Epub 2016 Dec 2.
Limited accessibility to providers may delay appropriate control of asthma exacerbations. The objective of our study is to estimate the contributors to the hospital/emergency department (ED) visits among adults with asthma focusing on the availability of healthcare providers.
We conducted a pooled cross-sectional analysis using the 2011-2013 Asthma Call-Back Survey linked with 2012-2016 Area Health Resource Files. We employed multivariable logistic regression with dichotomous outcomes of hospitalization and ED visits. Key covariates were the availability of county-level healthcare provider variables per 100,000 persons such as the number of lung disease specialists (including pulmonary care specialists, and allergy and immunology specialists), the number of hospitals, the number of safety-net facilities including rural health centers (RHCs) and federally qualified health centers (FQHCs), and the number of primary care physicians (PCPs).
Among 25,621 adults, proportions of hospital visits and ED visits were 3.3% and 13.2%, respectively. An additional RHC reduced by 3% the odds of having an ED visit (odds ratio [OR] = 0.97, p = .004). Patients with cost barriers to seeing a PCP were 60% (OR = 1.60, p = .028) more likely to have a hospital visit than those without. In addition, patients with cost barriers to seeing a specialist were 90% (OR = 1.90, p = .007) and 111% (OR = 2.11, p = .001) more likely to have a hospital visit and ED visit, respectively, than those without.
Hospital and ED visits among adults with asthma are partially related to the availability of providers, and more related to financial barriers. Therefore, financial support for the vulnerable asthma population might be a target for policy makers interested in reducing hospitalizations and ED visits.
患者获得医疗服务提供者的机会有限可能会延迟对哮喘急性加重的适当控制。我们研究的目的是评估成年哮喘患者前往医院/急诊科(ED)就诊的影响因素,重点关注医疗服务提供者的可及性。
我们使用2011 - 2013年哮喘回访调查与2012 - 2016年地区卫生资源文件进行了汇总横断面分析。我们采用多变量逻辑回归分析,以住院和急诊就诊的二分结果作为变量。关键协变量是每10万人中县级医疗服务提供者变量的可及性,如肺病专科医生(包括肺科护理专家、过敏和免疫专家)的数量、医院数量、包括农村卫生中心(RHCs)和联邦合格健康中心(FQHCs)在内的安全网设施数量以及初级保健医生(PCP)的数量。
在25621名成年人中,住院就诊和急诊就诊的比例分别为3.3%和13.2%。每增加一家农村卫生中心,急诊就诊的几率降低3%(优势比[OR] = 0.97,p = 0.004)。与没有费用障碍的患者相比,看初级保健医生存在费用障碍的患者住院就诊的可能性高60%(OR = 1.60,p = 0.028)。此外,与没有费用障碍的患者相比,看专科医生存在费用障碍的患者住院就诊和急诊就诊的可能性分别高90%(OR = 1.90,p = 0.007)和111%(OR = 2.11,p = 0.001)。
成年哮喘患者的住院和急诊就诊部分与医疗服务提供者的可及性有关,更多与经济障碍有关。因此,对于有兴趣减少住院和急诊就诊的政策制定者来说,为脆弱的哮喘人群提供财政支持可能是一个目标。