Gudleski Gregory D, Satchidanand Nikhil, Dunlap Laura J, Tahiliani Varnita, Li Xiaohua, Keefer Laurie, Lackner Jeffrey M
Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, United States.
Department of Family Medicine, University at Buffalo, SUNY, Buffalo, NY, United States.
Behav Res Ther. 2017 Jan;88:65-75. doi: 10.1016/j.brat.2016.07.006.
Because health care demand among IBS patients imposes a heavy economic burden, identifying high utilizers has potential for improving quality and efficiency of care. Previous research has not identified reliable predictors of utilization of IBS patients. We sought to identify factors predictive of health care utilization among severe IBS patients. 291 IBS patients completed testing whose content mapped onto the Andersen model of health care utilization. 2-stage hurdle models were used to determine predictors of health care use (probability and frequency). Separate analyses were conducted for mental health and medical services. Whether patients used any medical care was predicted by diet and insurance status. Tobacco use, education, and health insurance predicted the probability of using mental health care. The frequency of medical care was associated with alcohol use and physical health status, while frequency of mental health services was associated with marital status, tobacco use, education, distress, stress, and control beliefs over IBS symptoms. For IBS patients, the demand for health care involves a complex decision-making process influenced by many factors. Particularly strong determinants include predisposing characteristics (e.g., dietary pattern, tobacco use) and enabling factors (e.g., insurance coverage) that impede or facilitate demand. Which factors impact use depends on whether the focus is on the decision to use care or how much care is used. Decisions to use medical and mental health care are not simply influenced by symptom-specific factors but by a variety of lifestyle (e.g., dietary pattern, education, smoking) and economic (e.g., insurance coverage) factors.
由于肠易激综合征（IBS）患者的医疗保健需求带来了沉重的经济负担，识别高医疗利用率者对于提高医疗质量和效率具有潜力。先前的研究尚未确定IBS患者医疗利用率的可靠预测因素。我们试图识别重度IBS患者医疗保健利用率的预测因素。291名IBS患者完成了测试，其内容符合医疗保健利用的安德森模型。采用两阶段障碍模型来确定医疗保健使用（概率和频率）的预测因素。对心理健康和医疗服务进行了单独分析。饮食和保险状况可预测患者是否使用任何医疗服务。吸烟、教育程度和健康保险可预测使用心理健康服务的概率。医疗服务的频率与饮酒和身体健康状况相关，而心理健康服务的频率与婚姻状况、吸烟、教育程度、痛苦、压力以及对IBS症状的控制信念相关。对于IBS患者而言，医疗保健需求涉及一个受多种因素影响的复杂决策过程。特别重要的决定因素包括 predisposing characteristics（例如饮食模式、吸烟）和 enabling factors（例如保险覆盖范围），这些因素会阻碍或促进需求。哪些因素影响使用取决于关注的是使用医疗服务的决策还是使用了多少医疗服务。使用医疗和心理健康服务的决策不仅受特定症状因素的影响，还受多种生活方式（例如饮食模式、教育程度、吸烟）和经济（例如保险覆盖范围）因素的影响。
