Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Health Serv Res. 2018 Apr;53(2):1065-1091. doi: 10.1111/1475-6773.12679. Epub 2017 Mar 15.
Little attention has been given to psychological factors as correlates of health care use, which could be an important key to manage it. We analyzed the association of psychological factors with health care use.
Primary data were obtained from three follow-ups (2002, 2008, and 2011) of a large population-based study with participants aged 40+.
Using a longitudinal observational study, we analyzed the psychological factors of negative and positive affect (affective well-being), life satisfaction (cognitive well-being), self-efficacy, loneliness, self-esteem, optimism, and flexible goal adjustment using fixed-effects regressions.
The participants provided data on health care use (visits to general practitioners [GPs] and specialists as well as hospitalization) and psychological factors via self-administered questionnaires and personal interviews (7,116 observations). The sample was drawn using national probability sampling.
Controlling for self-rated health, chronic diseases and sociodemographics, increases in affective well-being, and optimism decreased health care use of GPs, specialists, and hospital treatment. Increases in cognitive well-being decreased health care use of GPs and specialists. Increases in self-efficacy decreased hospitalization.
The study underlines the influence of psychological factors on health care use. Thus, whenever possible, future studies of health care use should include psychological factors, and efforts to reduce health care use might focus on such factors.
很少关注心理因素与医疗保健使用之间的相关性，而这可能是管理医疗保健使用的一个重要关键。我们分析了心理因素与医疗保健使用之间的关系。
主要数据来自一项基于人群的大型研究的三次随访（2002 年、2008 年和 2011 年），参与者年龄在 40 岁以上。
使用纵向观察性研究，我们使用固定效应回归分析了消极和积极影响（情感幸福感）、生活满意度（认知幸福感）、自我效能感、孤独感、自尊心、乐观主义和灵活目标调整等心理因素。
参与者通过自我管理问卷和个人访谈提供了关于医疗保健使用（看全科医生和专家以及住院治疗）和心理因素的数据（7116 次观察）。该样本是通过全国概率抽样抽取的。
在控制自评健康、慢性病和社会人口统计学因素后，情感幸福感的增加和乐观主义的增加降低了全科医生、专家和住院治疗的医疗保健使用。认知幸福感的增加降低了全科医生和专家的医疗保健使用。自我效能感的增加降低了住院治疗。
该研究强调了心理因素对医疗保健使用的影响。因此，未来的医疗保健使用研究只要有可能就应包括心理因素，而减少医疗保健使用的努力可能应侧重于这些因素。
