Augustin Jobst, Schäfer Ines, Augustin Matthias, Zander Nicole
Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Germany.
J Dtsch Dermatol Ges. 2017 Apr;15(4):430-438. doi: 10.1111/ddg.13218. Epub 2017 Mar 17.
With respect to health care planning, it is commonly assumed that patients consult the nearest physician. In reality, however, patients frequently accept great-er efforts/expenses than necessary to see a physician. The objective of the present study was to determine under which circumstances patients were willing to accept additional efforts/expenses, and which role sociodemographic and clinical characteristics play in this regard.
Data collection was carried out in the context of a multicenter cross-sectional study among office-based and hospital-affiliated (University Medical Center Hamburg-Eppendorf) dermatologists. Patients (n = 309) with psoriasis and chronic wounds were surveyed about their mobility patterns and disease severity. Data analysis was performed using descriptive and multivariate methods.
The willingness to accept additional efforts/expenses is primarily determined by a physician's expertise and service portfolio. Comparing both diagnoses showed that psoriasis patients usually traveled longer distances than wound patients. Among psoriasis patients, one significant predictor for accepting additional efforts/expenses was the level of education. With regard to wound patients, key factors included wound size (severity).
The present study revealed complex mobility patterns among patients, which are affected by numerous personal as well as clinical factors. Depending on the diagnosis and individual preferences, additional efforts/expenses can - among other things - be explained by disease severity. Further studies are required to obtain more conclusive data.
在医疗保健规划方面，通常认为患者会咨询距离最近的医生。然而，在现实中，患者经常会付出比必要情况更多的努力/费用去看医生。本研究的目的是确定在哪些情况下患者愿意接受额外的努力/费用，以及社会人口统计学和临床特征在这方面发挥何种作用。
数据收集是在一项多中心横断面研究中进行的，该研究涉及门诊皮肤科医生和附属医院（汉堡-埃彭多夫大学医学中心）的皮肤科医生。对309名患有银屑病和慢性伤口的患者进行了关于其就医移动模式和疾病严重程度的调查。使用描述性和多变量方法进行数据分析。
接受额外努力/费用的意愿主要取决于医生的专业知识和服务组合。比较两种诊断情况发现，银屑病患者通常比伤口患者出行距离更远。在银屑病患者中，接受额外努力/费用的一个重要预测因素是教育水平。对于伤口患者，关键因素包括伤口大小（严重程度）。
本研究揭示了患者复杂的就医移动模式，这些模式受到众多个人因素以及临床因素的影响。根据诊断和个人偏好，额外的努力/费用在一定程度上可以由疾病严重程度来解释。需要进一步研究以获得更具决定性的数据。
