Rommel Alexander, Kroll Lars Eric
Department 2: Epidemiology and Health Monitoring, Robert Koch Institute, POB 65 02 61, D-13302 Berlin, Germany.
Department 2: Epidemiology and Health Monitoring, Robert Koch Institute.
Phys Ther. 2017 May 1;97(5):512-523. doi: 10.1093/ptj/pzx022.
Physical therapy is included in many clinical guidelines and is a commonly used health service. However, access to its benefits should not strongly depend on social or demographic factors.
The present study used the Andersen model to explain to what extent physical therapy utilization in Germany depends on factors beyond medical need.
The German Health Interview and Examination Survey for Adults (DEGS, 2008-2011; target population, 18-79 years) is part of the German health-monitoring system. Two-stage stratified cluster sampling resulted in a sample of 8152 participants. Data were matched with district-related information on social structures and service supply. Following Andersen's Behavioral Model of Health Services Use, this study identified predisposing, enabling, and need factors for physical therapy utilization using multilevel logistic regression analyses.
Physical therapy was used by 23.4% (95% CI: 22.0-24.8) of the German population within one year, with a higher proportion of females (26.8%; 95% CI: 25.1-28.6) than males (19.9%; 95% CI: 18.1-21.8) and an increase with age. Beyond medical need, physical therapy utilization depended on higher education, migrant background, nonsmoking (predisposing), social support, higher income, private health insurance, and gatekeeping service contact (enabling). Variation among districts partly reflected regional supply.
Because the present study was cross-sectional, its findings provide representative information on physical therapy use but do not establish final causal links or identify whether utilization or supply in certain districts or population groups is adequate.
Whether certain regions are under- or overserved and whether further regulations are needed is of political interest. Physicians and therapists should develop strategies to improve both adherence of hard-to-reach groups and supply in low-supply regions.
物理治疗被纳入许多临床指南，是一种常用的医疗服务。然而，获得其益处不应强烈依赖于社会或人口因素。
本研究使用安德森模型来解释德国物理治疗的利用在多大程度上取决于医疗需求以外的因素。
德国成人健康访谈与检查调查（DEGS，2008 - 2011年；目标人群为18 - 79岁）是德国健康监测系统的一部分。两阶段分层整群抽样产生了8152名参与者的样本。数据与社会结构和服务供应的地区相关信息相匹配。根据安德森的卫生服务利用行为模型，本研究使用多水平逻辑回归分析确定了物理治疗利用的易患因素、促成因素和需求因素。
德国23.4%（95%置信区间：22.0 - 24.8）的人口在一年内使用过物理治疗，女性比例（26.8%；95%置信区间：25.1 - 28.6）高于男性（19.9%；95%置信区间：18.1 - 21.8），且随年龄增长而增加。除医疗需求外，物理治疗的利用还取决于高等教育、移民背景、不吸烟（易患因素）、社会支持较高、收入较高、私人医疗保险以及守门人服务接触（促成因素）。地区间差异部分反映了区域供应情况。
由于本研究为横断面研究，其结果提供了关于物理治疗使用的代表性信息，但未建立最终的因果联系，也未确定某些地区或人群组的利用或供应是否充足。
某些地区是服务不足还是服务过度以及是否需要进一步监管具有政治意义。医生和治疗师应制定策略，以提高难以接触到的群体的依从性，并改善供应不足地区的服务供应。
