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澳大利亚儿童全科医疗服务利用中的社会人口学差异——一项全国代表性纵向研究的结果

Socio-demographic disparities in the utilisation of general practice services for Australian children - Results from a nationally representative longitudinal study.

作者信息

Ou Lixin, Chen Jack, Hillman Ken

机构信息

Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.

Ingham Institute for Applied Medical Research, New South Wales, Australia.

出版信息

PLoS One. 2017 Apr 27;12(4):e0176563. doi: 10.1371/journal.pone.0176563. eCollection 2017.

Abstract

OBJECTIVE

This study aimed to investigate the pattern of general practice services utilization for Australian children and to examine socio-demographic disparities in general practitioner (GP) visits.

METHODS

We used the linked data from the nationally representative Longitudinal Study of Australian Children (LSAC) and the Medicare Australia claims data record. We used survey negative binomial and logistic regression to examine the socio-demographic factors associated with the utilisation of general practice services.

RESULTS

The average number of annual GP visits gradually declined from 7.0 at 0-1 year old to 2.4 at 5-8 years (p< .001 for trend) in the infant cohort and from 3.5 at 2-4 years to 2.0 at 9-12 years (p < .001 for trend) in the child cohort. Girls were more likely to visit GPs than boys at 0-1 year old in the infant cohort (RR = 1.06, 95%CI: 1.02-1.11) and at 2-4 years in the child cohort (RR = 1.09, 95%CI: 1.04-1.14), but there were no differences at 2-4 to 5-8 year age periods in the infant cohort and at 5-8 to 9-12 year age period in the child cohort. Children from non-English speaking background were more likely to have a greater number of GP visits compared with their counterparts from English-speaking and Indigenous background up to eight year old in both cohorts (all p < .001). Children from families with the higher socio-economic position, children without private health insurance and children living in non-metropolitan were less likely to have GP consultations in both cohorts. Fair or poor parent-rated health status was associated with greater number of GP visits.

CONCLUSION

Socio-demographic disparities existed in the utilisation of general practice services and varied at different age periods. Family socio-economic position, private health insurance coverage and region of residence strongly associates with the utilisation disparities over all age period. Further policy interventions are called to minimise the disparities in GP utilisation for children in Australian context.

摘要

目的

本研究旨在调查澳大利亚儿童的全科医疗服务利用模式,并探讨全科医生(GP)就诊方面的社会人口统计学差异。

方法

我们使用了具有全国代表性的澳大利亚儿童纵向研究(LSAC)的关联数据以及澳大利亚医疗保险索赔数据记录。我们使用调查负二项式和逻辑回归来研究与全科医疗服务利用相关的社会人口统计学因素。

结果

在婴儿队列中,年平均全科医生就诊次数从0至1岁时的7.0次逐渐下降到5至8岁时的2.4次(趋势p <.001),在儿童队列中从2至4岁时的3.5次下降到9至12岁时的2.0次(趋势p <.001)。在婴儿队列中,0至1岁时女孩比男孩更有可能看全科医生(RR = 1.06,95%CI:1.02 - 1.11),在儿童队列中2至4岁时也是如此(RR = 1.09,95%CI:1.04 - 1.14),但在婴儿队列中2至4岁至5至8岁年龄段以及儿童队列中5至8岁至9至12岁年龄段没有差异。在两个队列中,直到8岁,来自非英语背景的儿童与来自英语背景和原住民背景的儿童相比,更有可能有更多的全科医生就诊次数(所有p <.001)。在两个队列中,来自社会经济地位较高家庭的儿童、没有私人健康保险的儿童以及居住在非大都市地区的儿童看全科医生的可能性较小。家长评定的健康状况为一般或较差与更多的全科医生就诊次数相关。

结论

全科医疗服务利用存在社会人口统计学差异,且在不同年龄阶段有所不同。家庭社会经济地位、私人健康保险覆盖范围和居住地区与所有年龄段的利用差异密切相关。需要进一步的政策干预以尽量减少澳大利亚儿童在全科医生利用方面的差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208d/5407608/add3ce7d8250/pone.0176563.g001.jpg

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