Kurichi Jibby E, Pezzin Liliana, Streim Joel E, Kwong Pui L, Na Ling, Bogner Hillary R, Xie Dawei, Hennessy Sean
Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Arch Gerontol Geriatr. 2017 Sep;72:45-51. doi: 10.1016/j.archger.2017.05.007. Epub 2017 May 18.
Many Medicare beneficiaries perceive barriers to receiving healthcare, although the consequences are unknown. Facilitators can aid in the receipt of healthcare services. The objective was to assess the relationship between perceived facilitators and barriers to healthcare and actual receipt of recommended medical care among elderly beneficiaries.
A cohort study using data from the 2001-2008 entry panels of the Medicare Current Beneficiary Survey that included 24,607 community-dwelling beneficiaries 65 years of age and older. Surveys elicited perceptions of healthcare with respect to: care coordination and quality; access to medical care; getting or delaying healthcare because of financial reasons; transportation; and usual source of care. The outcome was receipt of recommended medical care, expressed as an aggregate of 38 indicators covering initial evaluation, diagnostic tests, therapeutic interventions, hospitalization follow-up, and routine preventive care. Multivariable survey logistic regression produced odds ratios (ORs) and 95% confidence intervals (CIs) for receipt of recommended medical care, adjusted for sociodemographics, insurance, comorbidities, and disability.
Beneficiaries who reported having trouble getting or reported delaying healthcare because of financial reasons (barrier) (adjusted OR=0.79, 95% CI: 0.73-0.86) and those who reported having no usual source of care (facilitator) (adjusted OR=0.55, 95% CI: 0.48-0.63) were less likely to receive recommended medical care.
Survey data that capture patient perceptions of facilitators and barriers to healthcare may be useful for identifying system factors that affect timely receipt of recommended medical care. This information can inform the design of policies and programs to improve the healthcare of older adults.
许多医疗保险受益人认为在获得医疗保健方面存在障碍，但其后果尚不清楚。促进因素有助于获得医疗服务。目的是评估老年受益人中感知到的促进因素和障碍与实际接受推荐医疗护理之间的关系。
一项队列研究，使用医疗保险当前受益人调查2001 - 2008年入选小组的数据，该研究纳入了24,607名65岁及以上的社区居住受益人。调查引发了对医疗保健的看法，涉及：护理协调与质量；获得医疗服务；因经济原因获得或推迟医疗保健；交通；以及通常的医疗服务来源。结果是接受推荐的医疗护理，以涵盖初始评估、诊断测试、治疗干预、住院随访和常规预防保健的38项指标的总和表示。多变量调查逻辑回归得出接受推荐医疗护理的比值比（OR）和95%置信区间（CI），并根据社会人口统计学、保险、合并症和残疾情况进行了调整。
报告因经济原因难以获得或推迟医疗保健（障碍）的受益人（调整后的OR = 0.79，95% CI：0.73 - 0.86）以及报告没有通常医疗服务来源（促进因素）的受益人（调整后的OR = 0.55，95% CI：0.48 - 0.63）接受推荐医疗护理的可能性较小。
反映患者对医疗保健促进因素和障碍看法的调查数据可能有助于识别影响及时接受推荐医疗护理的系统因素。这些信息可为改善老年人医疗保健的政策和项目设计提供参考。
