School of Nursing, University of Pittsburgh.
RAND Corporation, Pittsburgh, PA.
Med Care. 2018 Apr;56(4):329-336. doi: 10.1097/MLR.0000000000000886.
Having a "personal" physician is a critical element to care continuity. Little is known about which older adults are more likely to lack personal physicians and if their care experiences differ from those with a personal physician.
The objective of this study was to describe care experiences and characteristics associated with not having a personal physician.
We compare rates of lacking a personal physician across subgroups. Using doubly robust propensity-score-weighted regression, we compare patient experience among beneficiaries with and without a personal physician.
A total of 272,463 nationally representative beneficiaries age 65+ responding to the 2012 Medicare CAHPS survey.
Beneficiary characteristics, having a personal physician, 4 patient experience measures.
Five percent of respondents reported no personal physician. Lacking a personal physician was more common for men, racial/ethnic minorities (eg, 16% of American Indian/Alaska Natives), and the younger and less educated. Those without a personal physician reported substantially poorer experiences on 4 measures (P<0.001); these differences are larger than those observed by key demographic characteristics. Beneficiaries without a personal physician were more than 3 times as likely to have not seen any health care provider in the last 6 months.
Even with the access provided by Medicare, a small but nontrivial proportion of seniors report having no personal physician. Those without a personal physician report substantially worse patient experiences and lacking a personal physician is more common for some vulnerable groups. This may underlie some previously observed disparities. Efforts should be made to encourage and help seniors without personal physicians to select one.
拥有“私人”医生是医疗连续性的关键因素。对于哪些老年人更有可能没有私人医生，以及他们的护理体验是否与有私人医生的人不同，人们知之甚少。
本研究旨在描述与没有私人医生相关的护理体验和特征。
我们比较了不同亚组中缺乏私人医生的比例。使用双重稳健倾向评分加权回归，我们比较了有和没有私人医生的受益人的患者体验。
共有 272463 名年龄在 65 岁及以上的全国代表性受益人参与了 2012 年医疗保险 CAHPS 调查。
受益人的特征、是否有私人医生、4 项患者体验测量。
5%的受访者报告没有私人医生。缺乏私人医生的情况在男性、少数族裔（例如，16%的美国印第安人/阿拉斯加原住民）以及年轻和受教育程度较低的人群中更为常见。没有私人医生的人在 4 项指标上报告了明显较差的体验（P<0.001）；这些差异大于通过关键人口特征观察到的差异。没有私人医生的受益人与过去 6 个月内未看过任何医疗保健提供者的可能性高出 3 倍以上。
即使有医疗保险提供的服务，一小部分老年人仍报告没有私人医生。没有私人医生的人报告的患者体验明显较差，并且一些弱势群体更有可能没有私人医生。这可能是之前观察到的一些差异的基础。应努力鼓励和帮助没有私人医生的老年人选择一位。
