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加拿大患者与普通医生的医患关系和自我感知的未满足医疗需求之间的关联:基于2013至2014年加拿大社区健康调查的人群分析。

Association between patient attachment to a regular doctor and self-perceived unmet health care needs in Canada: A population-based analysis of the 2013 to 2014 Canadian community health surveys.

作者信息

Awe Oluwakemi A, Okpalauwaekwe Udoka, Lawal Adegboyega K, Ilesanmi Marcus M, Feng Cindy, Farag Marwa

机构信息

School of Public Health, University of Saskatchewan, Saskatoon, Canada.

Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada.

出版信息

Int J Health Plann Manage. 2019 Jan;34(1):309-323. doi: 10.1002/hpm.2632. Epub 2018 Aug 29.

DOI:10.1002/hpm.2632
PMID:30156709
Abstract

BACKGROUND

Although Canada operates a universal health care insurance system, equitable access to required health care services when needed still poses a challenge for some. The aim of this study was to examine the relationship between patient attachment to a family physician and self-perceived unmet health care needs (UHN) in Canada, after adjusting for predisposing, enabling, and need factors of the behavioral model of health services use.

METHODS

This cross-sectional study used data from the Canadian Community Health Surveys, cycle 2013 to 2014. A sample of 58 462 individuals aged 12 years and over was analyzed. Logistic regression models were used to examine the relationship between patient attachment and self-perceived UHN.

RESULTS

An estimated 10.41% of the Canadian population 12 years and older reported having UHN in the previous year. Among people with self-perceived UHN, there was significantly greater likelihood of unattachment to a family physician-no regular doctor or having a regular site of care, being younger, being female, being divorced, separated or widowed, having higher education, having lower income, having poorer perceived physical or mental health, having a weak sense of community belonging, having at least one chronic condition, and having greater activity limitations.

CONCLUSION

Ongoing public discourses on improving primary health care performance and reducing the burden of UHN in Canada should prioritize efforts that promote and facilitate the use of a regular family physician.

摘要

背景

尽管加拿大实行全民医疗保险制度,但对一些人来说,在需要时公平获得所需的医疗服务仍然是一项挑战。本研究的目的是在对卫生服务利用行为模型的易患因素、促成因素和需求因素进行调整之后,研究加拿大患者与家庭医生的联系和自我感知的未满足医疗需求(UHN)之间的关系。

方法

这项横断面研究使用了2013年至2014年加拿大社区健康调查的数据。对58462名12岁及以上的个体样本进行了分析。采用逻辑回归模型来研究患者与家庭医生的联系和自我感知的未满足医疗需求之间的关系。

结果

据估计,12岁及以上的加拿大人口中有10.41%报告在前一年有未满足的医疗需求。在自我感知有未满足医疗需求的人群中,与家庭医生无联系(没有固定医生或没有固定的就医地点)、年龄较小、女性、离婚、分居或丧偶、受过高等教育、收入较低、自我感知的身心健康较差、社区归属感较弱、患有至少一种慢性病以及活动受限程度较高的可能性显著更大。

结论

加拿大正在进行的关于改善初级卫生保健绩效和减轻未满足医疗需求负担的公众讨论,应优先考虑促进和便利使用固定家庭医生的努力。

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