Stransky Michelle L
Department of Community Health, Tufts University, Medford, MA, USA.
Social Science Applied Research Center, University of North Carolina, Wilmington, NC, USA.
J Patient Exp. 2018 Dec;5(4):258-266. doi: 10.1177/2374373518755499. Epub 2018 Mar 8.
Provider discontinuity is associated with poorer health-care outcomes compared to continuity in studies using retrospective reports of provider (dis)continuity. This study examined unmet needs for care and assessed cost as the reason for and the level of the problem resulting from unmet needs by provider (dis)continuity using longitudinal data.
Pooled data on 10 714 working-age adults (aged 18-64) from the Medical Expenditure Panel Survey (panels 16 [2011-2012] and 17 [2012-2013]) were analyzed. Provider (dis)continuity was defined by 2 reports of having a health-care provider during the period.
Persons who lost providers were more likely to forego medical care and prescription medications, forego care due to cost, and report that delaying care was a big problem than their peers who experienced continuity. Persons who gained providers were more likely to delay dental care than those who always had, lost, or never had providers.
Persons who experience discontinuity have poorer access to care than their peers who experience continuity. Public health initiatives should promote longitudinal relationships between persons and health-care providers.
在使用医疗服务提供者(不)连续性回顾性报告的研究中,与连续性相比,医疗服务提供者的不连续性与较差的医疗保健结果相关。本研究使用纵向数据,考察了未满足的护理需求,并评估了因医疗服务提供者的(不)连续性导致的未满足需求所产生问题的原因及程度。
对来自医疗支出小组调查(第16组[2011 - 2012年]和第17组[2012 - 2013年])的10714名工作年龄成年人(18 - 64岁)的汇总数据进行了分析。医疗服务提供者的(不)连续性由该时期内有医疗服务提供者的两份报告来定义。
与经历连续性的同龄人相比,失去医疗服务提供者的人更有可能放弃医疗护理和处方药,因费用问题放弃护理,并报告延迟护理是一个大问题。与一直有、失去或从未有过医疗服务提供者的人相比,获得医疗服务提供者的人更有可能延迟牙科护理。
与经历连续性的同龄人相比,经历不连续性的人获得护理的机会更少。公共卫生倡议应促进个人与医疗服务提供者之间的长期关系。