Choi Namkee G, Sullivan John E, DiNitto Diana M, Kunik Mark E
The University of Texas at Austin Steve Hicks School of Social Work, Houston, TX.
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.
Kidney Med. 2019 Jul 13;1(4):162-170. doi: 10.1016/j.xkme.2019.07.002. eCollection 2019 Jul-Aug.
RATIONALE & OBJECTIVE: Despite extensive research on health care access for individuals with chronic kidney disease (CKD), there is little research on the relationship between health care access barriers and psychological distress.
An observational study based on the publicly available 2013 to 2017 US National Health Interview Survey data.
SETTING & PARTICIPANTS: 3,923 respondents 18 years or older who self-reported a diagnosis of CKD in the preceding 12 months.
Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Barriers to health care access included lack of health insurance coverage, lack of a usual source of health care, and financial barriers to accessing/obtaining health care, including medical specialist services, prescription drugs, mental health counseling, and dental care.
Multinomial logistic regression with 3 levels of K6 scores (no distress, mild to moderate distress, and serious distress) as the dependent variable.
15% of respondents reported mild to moderate and 11% reported serious psychological distress. Compared with those with no distress, those with mild to moderate and serious distress were younger but less likely to have worked in the preceding year, had more chronic medical conditions, and visited an emergency department more frequently. Multivariable regression models show that each financial barrier to health care access (likely due to lack of health insurance) was significantly associated with mild to moderate and serious distress.
CKD diagnosis was self-reported and CKD stage was unknown. Because this is a cross-sectional study, associations cannot be assumed to imply causal relationships.
Access to sick and preventive/routine care should be improved. People with CKD should be assessed for psychological distress, treated as needed, and offered case management and social services to help them navigate the health care system and alleviate personal stressors.
尽管对慢性肾脏病（CKD）患者的医疗保健可及性进行了广泛研究，但关于医疗保健可及性障碍与心理困扰之间的关系却鲜有研究。
一项基于公开的2013年至2017年美国国家健康访谈调查数据的观察性研究。
3923名18岁及以上的受访者，他们在过去12个月内自我报告患有CKD。
使用凯斯勒心理困扰量表（K6）测量心理困扰。医疗保健可及性障碍包括缺乏医疗保险覆盖、缺乏常规医疗保健来源以及获得/获取医疗保健（包括专科医疗服务、处方药、心理健康咨询和牙科护理）的经济障碍。
以K6评分的三个水平（无困扰、轻度至中度困扰和严重困扰）作为因变量的多项逻辑回归。
15%的受访者报告有轻度至中度困扰，11%报告有严重心理困扰。与无困扰者相比，有轻度至中度和严重困扰者更年轻，但前一年工作的可能性较小，患有更多慢性疾病，且更频繁地前往急诊科就诊。多变量回归模型显示，医疗保健可及性的每一项经济障碍（可能由于缺乏医疗保险）都与轻度至中度和严重困扰显著相关。
CKD诊断为自我报告，且CKD分期未知。由于这是一项横断面研究，不能假定关联意味着因果关系。
应改善患病及预防/常规护理的可及性。应对CKD患者进行心理困扰评估，根据需要进行治疗，并提供病例管理和社会服务，以帮助他们应对医疗保健系统并减轻个人压力源。
