College of Nursing, University of Central Florida.
Disability, Aging, and Technology Cluster, University of Central Florida.
Prev Chronic Dis. 2020 Oct 15;17:E128. doi: 10.5888/pcd17.200148.
Health care avoidance by Medicare beneficiaries with chronic conditions such as type 2 diabetes can result in adverse health and economic outcomes. The objective of this study was to describe factors associated with choices to avoid health care among Medicare beneficiaries with type 2 diabetes.
We used a survey-weighted logistic model and the nationally representative 2016 Medicare Current Beneficiary Survey to analyze data on 1,782 Medicare beneficiaries aged ≥65 with type 2 diabetes, to examine associations between Medicare beneficiaries' decisions to avoid health care and multiple factors (eg, dissatisfaction with information given by providers, health problems that should have been discussed with providers but were not, worry about health more than other people their age).
Of our study sample, 26.1% reported they avoid health care. Five factors were associated with avoiding health care: delaying care (vs not) because of costs (adjusted odds ratio [aOR] = 2.06; P = .005); having health problems that should have been discussed with providers but were not (vs having discussions) (aOR = 1.50; P = .04); worrying (vs not) about health more than other people their age (aOR = 2.13; P < .001); self-reporting "other" minority race (vs non-Hispanic White) (aOR = 2.01; P = .006); and education levels. Participants with less than a high school diploma (aOR = 1.95; P = .001) and participants with a high school diploma only (aOR = 1.49; P = .049) were more likely than participants with an education beyond high school to report avoiding health care.
Approximately 1 in 4 Medicare beneficiaries with type 2 diabetes avoid health care. We found inequities in care-seeking behavior by race/ethnicity and education level. Health care perceptions and lack of appropriate discussion of health care concerns with health care providers are also associated with this behavior. Clinical interventions (eg, improved patient-provider communication) and educational outreach are needed to decrease the numbers of Medicare beneficiaries who avoid health care.
患有 2 型糖尿病等慢性病的 Medicare 受保人回避医疗保健可能会导致不良的健康和经济后果。本研究的目的是描述与 2 型糖尿病 Medicare 受保人回避医疗保健的选择相关的因素。
我们使用经过调查加权的逻辑模型和具有全国代表性的 2016 年 Medicare 现行受保人调查，对 1782 名年龄≥65 岁且患有 2 型糖尿病的 Medicare 受保人进行数据分析，以检查 Medicare 受保人避免医疗保健的决定与多种因素（例如，对提供者提供的信息不满意，有健康问题本应与提供者讨论但未讨论，比同龄人更担心健康）之间的关联。
在我们的研究样本中，有 26.1%的人报告说他们回避医疗保健。有五个因素与回避医疗保健有关：由于费用而延迟护理（与不延迟相比）（调整后的优势比 [aOR] = 2.06；P =.005）；有本应与提供者讨论但未讨论的健康问题（与有讨论相比）（aOR = 1.50；P =.04）；比同龄人更担心（与不担心相比）健康（aOR = 2.13；P <.001）；自我报告为“其他”少数民族（与非西班牙裔白人相比）（aOR = 2.01；P =.006）；和教育程度。未完成高中学业（aOR = 1.95；P =.001）和仅完成高中学业（aOR = 1.49；P =.049）的参与者比接受过高中以上教育的参与者更有可能报告回避医疗保健。
大约四分之一的患有 2 型糖尿病的 Medicare 受保人回避医疗保健。我们发现，种族/民族和教育程度的医疗保健寻求行为存在不平等现象。对医疗保健的看法以及与医疗保健提供者缺乏适当讨论医疗保健问题也与这种行为有关。需要临床干预（例如，改善医患沟通）和教育外展，以减少回避医疗保健的 Medicare 受保人数。
