1998-2013 年巴西卫生服务利用趋势及其与多种疾病的关系。
Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998-2013.
机构信息
Programa de Pós-graduação em Saúde Coletiva, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Departamento de Epidemiologia, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brazil.
出版信息
BMC Health Serv Res. 2020 Nov 25;20(1):1080. doi: 10.1186/s12913-020-05938-4.
BACKGROUND
Chronic non-communicable diseases (NCDs) are the leading cause of multimorbidity. Access to effective and equitable health services that meet NCDs' needs is still limited in many countries. This constitutes the main barrier to coping with NCDs, especially in minimising the suffering of those who are already sick. The present study aimed to identify the relationship between multimorbidity and the use of different health services in Brazil from 1998 to 2013.
METHODS
This is a panel study using data from the health supplement of the National Household Sample Survey of 1998, 2003 and 2008 and data from the National Health Survey carried out in 2013. Three health service utilization outcomes were considered: 1. search for health services in the last 15 days (excluding dental services), 2. medical consultation in the previous 12 months and 3. hospitalisations over the last 12 months. Multimorbidity was assessed by counting the number of morbidities from a list of 10 morbidities. Poisson regression models stratified by sex were used to estimate the crude and adjusted prevalence ratios and their respective 95% confidence intervals for each outcome of health service use and multimorbidity, per year.
RESULTS
There was an increase in the prevalence of demand for health services and medical consultations in the last 12 months between 1998 and 2013, regardless of the multimorbidity classification. The prevalence of hospitalisations has decreased over the study period and increased twofold in individuals with multimorbidity. Having multimorbidity increased the use of health services for the three outcomes under the study, being more expressive among men.
CONCLUSIONS
This study found that individuals with multimorbidity have higher levels of use of health services. Better understand the multimorbidity epidemiology and the associated impacts on the use and costs of health services can increase the quality of care provided to these patients and reduce rising health care costs.
背景
慢性非传染性疾病（NCDs）是多种疾病的主要原因。在许多国家，获得满足 NCD 需求的有效和公平的卫生服务仍然有限。这是应对 NCD 的主要障碍，特别是在减轻已经患病的人的痛苦方面。本研究旨在确定 1998 年至 2013 年期间巴西多种疾病与不同卫生服务使用之间的关系。
方法
这是一项使用 1998 年、2003 年和 2008 年全国家庭抽样调查健康补充数据以及 2013 年全国健康调查数据的面板研究。考虑了三种卫生服务利用结果：1. 在过去 15 天内寻求卫生服务（不包括牙科服务），2. 在过去 12 个月内进行医疗咨询，3. 在过去 12 个月内住院。通过从 10 种疾病列表中计数疾病数量来评估多种疾病。使用按性别分层的泊松回归模型，估计每种卫生服务使用结果和多种疾病的粗患病率比及其各自的 95%置信区间，每年一次。
结果
无论多种疾病分类如何，1998 年至 2013 年间，对卫生服务和过去 12 个月内医疗咨询的需求的患病率都有所增加。在研究期间，住院率有所下降，但在患有多种疾病的人群中增加了两倍。患有多种疾病会增加三种研究结果的卫生服务使用，在男性中更为明显。
结论
本研究发现，患有多种疾病的人使用卫生服务的水平更高。更好地了解多种疾病的流行病学及其对卫生服务的使用和成本的影响，可以提高为这些患者提供的护理质量，并降低不断上升的医疗保健成本。
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