Centre for Women's Health Research, The University of Newcastle, New South Wales.
Health Behaviour Research Group, The University of Newcastle, New South Wales.
Aust N Z J Public Health. 2021 Oct;45(5):497-503. doi: 10.1111/1753-6405.13146. Epub 2021 Jul 26.
To assess the use of Medicare-subsidised health services by women with and without dementia.
Data from women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models.
A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non-emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators.
The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).
评估患有痴呆症和无痴呆症的女性对医疗保险补贴医疗服务的使用情况。
从澳大利亚女性健康纵向研究中 1921-26 年出生队列的女性数据中提取信息，并将其与各种行政数据集进行链接，以确定痴呆症的诊断。使用纵向 GEE 模型分析了这些女性在 2000 年至 2013 年期间补贴的全科医生（GP）服务（75+健康评估[HA]、慢性病管理会议[CDM]、多学科病例会议[MCC]）和专科及辅助医疗服务的使用情况。
共纳入 9683 名女性，其中 1444 名（15%）女性被诊断为痴呆症。与无痴呆症迹象的女性相比，患有痴呆症的女性每年的非紧急 GP 就诊次数更多（短[<30 分钟]IRR=1.11[1.07, 1.13]；长[>30 分钟]IRR=1.11[1.04, 1.19]），而专科就诊次数更少（IRR=0.91[0.85, 0.97]），并且更有可能进行紧急 GP 就诊（OR=2.29[2.05, 2.57]）。有痴呆症和无痴呆症迹象的女性在 HA 或 CDM 就诊或使用辅助医疗服务的可能性方面没有显著差异。
总体而言，用于改善患有慢性疾病的老年人的预防和护理协调的服务使用率较低。患有痴呆症的女性不太可能获得这些服务。对公共卫生的启示：一些专为患有复杂慢性疾病的人群设计的初级和辅助医疗服务使用率较低。患有痴呆症的女性可以更好地利用这些服务，以改善复杂合并症的管理（如 CDM），预防残疾的发生（如物理治疗），并增强需求评估和服务获取（如 HA）。
