NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal.
BMC Health Serv Res. 2021 Sep 28;21(1):1022. doi: 10.1186/s12913-021-07045-4.
Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen's behavioural model.
We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt, in Portugal. Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables.
In our sample, a high proportion of participants are overweight or obese (82,6%, n = 748) and physically inactive (20,6%, n = 201) and a small proportion had physiotherapy management (14,4%, n = 141). We identified three profiles of healthcare utilisation: "HighUsers"; "GPUsers"; "LowUsers". "HighUsers" represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. "GPUsers" represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location - indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations (p < 0,05) with the higher utilisation of healthcare services profiles.
Healthcare utilisation by people with knee osteoarthritis is not driven only by clinical needs. The predisposing characteristics and enabling factors associated with healthcare utilisation reveal inequities in the access to healthcare and variability in the management of people with knee osteoarthritis. Research and implementation of whole-system strategies to improve equity in the access and quality of care are paramount in order to diminish the impact of osteoarthritis at individual-, societal- and economic-level.
在全球范围内，膝关节骨关节炎的当前管理方法似乎存在差异，成本高昂，而且往往不是基于当前的最佳证据。缺乏关于医疗保健服务利用情况的流行病学数据可能掩盖了改善骨关节炎管理的必要性。本研究旨在根据安德森行为模型探讨膝关节骨关节炎患者的医疗保健服务利用情况，并分析其决定因素。
我们分析了葡萄牙基于人群的 EpiReumaPt 研究中诊断为膝关节骨关节炎的 978 名参与者的样本。通过结构化访谈收集数据，并且由风湿病学家团队验证膝关节骨关节炎的诊断。通过两步聚类程序，我们首先根据患者最常使用的服务确定医疗保健利用的不同模式。其次，我们根据倾向特征、使能因素和需求变量，使用多项逻辑回归分析每个模式的决定因素。
在我们的样本中，很大一部分参与者超重或肥胖（82.6%，n=748）且身体不活跃（20.6%，n=201），只有一小部分接受过物理治疗管理（14.4%，n=141）。我们确定了三种医疗保健利用模式：“高使用者”；“全科医生使用者”；“低使用者”。“高使用者”代表了样本中的 35%以上，也是医疗预约利用率较高的参与者。“全科医生使用者”代表了更频繁使用全科医生预约的参与者。在这些模式中，年龄和地理位置（作为倾向特征）；就业状况和医疗保险（作为使能因素）；共病数量、身体功能、健康相关生活质量、焦虑和身体活动（作为需求变量）与更高的医疗保健服务利用模式相关（p<0.05）。
膝关节骨关节炎患者的医疗保健利用不仅由临床需求驱动。与医疗保健利用相关的倾向特征和使能因素揭示了获得医疗保健服务的不平等现象，以及膝关节骨关节炎患者管理的变异性。研究和实施改善医疗保健获取和质量的全系统战略对于减轻骨关节炎在个人、社会和经济层面的影响至关重要。
