在有和没有现场初级保健的情况下，瑞典接受阿片类药物替代治疗的患者的躯体疾病的医疗保健利用情况。
Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare.
机构信息
Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503, 22, Malmö, Sweden.
Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.
出版信息
BMC Health Serv Res. 2022 Jul 29;22(1):971. doi: 10.1186/s12913-022-08351-1.
BACKGROUND
Opioid substitution treatment (OST) populations are aging and have increased mortality and somatic morbidity compared to general populations internationally. While OST patients have poor self-rated physical health and unmet healthcare needs, documented healthcare utilization has been sparsely investigated. The aim of this study was to assess registered healthcare utilization for somatic conditions in a sample of Swedish OST patients, and compare healthcare utilization among OST patients with and without use of on-site primary healthcare (PHC).
METHODS
Patients in OST in Malmö, Sweden, were recruited for a survey study conducted in 2017-2018. Survey data were compared with comprehensive patient records from specialized and primary care during one year prior to study inclusion (total n = 190). All patient records were examined for healthcare utilization, source of healthcare (PHC, emergency care and secondary care), and documented diagnoses and symptoms. Factors associated with healthcare utilization were analyzed by using logistic regression analysis. Patients with and without on-site PHC were compared by using descriptive statistics and Chi-2 test.
RESULTS
A total of 88% of the sample had been in direct or indirect contact with somatic healthcare during one year (PHC 66%; emergency care 28%; secondary care 67%). The most prevalent somatic diagnoses were infectious diseases (39%) and symptom diagnoses (37%). Respiratory, dermatological and musculoskeletal diagnoses, and trauma/intoxication were documented in 21-26% of the sample, respectively. PHC utilization was associated with older age and being born in Sweden. Among patients with on-site PHC (n = 25), the number utilizing secondary care was 84%, and certain diagnostic codes were more frequent in this group.
CONCLUSION
OST patients are seemingly underserved as regards their physical health. Since increased OST access decreases opioid overdose fatalities, the life expectancy among OST patients is likely to increase and thereby also increases the risk of age-related conditions. Thus, easily accessible physical healthcare is of great importance in this group. On-site PHC might be a way to establish healthcare contact with OST patients, especially for non-acute conditions, although further research is needed.
背景
与国际上的一般人群相比，阿片类物质替代治疗（OST）人群年龄更大，死亡率和躯体发病率更高。尽管 OST 患者自我报告的身体健康状况较差，且医疗需求未得到满足，但对其医疗保健的利用情况却鲜有研究。本研究旨在评估瑞典 OST 患者样本中躯体疾病的注册医疗保健利用情况，并比较有和没有使用现场初级保健（PHC）的 OST 患者的医疗保健利用情况。
方法
在瑞典马尔默接受 OST 的患者被招募参加了 2017-2018 年进行的一项调查研究。在研究纳入之前的一年中，将调查数据与专门和初级保健的综合患者记录进行了比较（总共 n=190）。对所有患者记录进行了检查，以了解医疗保健的利用情况、医疗保健的来源（PHC、急诊和二级保健）以及记录的诊断和症状。使用逻辑回归分析来分析与医疗保健利用相关的因素。使用描述性统计和卡方检验比较有和没有现场 PHC 的患者。
结果
在一年中，该样本中有 88%的人直接或间接接触过躯体保健（PHC 66%；急诊 28%；二级保健 67%）。最常见的躯体诊断是传染病（39%）和症状诊断（37%）。呼吸系统、皮肤病学和肌肉骨骼疾病以及创伤/中毒分别占样本的 21-26%。PHC 的利用与年龄较大和出生在瑞典有关。在有现场 PHC 的患者中（n=25），有 84%的人利用了二级保健，并且该组中某些诊断代码更为常见。
结论
OST 患者的身体健康似乎得不到充分的关注。由于增加 OST 的获取途径可以降低阿片类药物过量的死亡率，因此 OST 患者的预期寿命可能会增加，从而增加了与年龄相关的疾病的风险。因此，在该人群中，获得便捷的身体保健非常重要。现场 PHC 可能是与 OST 患者建立医疗保健联系的一种方式，特别是对于非急性疾病，但需要进一步的研究。
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