与移动医疗诊所使用相关的因素：一项回顾性队列研究。
Factors associated with mobile medical clinic use: a retrospective cohort study.
机构信息
California Baptist University, College of Nursing, 8432 Magnolia Ave, Riverside, Ca, 92504, USA.
University of California, San Francisco, CA, 94143, USA.
出版信息
Int J Equity Health. 2023 Sep 26;22(1):195. doi: 10.1186/s12939-023-02004-3.
BACKGROUND
Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension.
METHODS
We conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen's Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors.
RESULTS
Over the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36-1.92; 1.22, 95% CI, 1.02-1.45).
CONCLUSIONS
Mobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.
背景
移动医疗诊所已经使用了几十年，为服务不足的人群提供初级和预防保健。虽然有几项研究调查了移动医疗诊所在美国中大西洋和东海岸地区的投资回报率及其对慢性病管理结果的影响，但对于在西海岸地区接受移动诊所护理的成年人的特征和临床结果知之甚少。本研究以安德森行为模型为指导，描述了南加州移动医疗诊所患者使用移动医疗诊所的倾向因素、促成因素和需求因素，并考察了移动诊所利用与糖尿病和高血压的存在和控制之间的关系。
方法
我们对 2018 年 1 月 1 日至 2019 年 12 月 31 日期间在南加州四个移动诊所就诊的 411 名成年人进行了回顾性队列研究。数据来自患者病历，根据安德森行为模型收集了倾向因素（如性别、种族、年龄）、促成因素（如保险和住房状况）和需求因素（如慢性病）。使用零截断负二项回归检验了慢性病（高血压和糖尿病）与就诊次数的关联，同时考虑了潜在的混杂因素。
结果
在为期 2 年的研究期间，411 名患者共就诊 1790 次。大多数患者为女性（68%）、西班牙裔（78%）、已婚（47%），平均年龄为 50 岁（SD=11 岁）。44%的患者患有高血压，29%的患者患有糖尿病。移动医疗诊所的使用频率与慢性病显著相关。患有高血压和糖尿病的患者就诊次数分别是无这些疾病患者的 1.22 倍和 1.61 倍（IRR=1.61，95%CI，1.36-1.92；1.22，95%CI，1.02-1.45）。
结论
移动诊所是医疗保健提供系统的重要组成部分，尤其对于未控制的糖尿病和高血压的成年人。
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