Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Front Public Health. 2024 Sep 27;12:1384604. doi: 10.3389/fpubh.2024.1384604. eCollection 2024.
The Canada Health Act mandates universal access to medical services for all Canadians. Despite this, there are significant disparities in access based on socioeconomic status, race and ethnicity, immigrant status, and indigeneity. However, there is limited evidence on the use of specialist services among older adults in Canada. The primary objective of this study is to identify the associations of social determinants of health with access to medical specialist services for Canadians aged 45 years and older. The second objective is to identify the reasons for not being able to access the needed specialist care.
A cross-sectional analysis of the Canadian Longitudinal Study on Aging survey was conducted. Based on the Andersen's model of health services use, a multivariable logistic regression model was used to evaluate the associations between 'not being able to access the needed specialist service(s) in the last 12 months' and individual-level sociodemographic determinants.
Approximately 97% of those who required specialist care in the last year were able to visit a specialist. Of the participants who were not able to access the needed specialist services, about half (50.90%) were still waiting for a visit. The following factors were associated with greater difficulty in accessing specialist care: being younger (45-54 years), living in a rural area, having some post-secondary education, having a household income below $50,000 a year, not having a family physician, and having fair or poor perceived general health. Residents of British Columbia and Nova Scotia had a higher likelihood of reporting difficulty compared to those residing in Ontario.
While a majority of respondents were able to access specialist services when needed, those who had difficulty in accessing care were more likely to come from socially marginalized groups. Targeted policy interventions and improved health system coordination can reduce these barriers to care.
《加拿大健康法案》规定所有加拿大人都享有获得医疗服务的普遍权利。尽管如此，基于社会经济地位、种族和民族、移民身份以及原住民身份等因素，在获得医疗服务方面仍存在显著差异。然而，关于加拿大老年人使用专科服务的证据有限。本研究的主要目的是确定健康社会决定因素与 45 岁及以上加拿大人获得医疗专科服务的关系。第二个目的是确定无法获得所需专科护理的原因。
对加拿大老龄化纵向研究调查进行了横断面分析。基于安德森健康服务利用模型，使用多变量逻辑回归模型评估了“在过去 12 个月内无法获得所需专科服务”与个体社会人口统计学决定因素之间的关系。
大约 97%的在过去一年中需要专科护理的人能够就诊专科医生。在无法获得所需专科服务的参与者中，约有一半（50.90%）仍在等待就诊。以下因素与获得专科护理的难度增加有关：年龄较小（45-54 岁）、居住在农村地区、接受过一些高等教育、家庭年收入低于 50,000 加元、没有家庭医生以及自我感知的一般健康状况较差。与居住在安大略省的人相比，不列颠哥伦比亚省和新斯科舍省的居民更有可能报告在获得护理方面存在困难。
尽管大多数受访者在需要时能够获得专科服务，但那些在获得护理方面存在困难的人更有可能来自社会边缘化群体。有针对性的政策干预和改善卫生系统协调可以减少这些护理障碍。
