Schuldt Robert, Jinnett Kimberly
Genentech Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
University of California San Francisco, San Francisco, CA, USA.
BMC Health Serv Res. 2024 Dec 5;24(1):1549. doi: 10.1186/s12913-024-11921-0.
Specialty care is a critical component of the healthcare system in the United States (US). Despite the frequency and importance of specialty referrals, disparities accessing specialty care have been reported across geographic regions and sociodemographic groups in the US.
The purpose of this study is to help inform health policy and practical solutions for improving access to specialty care in the US. We examined patients' perspectives and experiences regarding access to specialty care for themselves and family members across 5 specialty areas (oncology, neurology, ophthalmology, endocrinology, and other specialty). Data for access to care were collected from the RAND American Life Panel, a nationally representative probability-based panel of 6,000 participants who are regularly interviewed over the internet.
The survey population consisted of 2,137 adults, with a specialist referral recommended for 1,391 respondents (65%). The mean age of the population was 59.4 years, 23.0% were rural dwellers, 57.6% were female, 80.8% were White, 59.4% were married or living with a partner, and 85.4% were in good health. Approximately one-third (28%) of the US population experienced a barrier accessing a care specialist (oncologist, neurologist, ophthalmologist, endocrinologist, or other specialist) for themselves or for their families in 2021. Differences in access to specialty care were observed between US census regions. Difficulty accessing specialty care differed according to sociodemographic groups; a greater percentage of respondents who were < 65 years, women, or BIPOC (Black, Indigenous, and people of color) experienced a problem accessing a specialist. Numerous barriers were identified that limited access to specialty care in the overall US population, with difficulty getting an appointment and long wait times being identified as primary barriers.
Patient access to specialty care may be further complicated by patient-specific compounding factors including the number of specialty referrals, insurance providers, and barriers.
专科护理是美国医疗保健系统的重要组成部分。尽管专科转诊频繁且重要，但美国不同地理区域和社会人口群体在获得专科护理方面存在差异的情况已被报道。
本研究的目的是为改善美国专科护理可及性的卫生政策和实际解决方案提供参考。我们考察了患者在5个专科领域（肿瘤学、神经病学、眼科、内分泌学和其他专科）为自己及家庭成员获得专科护理方面的观点和经历。获取护理的数据来自兰德美国生活面板，这是一个具有全国代表性的基于概率的面板，由6000名参与者组成，他们通过互联网接受定期访谈。
调查对象包括2137名成年人，其中1391名受访者（65%）被建议进行专科转诊。人群的平均年龄为59.4岁，23.0%为农村居民，57.6%为女性，80.8%为白人，59.4%已婚或与伴侣同住，85.4%健康状况良好。2021年，约三分之一（28%）的美国人口在为自己或家人获取护理专科医生（肿瘤学家、神经科医生、眼科医生、内分泌科医生或其他专科医生）时遇到了障碍。在美国人口普查区域之间观察到了获得专科护理的差异。获得专科护理的困难因社会人口群体而异；年龄小于65岁、女性或有色人种（黑人、原住民和有色人种）的受访者中，有更大比例的人在获取专科医生方面遇到问题。确定了许多限制美国总体人群获得专科护理的障碍，其中难以预约和等待时间长被确定为主要障碍。
患者获得专科护理可能会因患者特定的复合因素而进一步复杂化，这些因素包括专科转诊数量、保险提供者和障碍。
