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多物种家庭中人类和兽医医疗保健服务获取情况的概况及预测因素

Profiles and predictors of access to human and veterinary healthcare in multispecies households.

作者信息

Applebaum Jennifer W, Dunn Courtney, McDonald Shelby E, Escobar Kaylinn, King Erin K, Corona Rosalie, Mueller Megan K

机构信息

University of Florida, Gainesville, FL, United States of America.

Virginia Commonwealth University, Richmond, VA, United States of America.

出版信息

One Health. 2025 Jan 29;20:100981. doi: 10.1016/j.onehlt.2025.100981. eCollection 2025 Jun.

Abstract

This study extends a behavioral-ecological framework for healthcare access and utilization to explore patterns of healthcare and veterinary care access within pet-owning households in the United States. Using Latent Class Analysis, a person-centered analytic approach, we identified five subgroups of pet owners in a diverse national sample ( = 750), each characterized by unique patterns of perceived access and actual usage of both human and veterinary healthcare. The first subgroup, "Good access/unfair system" (27%) and the second subgroup, "Good access/fair system" (30%) reported high probabilities of good healthcare and veterinary care access and limited financial burden but differed in their perceptions of healthcare fairness. The third subgroup, "Good access/Medicare" (14%), primarily comprised of older adults with Medicare, reported good access to both human and veterinary care and limited financial burden, underscoring Medicare's role in stable healthcare access. The fourth subgroup, "Moderate access" (11%), characterized by financial barriers despite non-employer health insurance, showed a lower likelihood of recent dental and veterinary visits. The fifth subgroup, "Poor access" (18%), with the poorest healthcare access and highest probability of Medicaid or no insurance, highlighted significant inequalities in healthcare and veterinary care access. Sociodemographic and social environmental factors were associated with subgroup membership. For example, the groups with better access were likely to have low financial fragility (Good access/unfair system OR = 4.61,   0.001), and those with poorer access were unlikely (Poor access OR = 0.14). Additionally, the groups with better access were less likely to experience discrimination (Good access/fair system OR = 0.58,   0.001) and those with poorer access were more likely (Moderate and Poor access both ORs = 1.37,   0.001). These findings emphasize the need for policies addressing factors such as economic inequality and discrimination to improve healthcare and veterinary care access and utilization. Tailored interventions at individual and systemic levels are also suggested (i.e., the Colorado "Peticaid" proposal and the Seattle One Health Clinic) to mitigate disparities and enhance healthcare and veterinary care access for vulnerable populations.

摘要

本研究扩展了一个关于医疗保健获取与利用的行为生态框架,以探究美国家庭养宠户获取医疗保健和兽医护理的模式。我们采用以人为主的分析方法——潜在类别分析,在一个具有全国代表性的多样样本((n = 750))中识别出了五个宠物主人亚组,每个亚组都有其独特的人类和兽医医疗保健获取感知模式及实际使用模式。第一个亚组“良好获取/不公平系统”(27%)和第二个亚组“良好获取/公平系统”(30%)报告称,获得良好医疗保健和兽医护理的概率较高,且经济负担有限,但他们对医疗保健公平性的看法有所不同。第三个亚组“良好获取/医疗保险”(14%)主要由参加医疗保险的老年人组成,报告称获得人类和兽医护理的机会良好且经济负担有限,这凸显了医疗保险在稳定医疗保健获取方面的作用。第四个亚组“中等获取”(11%),其特征是尽管有非雇主医疗保险,但仍存在经济障碍,近期看牙和看兽医的可能性较低。第五个亚组“获取不佳”(18%),其医疗保健获取最差,且参加医疗补助或无保险的概率最高,凸显了医疗保健和兽医护理获取方面的显著不平等。社会人口统计学和社会环境因素与亚组成员身份相关。例如,获取情况较好的组可能财务脆弱性较低(“良好获取/不公平系统(OR = 4.61),(p < 0.001)),而获取情况较差的组则不太可能(‘获取不佳’(OR = 0.14))。此外,获取情况较好的组遭受歧视的可能性较小(‘良好获取/公平系统’(OR = 0.58),(p < 0.001)),而获取情况较差的组则更有可能(‘中等获取’和‘获取不佳’的(OR)值均为(1.37),(p < 0.001))。这些发现强调需要制定政策来解决经济不平等和歧视等因素,以改善医疗保健和兽医护理的获取与利用。还建议在个体和系统层面进行针对性干预(例如科罗拉多州的“宠物医疗补助”提案和西雅图的“同一健康诊所”),以减少差距并增强弱势群体获得医疗保健和兽医护理的机会。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf84/11835633/95978c32ef71/gr1a.jpg

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