Cunningham W E, Hays R D, Williams K W, Beck K C, Dixon W J, Shapiro M F
Department of Medicine, School of Medicine, University of California, Los Angeles, USA.
Med Care. 1995 Jul;33(7):739-54. doi: 10.1097/00005650-199507000-00009.
Despite growing interest in the accessibility of medical care and health-related quality of life for persons infected with human immunodeficiency virus, an association between these variables has not been documented. The authors conducted a cross-sectional study of access to care and its association with health-related quality of life among 205 persons of low income infected with the human immunodeficiency virus with constitutional symptoms and/or diarrhea at one public and one Veterans Administration hospital, using a 9-item measure of perceived access and a 55-item health-related quality of life instrument. Problems with access were widespread: 55% traveled for longer than 30 minutes to their usual source of care (compared with 9% to 12% of general populations in national surveys), 49% had problems meeting costs of care, and 48% had problems with clinic hours (compared with 23% in national surveys). In multivariate analyses, uninsured patients reported worse access than patients with Medicaid or Veterans Administration insurance, particularly for meeting the cost of care (P < 0.01). Adjusted health-related quality of life scores in this sample were far lower (by about 1 SD) than those of subjects in a large national acquired immune deficiency syndrome clinical trial. For 8 of 11 health-related quality of life subscales, worse perceived access was significantly (P < 0.05) associated with poorer health-related quality of life, even after controlling for T-4 lymphocyte count, symptoms and other factors. Access and health-related quality of life measures similar to those used in this study may prove useful in future evaluations of medical care systems serving poor, clinically ill populations infected with human immunodeficiency virus.
尽管人们越来越关注感染人类免疫缺陷病毒者获得医疗服务的机会以及与健康相关的生活质量，但这些变量之间的关联尚未得到证实。作者对一家公立医院和一家退伍军人管理局医院的205名低收入感染人类免疫缺陷病毒且有全身症状和/或腹泻的患者进行了一项关于获得医疗服务及其与健康相关生活质量之间关联的横断面研究，使用了一个包含9个项目的感知获得医疗服务情况的量表和一个包含55个项目的与健康相关生活质量的工具。获得医疗服务存在的问题很普遍：55%的人前往其通常的医疗服务机构需要花费超过30分钟（相比全国调查中普通人群的9%至12%），49%的人在支付医疗费用方面存在问题，48%的人在诊所就诊时间方面存在问题（相比全国调查中的23%）。在多变量分析中，未参保患者报告的获得医疗服务情况比有医疗补助或退伍军人管理局保险的患者更差，尤其是在支付医疗费用方面（P < 0.01）。该样本中经调整的与健康相关的生活质量得分远低于（约低1个标准差）一项大型全国性获得性免疫缺陷综合征临床试验中受试者的得分。在11个与健康相关生活质量子量表中的8个中，即使在控制了T-4淋巴细胞计数、症状和其他因素后，较差的感知获得医疗服务情况与较差的与健康相关生活质量显著相关（P < 0.05）。与本研究中使用的类似的获得医疗服务情况和与健康相关生活质量的测量方法可能在未来对为感染人类免疫缺陷病毒的贫困、临床患病群体提供服务的医疗系统评估中证明是有用的。
