Saag K G, Doebbeling B N, Rohrer J E, Kolluri S, Mitchell T A, Wallace R B
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242, USA.
Arthritis Care Res. 1998 Jun;11(3):177-85. doi: 10.1002/art.1790110305.
To compare the impact of urban-rural residence and other factors on the utilization of any type of arthritis-related physician care and on rheumatologist utilization.
A population-based random sample of adults 65 years of age or older with self-reported arthritis from 10 urban and 12 rural Iowa counties were surveyed by telephone interview. We estimated the arthritis prevalence and health service utilization in this sample and evaluated the effects of predisposing, enabling, and need factors on utilization and satisfaction. Health care utilization was defined as ever having visited specific types of providers for arthritis-related care.
A total of 488 individuals participated: 227 from urban counties and 261 rural respondents. Urban respondents more commonly reported having received a diagnosis of osteoarthritis from their physicians but were less likely to report rheumatoid arthritis. A greater proportion of urban versus rural respondents had utilized any physician for arthritis care (50.7% versus 41.0%, P = 0.032) and had more often seen an orthopedist (18.1% versus 9.6%, P = 0.006) or general internist (18.5% versus 8.8%, P = 0.002). A diagnosis of rheumatoid arthritis, younger age, living with another person, higher income, and further distance from an arthritis provider were significantly associated with prior rheumatologist utilization. The strongest adjusted predictor of any physician visit for arthritis care was whether older adults drove themselves to their provider. For rheumatologist utilization, a diagnosis of rheumatoid arthritis and age were independently associated.
The most striking finding was the consistent association of need factors (such as the desire for medical advice), joint swelling, and the presence of a diagnosis of rheumatoid arthritis with physician utilization. We identified significant urban-rural variations in factors both enabling and predisposing to arthritis care, although urban-rural status did not appear to independently influence arthritis physician utilization. In a rural state with a relatively small number of rheumatologists, deleterious enabling factors such as greater distance from the doctor and lack of supplemental insurance did not provide significant obstacles to either rheumatologist or generalist utilization.
比较城乡居住情况及其他因素对各类关节炎相关医疗服务利用情况以及对风湿病专科医生服务利用情况的影响。
通过电话访谈对来自爱荷华州10个城市和12个农村县的65岁及以上自我报告患有关节炎的成年人进行基于人群的随机抽样调查。我们估计了该样本中的关节炎患病率和医疗服务利用情况，并评估了易患因素、促成因素和需求因素对服务利用和满意度的影响。医疗服务利用被定义为曾因关节炎相关护理就诊于特定类型的医疗服务提供者。
共有488人参与：227人来自城市县，261人为农村受访者。城市受访者更常报告其医生诊断为骨关节炎，但报告类风湿关节炎的可能性较小。与农村受访者相比，更大比例的城市受访者利用过任何医生进行关节炎护理（50.7%对41.0%，P = 0.032），且更常看骨科医生（18.1%对9.6%，P = 0.006）或普通内科医生（18.5%对8.8%，P = 0.002）。类风湿关节炎诊断、较年轻年龄、与他人同住、较高收入以及距离关节炎医疗服务提供者较远与之前利用风湿病专科医生服务显著相关。任何医生进行关节炎护理就诊的最强校正预测因素是老年人是否自行开车前往医疗服务提供者处。对于风湿病专科医生服务利用情况，类风湿关节炎诊断和年龄独立相关。
最显著的发现是需求因素（如对医疗建议的渴望）、关节肿胀以及类风湿关节炎诊断与医疗服务利用之间始终存在关联。我们发现了在促成和易患关节炎护理的因素方面存在显著的城乡差异，尽管城乡状况似乎并未独立影响关节炎医生服务的利用。在一个风湿病专科医生数量相对较少的农村州，诸如距离医生较远和缺乏补充保险等有害促成因素并未对风湿病专科医生或全科医生服务的利用造成重大障碍。
