Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011.
Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011.
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DOI：
10.3205/psm000089
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
von Lengerke T
中科院分区：
文献类型：
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作者：
Babitsch B;Gohl D;von Lengerke T
目的：本系统回顾旨在评估罗纳德·M·安德森(Ronald M.Andersen)开发的卫生服务利用行为模型在最近的研究中的使用和实施情况。方法：应用PubMed数据库于2011年4月进行系统检索。搜索战略旨在查明1998年至2011年3月期间以英文或德文发表的所有采用安徒生模式的文章。这次搜索共产生了328篇文章。两名研究人员使用三步选择程序(1.标题/作者、2.摘要、3.全文)独立地审查了检索到的可能纳入的文章，每个步骤都有预先确定的纳入和排除标准。有16项研究符合所有纳入标准，并用于分析。开发了一个数据提取表格，从17个类别的文章中收集信息，包括作者、标题、人口描述、研究目的、方法方法、安徒生模型的使用、应用模型版本和主要结果。收集到的数据被整理成六个主要类别，并相应地列出。结果：安徒生的行为模型(BM)在卫生服务利用的研究中得到了广泛的应用。为这项审查确定的研究表明，该模式已用于保健系统的几个领域，并与非常不同的疾病有关。1995年版的BM是研究中使用最频繁的版本。然而，研究表明，所使用的变量存在很大差异。大多数回顾的研究包括年龄(N=15)、婚姻状况(N=13)、性别/性别(N=12)、教育(N=11)和种族(N=10)作为诱因，收入/经济状况(N=10)、医疗保险(N=9)和有通常的护理来源/家庭医生(N=9)作为诱因。作为需求因素，大多数研究包括评估健康状况(N=13)和自我报告/感知健康(N=9)以及非常广泛的各种疾病。尽管研究中考察的主要因素与卫生保健的利用之间存在关联，但这些发现缺乏一致性。审查的研究背景和研究人群的特征似乎对这些联系的存在、强度和方向有很大影响。结论：尽管经常使用的BM被明确用作回顾研究的理论背景，但他们对模型的操作表明，只使用了一组很小的共同变量，并且这些变量的分类方式有很大的差异，特别是涉及易感因素和使能因素。这可能源于大多数研究中使用的次要数据集，这限制了可供研究的变量。迫切需要进行初步研究，以丰富我们对卫生保健利用和医疗保健管理中所显示的过程的复杂性的理解。
Objective: This systematic review aims to assess the use and implementation of the Behavioral Model of Health Services Use developed by Ronald M. Andersen in recent studies explicity using this model. Methods: A systematic search was conducted using PubMed in April 2011. The search strategy aimed to identify all articles in which the Andersen model had been applied and which had been published between 1998 and March 2011 in English or German. The search yielded a total of 328 articles. Two researchers independently reviewed the retrieved articles for possible inclusion using a three-step selection process (1. title/author, 2. abstract, 3. full text) with pre-defined inclusion and exclusion criteria for each step. 16 studies met all of the inclusion criteria and were used for analysis. A data extraction form was developed to collect information from articles on 17 categories including author, title, population description, aim of the study, methodological approach, use of the Andersen model, applied model version, and main results. The data collected were collated into six main categories and are presented accordingly. Results: Andersen’s Behavioral Model (BM) has been used extensively in studies investigating the use of health services. The studies identified for this review showed that the model has been used in several areas of the health care system and in relation to very different diseases. The 1995 version of the BM was the version most frequently applied in the studies. However, the studies showed substantial differences in the variables used. The majority of the reviewed studies included age (N=15), marital status (N=13), gender/sex (N=12), education (N=11), and ethnicity (N=10) as predisposing factors and income/financial situation (N=10), health insurance (N=9), and having a usual source of care/family doctor (N=9) as enabling factors. As need factors, most of the studies included evaluated health status (N=13) and self-reported/perceived health (N=9) as well as a very wide variety of diseases. Although associations were found between the main factors examined in the studies and the utilization of health care, there was a lack of consistency in these findings. The context of the studies reviewed and the characteristics of the study populations seemed to have a strong impact on the existence, strength and direction of these associations. Conclusions: Although the frequently used BM was explicitly employed as the theoretical background for the reviewed studies, their operationalizations of the model revealed that only a small common set of variables was used and that there were huge variations in the way these variables were categorized, especially as it concerns predisposing and enabling factors. This may stem from the secondary data sets used in the majority of the studies, which limited the variables available for study. Primary studies are urgently needed to enrich our understanding of health care utilization and the complexity of the processes shown in the BM.