Have investments in on-reserve health services and initiatives promoting community control improved First Nations' health in Manitoba?
Have investments in on-reserve health services and initiatives promoting community control improved First Nations' health in Manitoba?
复制标题
DOI：
10.1016/j.socscimed.2010.04.037
复制
发表时间：
2010-08-01
影响因子：
5.4
通讯作者：
O'Neil, John D.
中科院分区：
文献类型：
--
作者：
Lavoie, Josee Gabrielle;Forget, Evelyn L.;O'Neil, John D.
本研究的目的是记录加拿大马尼托巴省第一民族的社区特征与门诊护理敏感性疾病（ACSC）住院率之间的关系。使用存放在马尼托巴卫生政策中心的去识别化行政数据，包括生命统计数据和健康信息，对选定的ACSC进行了基于人口的时间趋势分析。研究人口包括1984/85年至2004/05年期间符合普遍马尼托巴卫生服务保险计划资格并生活在第一民族保留地的所有马尼托巴居民。使用3、4和5位ICD-9-CM和ICD-10-CM代码定义的29个ACSC允许对住院率进行横截面和纵向比较。分析使用广义估计方程（GEE）模型，两个变量在我们的模型中是显着的：获得初级卫生保健的保留地的水平和地方自治的水平。当地能够获得更广泛的初级保健服务的社区显示，ACSC的住院率较低。我们还研究了是否有一个显着的趋势，随着时间的推移，ACSC的住院率签署了一项协议，增加当地的自主权资源分配。我们发现，ACSC的住院率下降，每年签署这样的agreement.This文章表明，社区更好地获得当地的初级卫生保健一致显示较低的ACSC率。其次，社区卫生服务实行社区管理的时间越长，其ACSC率越低。(C)2010爱思唯尔有限公司保留所有权利。
The objective of this study was to document the relationship between First Nation's community characteristics and the rates of hospitalization for Ambulatory Care Sensitive Conditions (ACSC) in the province of Manitoba, Canada. A population-based time trend analysis of selected ACSC was conducted using the de-identified administrative data housed at the Manitoba Centre for Health Policy, including vital statistics and health information. The study population included all Manitoba residents eligible under the universal Manitoba Health Services Insurance Plan and living on First Nation reserves between 1984/85 and 2004/05. Twenty-nine ACSC defined using 3, 4 and 5 digit ICD-9-CM and ICD-10-CM codes permitted cross-sectional and longitudinal comparison of hospitalization rates. The analysis used Generalized Estimated Equation (GEE) modeling.Two variables were significant in our model: level of access to primary health care on-reserve; and level of local autonomy. Communities with local access to a broader complement of primary health care services showed a lower rate of hospitalization for ACSC. We also examined whether there was a significant trend in the rates of hospitalization for ACSC over time following the signature of an agreement increasing local autonomy over resource allocation. We found the rates of hospitalization for ACSC decreased with each year following the signature of such an agreement.This article demonstrates that communities with better local access to primary health care consistently show lower rates of ACSC. Secondly, the longer community health services have been under community control, the lower its ACSC rate. (C) 2010 Elsevier Ltd. All rights reserved.