Variation in tertiary prevention and health service utilization among the elderly: the role of urban-rural residence and supplemental insurance.
Variation in tertiary prevention and health service utilization among the elderly: the role of urban-rural residence and supplemental insurance.
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DOI：
10.1097/00005650-199807000-00004
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发表时间：
1998-07
期刊：
影响因子：
3
通讯作者：
K. Saag;B. Doebbeling;J. Rohrer;S. Kolluri;R. Peterson;M. E. Hermann;R. Wallace
中科院分区：
文献类型：
--
作者：
K. Saag;B. Doebbeling;J. Rohrer;S. Kolluri;R. Peterson;M. E. Hermann;R. Wallace
目的三级预防旨在减少慢性病进展和疾病相关功能障碍。使用Aday-Andersen模型，我们评估了诱因、需求和促进因素对三级预防的影响，假设将检测到城乡地理差异。方法采用电话调查的方法，对6种常见的慢性标志性疾病：关节炎(n=488)、高血压(n=414)、心脏病(n=185)、糖尿病(n=125)、消化性溃疡(n=125)和慢性阻塞性肺疾病(n=103)进行评估。研究对象为787名(70%为女性)居家老人(年龄65岁)，他们有一个或多个指标条件，居住在爱荷华州12个农村最多的县和10个城市最多的县。三级预防措施包括以下方面的咨询和/或治疗：流感和肺炎球菌疫苗接种、戒烟、调整饮食、锻炼、药物副作用、慢性病康复、心脏病的阿司匹林/雌激素，以及糖尿病的足部/眼睛护理。计算了三级预防得分，以比较不同疾病类别的预防服务，并检查与促成因素的关系。结果在城市居民中，高中以上学历、饮酒、吸烟和使用医疗专科医生的比例都显著高于城市居民，而在农村居民中，家庭服务的使用比例更高。有健康维护组织或按服务收费的补充保险的受访者比没有补充保险的受访者有更高的三级预防得分。在调整了疾病数量、较高收入和居住地的显著影响后，拥有卫生保健组织补充覆盖的农村受访者的三级预防得分高于(好)其他受访者。结论：在这项以社区为基础的老年人研究中，参加保健组织计划，而不是医疗保险的按服务付费补充，提高了农村居民的三级预防质量，但对城市居民却没有。这项研究强调，需要进行更多的研究，以评估特定类型的保险覆盖范围对老年人预防性服务的重要性。
OBJECTIVES Tertiary prevention seeks to reduce chronic disease progression and illness-related dysfunction. Using the Aday-Andersen model, we evaluated the impact of predisposing, need, and enabling factors on tertiary prevention, hypothesizing that urban-rural geographic differences in delivery would be detected. METHODS A population-based telephone survey was conducted evaluating six common chronic indicator conditions: arthritis (n = 488), hypertension (n = 414), cardiac disease (n = 185), diabetes mellitus (n = 125), peptic ulcer disease (n = 125), and chronic obstructive pulmonary disease (n = 103). Subjects were 787 (70% women) home-dwelling elderly (age > 65 years) who had one or more of the indicator conditions and who resided in Iowa's 12 most rural and 10 most urban counties. Tertiary prevention measures included counseling for and/or treatment with: influenza and pneumococcal vaccination, smoking cessation, dietary modifications, exercise, drug side effects, chronic disease rehabilitation, aspirin/estrogen for cardiac disease, and foot/eye care for diabetes. Tertiary prevention scores were calculated to compare preventive services across disease categories and to examine relations, in particular, with enabling factors. RESULTS Education beyond high school, alcohol use, cigarette smoking, and medical specialist use were all significantly greater among urban residents, whereas home services use was greater among rural residents. Respondents with either health maintenance organization or fee-for-service supplemental coverage had higher tertiary prevention scores than respondents without supplemental coverage. After adjustment for the significant effects of the number of diseases, higher income, and place of residence, rural respondents having health maintenance organization supplemental coverage had higher (better) tertiary prevention scores than other respondents. CONCLUSIONS In this community-based study of elderly, enrollment in an health maintenance organization plan, as opposed to a fee-for-service supplement to Medicare, increased tertiary prevention quality for rural but not for urban residents. This study emphasizes that additional research is needed to evaluate the importance of specific types of insurance coverage for preventive services among the elderly.