Access to specialty health care for rural American Indians in two states
Access to specialty health care for rural American Indians in two states
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DOI：
10.1111/j.1748-0361.2008.00168.x
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发表时间：
2008-06-01
影响因子：
4.9
通讯作者：
Grossman, David C.
中科院分区：
文献类型：
--
作者：
Baldwin, Laura-Mae;Hollow, Walter B.;Grossman, David C.
背景：印第安人卫生服务（IHS）在美洲印第安人和阿拉斯加原住民（AI/AN）卫生服务方面的人均支出约为美国平民人口的一半，是许多农村AI/AN的唯一卫生保健资金来源。专业服务主要通过与外部从业人员的合同提供资金，可能受到低IHS资金水平的限制。目的：研究两个州印度农村人口的专业服务获取情况。方法：对蒙大拿州和新墨西哥州农村印第安人卫生诊所的106名初级保健提供者（总体回复率为60.4%）和距离印第安人诊所25英里范围内的95名农村非印第安人诊所的初级保健提供者（总体回复率为57.9%）进行了一项31项的邮件调查，内容涉及专业医生的获取情况、获取障碍和非医生临床服务的获取情况。研究结果：两个州相当比例的农村印度诊所提供者报告其患者获得非紧急专科服务的公平或差。蒙大拿州的农村印第安人诊所提供者报告说，与农村非印第安人诊所提供者相比，病人获得专科护理的机会更少，而新墨西哥州的农村印第安人和非印第安人提供者报告说，获得专科护理的机会相当。这两个州的印度诊所提供者最常提到专科护理的经济障碍。据报告，印度诊所提供者比非印度诊所提供者更容易获得大多数非医生服务。结论：据报道，印度农村诊所患者获得专科护理的限制似乎受到财政限制的影响。卫生保健系统因素可能在农村印度和非印度诊所患者在专科就诊方面的感知差异中发挥作用。
Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels. Purpose: To examine specialty service access among rural Indian populations in two states. Methods: A 31-item mail survey addressing perceived access to specialty physicians, barriers to access, and access to non-physician clinical services was sent to 106 primary care providers in rural Indian health clinics in Montana and New Mexico (overall response rate 60.4%) and 95 primary care providers in rural non-Indian clinics within 25 miles of the Indian clinics (overall response rate 57.9%). Findings: Substantial proportions of rural Indian clinic providers in both states reported fair or poor non-emergent specialty service access for their patients. Montana's rural Indian clinic providers reported poorer patient access to specialty care than rural non-Indian clinic providers, while New Mexico's rural Indian and non-Indian providers reported comparable access. Indian clinic providers in both states most frequently cited financial barriers to specialty care. Indian clinic providers reported better access to most non-physician services than non-Indian clinic providers. Conclusions: Reported limitations in specialty care access for rural Indian clinic patients appear to be influenced by financial constraints. Health care systems factors may play a role in perceived differences in specialty access between rural Indian and non-Indian clinic patients.