Barriers to healthcare utilization in fatiguing illness: a population-based study in Georgia
Barriers to healthcare utilization in fatiguing illness: a population-based study in Georgia
复制标题
DOI：
10.1186/1472-6963-9-13
复制
发表时间：
2009-01-20
影响因子：
2.8
通讯作者：
Reeves, William C.
中科院分区：
文献类型：
--
作者：
Lin, Jin-Mann S.;Brimmer, Dana J.;Reeves, William C.
背景：本研究的目的是确定疲劳性疾病患者医疗保健利用障碍的普遍性，并描述其与社会人口统计学、健康状况数量和医疗保健利用频率的关系。此外，我们试图确定哪些类型的障碍干扰了医疗保健的利用，以及它们发生的原因。方法：在一项基于人群的横断面调查中，780名受试者，其中112名患有慢性疲劳综合征（CFS），完成了医疗保健利用问卷。文本分析用于从逐字回复中创建关于医疗保健利用障碍的新主题。采用多元逻辑回归检验医疗保健利用障碍与其他因素之间的关系。结果：40%的受试者报告了至少一个医疗保健利用障碍。在112名慢性疲劳综合症患者中，55%的人报告了至少一项医疗保健利用障碍。疲劳状态、报告的疲劳持续时间、保险和BMI是阻碍医疗保健利用的重要危险因素。在对社会人口统计学、药物使用、健康问题数量和医疗保健利用频率进行调整后，疲劳状态仍然与医疗保健利用障碍显著相关。CFS患者在前一年放弃所需医疗保健的可能性是非疲劳患者的近4倍，而疲劳不足（ISF）患者的这一可能性是非疲劳患者的近3倍。从对医疗保健利用障碍的文本分析中得出三个领域：1)可及性；2)知识-态度-信念（kab）；3)医疗体系。CFS和报告的疲劳持续时间与这些领域显著相关。慢性疲劳综合症患者报告了每个领域的高水平医疗保健利用障碍：可及性（34%）、医疗保健系统（25%）和kab（19%）。在对医疗保健利用障碍域的进一步检查中，与具有“可达性”、“KAB”和“医疗保健系统”障碍域的非疲劳人群相比，调整后的ORs分别下降了40%、30%和19%。结论：在疲劳性疾病患者中，医疗保健利用障碍是一个重大问题。研究结果提出了双重含义：一个以症状为目标的模型，重点关注与疲劳相关的症状；以及一种互动模式，需要患者和提供者努力通过减少无障碍、kab和医疗保健系统方面的障碍来改善他们之间的互动。
Background: The purpose of this study was to determine the prevalence of barriers to healthcare utilization in persons with fatiguing illness and describe its association with socio-demographics, the number of health conditions, and frequency of healthcare utilization. Furthermore, we sought to identify what types of barriers interfered with healthcare utilization and why they occurred.Methods: In a cross-sectional population-based survey, 780 subjects, 112 of them with chronic fatigue syndrome (CFS), completed a healthcare utilization questionnaire. Text analysis was used to create the emerging themes from verbatim responses regarding barriers to healthcare utilization. Multiple logistic regression was performed to examine the association between barriers to healthcare utilization and other factors.Results: Forty percent of subjects reported at least one barrier to healthcare utilization. Of 112 subjects with CFS, 55% reported at least one barrier to healthcare utilization. Fatiguing status, reported duration of fatigue, insurance, and BMI were significant risk factors for barriers to healthcare utilization. After adjusting for socio-demographics, medication use, the number of health problems, and frequency of healthcare utilization, fatiguing status remained significantly associated with barriers to healthcare utilization. Subjects with CFS were nearly 4 times more likely to forego needed healthcare during the preceding year than non-fatigued subjects while those with insufficient fatigue (ISF) were nearly 3 times more likely.Three domains emerged from text analysis on barriers to healthcare utilization: 1) accessibility; 2) knowledge-attitudes-beliefs (KABs); and, 3) healthcare system. CFS and reported duration of fatigue were significantly associated with each of these domains. Persons with CFS reported high levels of healthcare utilization barriers for each domain: accessibility (34%), healthcare system (25%), and KABs (19%). In further examination of barrier domains to healthcare utilization, compared to non-fatigued persons adjusted ORs for CFS having "accessibility", "KAB" and "Healthcare System" barrier domains decreased by 40%, 30%, and 19%, respectively.Conclusion: Barriers to healthcare utilization pose a significant problem in persons with fatiguing illnesses. Study results suggested two-fold implications: a symptom-targeted model focusing on symptoms associated with fatigue; and an interactive model requiring efforts from patients and providers to improve interactions between them by reducing barriers in accessibility, KABs, and healthcare system.