FUNCTIONAL VERSUS STRUCTURAL SOCIAL SUPPORT AND HEALTH-CARE UTILIZATION IN A FAMILY MEDICINE OUTPATIENT PRACTICE
FUNCTIONAL VERSUS STRUCTURAL SOCIAL SUPPORT AND HEALTH-CARE UTILIZATION IN A FAMILY MEDICINE OUTPATIENT PRACTICE
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DOI：
10.1097/00005650-198903000-00001
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发表时间：
1989-03-01
期刊：
影响因子：
3
通讯作者：
KAPLAN, BH
中科院分区：
文献类型：
--
作者：
BROADHEAD, WE;GEHLBACH, SH;KAPLAN, BH
采用问卷调查和病历审核的方法，对343例家庭医生的社会支持与医疗服务利用的关系进行了研究。社会支持与实验室检查顺序无关。低信任支持（4.71 vs. 3.81，P < 0.10）和情感支持（5.21 vs. 3.60，P < 0.05）患者的年平均门诊次数高于高信任支持（4.71 vs. 3.81，P < 0.10）和情感支持（5.21 vs. 3.60，P < 0.05）患者。在1年的平均总费用中，低信任支持（232美元对148美元，P < 0.05）和情感支持（244美元对154美元，P <0.05）的患者高于高信任支持（232美元对148美元，P < 0.05）的患者。不好的知己和情感支持都与较长的访问。社会支持的结构性措施没有显着相关的任何利用指标。这些发现保持在控制身体健康和七个人口统计特征的多元回归模型中。二阶回归模型揭示了种族，就业状况和性别的相互作用。黑人在办公室访问中没有表现出知己支持的效果。穷人知己的支持导致201美元以上的总费用为失业者（P = 0.003），而49美元以上的就业者（P = 0.15）。低情感支持的女性多花费119美元（P = 0.001），而男性少花费16美元（P = 0.82）。结果表明，低功能的社会支持是增加医疗服务利用的重要决定因素，他们可能会有不同的种族，性别和就业状况的影响，所有这些都应该在未来的研究中独立考虑。
Three hundred forty-three family-practice patients were surveyed by questionnaire and medical record audit to evaluate the relationships between social support and medical care utilization. Social support was not associated with laboratory test ordering. The mean number of office visits per year was higher for patients with low versus high confidant support (4.71 vs. 3.81, P < 0.10) and affective support (5.21 vs. 3.60, P < 0.05). Mean total charges in 1 year were higher for patients with low versus high confidant support ($232 vs. $148, P < 0.05) and affective support ($244 vs. $154, P < 0.05). Poor confidant and affective support were both associated with longer visits. Structural measures of social support were not related significantly to any utilization indicator. These findings were maintained in multiple-regression models controlling for physical health and seven demographic characteristics. Second-order regression models revealed interaction by race, employment status, and sex. Blacks showed no effect of confidant support on office visits. Poor confidant support resulted in $201 more in total charges for the unemployed (P = 0.003) versus $49 more for the employed (P = 0.15). Women with low affective support had $119 more in charges (P = 0.001) versus $16 less for men (P = 0.82). The results suggest that low functional social supports are important determinants of increased medical service utilization and that they may have differential effects by race, sex, and employment status, all of which should be considered independently in future studies.