Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study
Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study
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DOI：
10.1186/ar3011
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发表时间：
2010-01-01
影响因子：
4.9
通讯作者：
Yelin, Edward H.
中科院分区：
文献类型：
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作者：
Yazdany, Jinoos;Tonner, Chris;Yelin, Edward H.
简介：癌症和感染是系统性红斑狼疮（SLE）循环系统疾病后死亡的主要原因，因此预防这些并发症很重要。在这项研究中，我们检查了两类SLE预防服务：癌症监测（宫颈癌、乳腺癌和结肠癌）和免疫接种（流感和肺炎球菌）。我们将SLE患者接受这些服务的情况与普通人群进行了比较，并确定了不太可能接受这些服务的患者亚组。我们比较了参加加州大学旧金山弗朗西斯科狼疮结局研究（n = 685）的SLE投保女性报告的预防服务与来自全州健康访谈调查的两个代表性样本，一般人群样本（n = 18，013）和非风湿性慢性疾病样本（n = 4，515）。此外，使用来自男性和女性队列的数据（n = 742），我们应用多变量回归分析来确定个体特征是否（例如，社会人口和疾病因素）、卫生系统（例如，就诊次数、全科医生或风湿病学家参与护理、健康保险类型）或社区结果：SLE患者预防保健的接受情况与两个对照样本相似。在癌症监测方面，70%的合格受访者报告接受了宫颈癌筛查和乳房X光检查，62%的受访者报告接受了结肠癌筛查。在免疫接种方面，59%的合格受访者报告接种了流感疫苗，60%报告接种了肺炎球菌疫苗。在多元回归分析中，有几个因素与接受预防服务的可能性较低有关，包括年龄较小和教育程度较低。我们没有观察到邻里贫困的任何影响。较高数量的医生访问和参与的通才提供者在护理与接受大多数services.Conclusions的可能性更高：虽然收到癌症筛查程序和免疫接种在我们的队列是可比的一般人群，我们观察到显着的变化，如年龄和教育程度的社会人口因素。需要进一步研究来确定导致这种观察到的变化的医生、患者或卫生系统因素，以便制定有效的质量改进干预措施。
Introduction: Cancer and infections are leading causes of mortality in systemic lupus erythematosus (SLE) after diseases of the circulatory system, and therefore preventing these complications is important. In this study, we examined two categories of preventive services in SLE: cancer surveillance (cervical, breast, and colon) and immunizations (influenza and pneumococcal). We compared the receipt of these services in SLE to the general population, and identified subgroups of patients who were less likely to receive these services.Methods: We compared preventive services reported by insured women with SLE enrolled in the University of California, San Francisco Lupus Outcomes Study (n = 685) to two representative samples derived from a statewide health interview survey, a general population sample (n = 18,013) and a sample with non-rheumatic chronic conditions (n = 4,515). In addition, using data from the cohort in both men and women (n = 742), we applied multivariate regression analyses to determine whether characteristics of individuals (for example, sociodemographic and disease factors), health systems (for example, number of visits, involvement of generalists or rheumatologists in care, type of health insurance) or neighborhoods (neighborhood poverty) influenced the receipt of services.Results: The receipt of preventive care in SLE was similar to both comparison samples. For cancer surveillance, 70% of eligible respondents reported receipt of cervical cancer screening and mammography, and 62% reported colon cancer screening. For immunizations, 59% of eligible respondents reported influenza immunization, and 60% reported pneumococcal immunization. In multivariate regression analyses, several factors were associated with a lower likelihood of receiving preventive services, including younger age and lower educational attainment. We did not observe any effects by neighborhood poverty. A higher number of physician visits and involvement of generalist providers in care was associated with a higher likelihood of receiving most services.Conclusions: Although receipt of cancer screening procedures and immunizations in our cohort was comparable to the general population, we observed significant variability by sociodemographic factors such as age and educational attainment. Further research is needed to identify the physician, patient or health system factors contributing to this observed variation in order to develop effective quality improvement interventions.