Factors underlying variation in receipt of physician advice on diet and exercise: Applications of the behavioral model of health care utilization
Factors underlying variation in receipt of physician advice on diet and exercise: Applications of the behavioral model of health care utilization
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DOI：
10.4278/0890-1171-18.5.370
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发表时间：
2004-05-01
影响因子：
2.7
通讯作者：
Honda, K
中科院分区：
文献类型：
--
作者：
Honda, K
目的.使用Andersen的卫生保健利用模型，确定与接受关于饮食和运动的医生建议相关的因素，包括患者的社会人口学特征、健康相关需求和卫生保健获取。采用2000年全国健康访谈调查（NHIS）的数据进行横断面分析。NHIS数据是通过人口普查调查员的个人家庭访谈收集的。2000年NHIS成人样本的总体应答率为82.受试者是18岁及以上的美国平民，非机构化人口的代表性样本。在消除缺失数据和报告在过去12个月内没有看医生的受访者后，医生关于饮食和运动建议的样本量分别为n = 26，255和n = 26，158。使用2000年NHIS，接受医生建议的饮食和运动的流行程度进行了评估。进行多元逻辑回归分析以检查接受医生关于饮食和运动的建议与潜在预测因素之间的关系，并对所有协变量进行调整。通过自我报告，分别有21.3%和24.5%的受访者接受了医生关于饮食和运动的建议。中年（饮食调整后的比值比[AOR] = 1.14，95%置信区间[CI]，1.0-1.29;运动调整后的比值比[AOR]= 1.55，95% CI = 1.33-1.79）和具有学士学位或更高学位（饮食AOR = 1.78，95%CI = 1.52-2.08; AOR = 1.75，95%CI = 1.47-2.07）与接受医生饮食和运动建议的可能性较高相关。非裔美国人（AOR = 0.78，95%CI = 0.67 - 0.92）和外国出生的移民（AOR = 0.57，95%CI = 0.38 - 0.86）不太可能接受医生的锻炼建议。选择医院门诊部作为常规护理来源的人接受医生建议的患病率高于其他类型常规护理场所的成年人（饮食的AOR = 2.36，95%CI = 1.66-3.36;运动的AOR = 2.39，95%CI = 1.68-3.4）。患者自测健康状况（饮食的AOR = 5.2，95%CI = 4.12-6.57;运动的AOR 2.63，95%CI = 2.04-3.38）和肥胖（饮食的AOR = 2.32，95%CI = 2.02-2.66;运动的AOR = 3.01，95%CI = 2.46-3.69）与接受医生饮食和运动建议的可能性呈正相关。增加医生咨询的有效战略应包括努力改善获得定期护理和医患沟通的机会。社会人口因素仍然是获得此类建议的独立和重要的预测因素。
Purpose. To identify factors associated with receipt of physician advice on diet and exercise, including patient sociodemographic characteristics, health-related needs, and health care access, using Andersen's model of health care utilization.Design. A cross-sectional analysis was performed using data from the 2000 National Health Interview Survey (NHIS).Setting. NHIS data were collected through personal household interviews by Census interviewers. The overall response rate for the 2000 NHIS adult sample was 82.6%.Subjects. Subjects were a representative sample of the American civilian, noninstitutionalized population aged 18 and older. After eliminating missing data and respondents who reported they did not see a doctor in the past 12 months, sample sizes for physician advice on diet and exercise were n = 26,255 and n = 26,158, respectively.Measures. Using the 2000 NHIS, the prevalence of receipt of physician advice on diet and exercise was assessed. Multiple logistic regression analyses were performed to examine the associations between receipt of physician advice on diet and exercise and potential predictors, adjusting for all covariates.Results. By self-report, 21.3% and 24.5% of respondents received physician advice on diet and exercise, respectively. Being middle-aged (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI], 1.0-1.29 for diet; AOR = 1.55, 95% CI = 1.33-1.79 for exercise) and having a baccalaureate degree or higher (AOR = 1.78, 95% CI = 1.52-2.08 for diet; AOR = 1.75, 95% CI = 1.47-2.07) were associated with a higher likelihood of receiving physician advice on diet and exercise. African-Americans (AOR = .78, 95% CI = .67-.92) and foreign-born immigrants (AOR = .57, 95% CI = .38-.86) were less likely to receive physician advice on exercise. The prevalence of physician advice was higher for persons who chose hospital outpatient departments as a usual source for care (A OR = 2.36, 95% C1 = 1.66-3.36 for diet; AOR = 2.39, 95% CI = 1.68-3.4 for exercise) than for adults with other types of usual care sites. Poorer self-rated health status (AOR = 5.2, 95% CI = 4.12-6.57 for diet; AOR 2.63, 95% CI = 2.04-3.38 for exercise) and obesity (AOR = 2.32, 95% CI = 2.02-2.66 for diet; AOR = 3.01, 95% CI = 2.46-3.69 for exercise) was positively associated with the likelihood of receiving physician advice on diet and exercise.Conclusions. Effective strategies to increase receipt of physician advice should include efforts to improve access to regular source of care and patient-physician communication. Sociodemographic factors remain independent and important Predictors of who obtains such advice.