Association of Military Deployment of a Parent or Spouse and Changes in Dependent Use of Health Care Services
Association of Military Deployment of a Parent or Spouse and Changes in Dependent Use of Health Care Services
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父母或配偶的军事部署与医疗保健服务依赖性使用变化协会
DOI：
10.1097/mlr.0b013e31825516d8
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发表时间：
2012
期刊：
影响因子：
3
通讯作者：
C. Tompkins
中科院分区：
文献类型：
--
作者：
M. Larson;Beth A. Mohr;R. Adams;G. Ritter;J. Perloff;T. V. Williams;D. Jeffery;C. Tompkins
背景：美国武装部队成员及其配偶报告称，与战斗部署相关的压力增加。然而，目前尚不清楚这些部署应激源是否会导致依赖药物使用和卫生保健利用的增加。目的：确定陆军现役军人(赞助者)的部署是否与依赖医疗保健利用的变化有关。设计：对55,000多名未怀孕的配偶和137,000名已部署赞助者的子女和一组受抚养人的健康护理模式进行准实验性、事前研究。措施：在赞助者部署办公室访问服务(全科医生、专科医生)；急诊科就诊；住院；精神药物(任何抗抑郁药、抗焦虑药、抗兴奋剂类)的部署月后的第二年，军队卫生系统的依赖总使用率以及军队提供和购买的护理服务分别发生变化。结果：赞助商的使用与专家办公室就诊(相对百分比变化4.2%；子女8.8%)、抗抑郁药物(6.7%配偶；17.2%子女)和抗焦虑药物(14.2%配偶；10.0%子女；P<；0.01)的净增加有关。部署始终与增加使用购买的护理服务有关，但部分或完全被减少使用军事治疗设施所抵消。结论：这些结果表明，情绪或行为问题正在导致赞助商部署期间更多的专家就诊和对药物的依赖。向从平民环境接受服务的转变引发了家庭临时搬迁时的护理协调、家庭偏好以及部署阶段军事提供者能力的问题。研究结果对军队卫生系统和为军人家庭提供服务的社区提供者具有重要影响，特别是那些有孩子的家庭。
Background:U.S. Armed Forces members and spouses report increased stress associated with combat deployment. It is unknown, however, whether these deployment stressors lead to increased dependent medication use and health care utilization. Objective:To determine whether the deployment of Army active duty members (sponsors) is associated with changes in dependent health care utilization. Design:A quasi-experimental, pre-post study of health care patterns of more than 55,000 nonpregnant spouses and 137,000 children of deployed sponsors and a comparison group of dependents. Measures:Changes in dependent total utilization in the military health system, and separately in military-provided and purchased care services in the year following the sponsors’ deployment month for office visit services (generalist, specialist); emergency department visits; institutional stays; psychotropic medication (any, antidepressant, antianxiety, antistimulant classes). Results:Sponsor deployment was associated with net increased use of specialist office visits (relative percent change 4.2% spouses; 8.8% children), antidepressants (6.7% spouses; 17.2% children), and antianxiety medications (14.2% spouses; 10.0% children; P<0.01) adjusting for group differences. Deployment was consistently associated with increased use of purchased care services, partially, or fully offset by decreased use of military treatment facilities. Conclusions:These results suggest that emotional or behavioral issues are contributing to increased specialist visits and reliance on medications during sponsors’ deployments. A shift to receipt of services from civilian settings raises questions about coordination of care when families temporarily relocate, family preferences, and military provider capacity during deployment phases. Findings have important implications for the military health system and community providers who serve military families, especially those with children.