Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort
Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort
复制标题
孕产妇健康不平等和全科医生的提供：调查布拉德福德出生人群中女性就诊率的变化
DOI：
10.1093/pubmed/fdw064
复制
发表时间：
2016
影响因子：
4.4
通讯作者：
C. Bates
中科院分区：
文献类型：
--
作者：
B. Kelly;D. Mason;E. Petherick;John Wright;M. A. Mohammed;C. Bates
背景
“五年远景”（英国国家医疗服务体系）呼吁彻底升级公共卫生服务。孕产妇健康方面的不平等可能会使健康不平等的普遍模式在几代人之间长期存在；因此，孕产期间公平获得全科医学 (GP) 服务非常重要。本文探讨了弱势母亲的全科医生咨询率的变化。
方法
来自布拉德福德出生人群（约 12,000 名女性）的数据，结合全科医生记录和全科医生实践变量，经过建模来预测在调整个人健康和全科医生服务之前和之后的全科医生咨询率。
结果
据观察，物质匮乏社区的女性和巴基斯坦女性的全科医生咨询率较高。然而，在控制个人健康状况后，发现这些群体咨询的频率较低。这种差异（大约每年一次预约）可以通过全科医生服务的性质来“解释”。与全科医生与患者比例最高的诊所中的女性相比，六年期间，全科医生与患者比例较低的诊所中的女性咨询次数减少了约 09 次。
结论
公平获得全科医生服务，尤其是产妇期间的妇女，对于解决根深蒂固的健康不平等问题至关重要。未来的全科医生资助应考虑到社区物质匮乏的情况，将资源集中在最需要的领域。
Background
The 'Five Year Forward View' (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to general practice (GP) provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers.
Method
Data from the Born in Bradford cohort (around 12 000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision.
Results
Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is 'explained' by the nature of GP provision. Women in practices with a low GP to patient ratio had around 09 fewer consultations over the six year period compared to women in practices with the highest ratio.
Conclusions
Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need.