Disparities in Health Care Utilization and Functional Limitations Among Adults With Serious Psychological Distress, 2006-2014
Disparities in Health Care Utilization and Functional Limitations Among Adults With Serious Psychological Distress, 2006-2014
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DOI：
10.1176/appi.ps.201600260
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发表时间：
2017-07-01
影响因子：
3.8
通讯作者：
Pegus, Cheryl
中科院分区：
文献类型：
--
作者：
Weissman, Judith;Russell, David;Pegus, Cheryl
目的：本研究比较了在实施《患者保护和平价医疗法案》（ACA）的几年中，有和没有严重心理困扰（SPD）的成年人的医疗保健获得、利用和功能指标。2006-2014年全国健康访谈调查中18至64岁的成年人（N=207，853）的11个访问，利用和功能指标进行了检查：健康保险（医疗保险）、没有足够的钱买药、医疗保健延误（延迟治疗）、医疗费用不足、过去12个月内就医10次或以上、医疗地点变更、因保险原因变更医疗地点、工作能力受限、日常生活活动受限（ADL）、没有足够的钱进行精神卫生保健，并且已经看过精神卫生保健提供者。根据健康覆盖率和社会人口学特征调整的多变量模型表明，与没有SPD的成年人相比，患有SPD的成年人更有可能缺乏药物治疗（AOR=10.0）和保健（AOR=3.1），经历护理延迟（AOR=2.7），在过去12个月内看过医生10次或以上（AOR=3.2），改变通常的医疗保健地点（AOR=1.5），由于保险而改变通常的医疗保健地点（AOR=1.5），以及ADL（AOR=3.6）和工作能力（AOR=1.8）受到限制。在研究期间，缺乏健康保险和购买处方的SPD成年人比例增加。虽然这一趋势在2014年逆转，SPD经历障碍的比例仍然高于2006年的水平。结论：成人SPD的医疗保健模式需要更多的关注。
Objective: This study compared health care access, utilization, and functional indicators among adults with and without serious psychological distress (SPD) in the years surrounding implementation of the Patient Protection and Affordable Care Act (ACA).Methods: Adults ages 18 to 64 from the 2006-2014 National Health Interview Survey (N=207, 853) were examined on 11 access, utilization, and functional indicators: health insurance coverage (health coverage), insufficient money for medications, delay in health care (delay in care), insufficient money for health care, visiting a doctor ten or more times in the past 12 months, change in place of health care, change in place of health care due to insurance, limitations in ability to work, limitations in activities of daily living (ADLs), insufficient money for mental health care, and having seen a mental health care provider.Results: Multivariate models that were adjusted for health coverage and sociodemographic characteristics indicated that compared with adults without SPD, adults with SPD had greater odds of lacking money for medications (AOR=10.0) and health care (AOR=3.1), experiencing delays in care (AOR=2.7), visiting a doctor ten or more times in the past 12 months (AOR=3.2), changing usual place of health care (AOR=1.5), changing usual place of health care because of insurance (AOR=1.5), and experiencing limitations in ADLs (AOR=3.6) and ability to work (AOR=1.8). The proportions of adults with SPD who lacked health coverage and money to buy prescriptions increased during the study period. Although this trend reversed in 2014, the proportion with SPD experiencing barriers remained above 2006 levels.Conclusions: Health care patterns among adults with SPD require greater attention.