Is Personality Associated with Health Care Use by Older Adults?
Is Personality Associated with Health Care Use by Older Adults?
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DOI：
10.1111/1468-0009.12024
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发表时间：
2013-09-01
影响因子：
6.6
通讯作者：
Duberstein, Paul R.
中科院分区：
文献类型：
--
作者：
Friedman, Bruce;Veazie, Peter J.;Duberstein, Paul R.
背景美国的医疗保健利用模式对公共政策提出了既定的挑战。尽管经济和社会学研究已经对影响卫生服务使用的因素有了相当多的了解，但该领域的心理学文献尚不发达。重要的是，目前尚不清楚性格特征是否与老年人使用急性和长期护理服务有关。方法数据收集自参加医疗保险示范的 1,074 名社区居住老年人。首先，他们完成了一份自我报告问卷，衡量“五大”人格特征：神经质、外向性、开放性、宜人性和责任心。在接下来的两年里，参与者每天记录他们使用医疗保健服务的情况。我们使用基于医疗保健利用的安德森行为模型的回归模型来测试关联性。结果我们的假设是，较高的神经质与更多的医疗保健使用相关，这一假设在三种服务中得到了证实——任何急诊室 (ED) 使用的概率、任何监护疗养院使用的可能性以及 SNF 用户的更熟练的护理设施 (SNF) 天数，但对于住院患者的住院天数则没有得到证实。对经验的开放性越高，使用托管家庭护理的可能性越大，而宜人性越高，责任心越低，使用托管养老院的可能性越高。对于用户来说，较低的开放性与更多的急诊就诊和 SNF 天数相关，而较低的尽责性与更多的急诊就诊相关。对于许多具有显着关联的特征，特定特征高（低）的人与低（高）的人相比，预测的使用率要高出 16％ 至 30％。结论人格特征与 Medicare 受益人对许多昂贵的医疗保健服务的使用有关，这一发现对医疗服务研究和政策具有影响。因此，应考虑以人为中心的干预措施、基于人群的转化有效性计划以及其他利用近几十年来人格心理学的深刻进展的个性化方法。
ContextThe patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults' use of acute and long-term care services.MethodsData were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the "Big Five" personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations.FindingsOur hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services-probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users-but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits.ConclusionsPersonality traits are associated with Medicare beneficiaries' use of many expensive health care services, findings that have implications for health services research and policy. Accordingly, person-centered interventions, population-based translational effectiveness programs, and other personalized approaches that leverage the profound advances in personality psychology in recent decades should be considered.