Access to US primary care physicians for new patients concerned about smoking or weight.
Access to US primary care physicians for new patients concerned about smoking or weight.
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担心吸烟或体重的新患者可以咨询美国初级保健医生。
DOI：
10.1016/j.ypmed.2018.04.031
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发表时间：
2018
影响因子：
5.1
通讯作者：
Stano,Miron
中科院分区：
文献类型：
--
作者：
Tinkler,SarahE;Sharma,RajivL;Susu-Mago,RavenRH;Pal,Sudeshna;Stano,Miron
吸烟和肥胖是美国可预防的发病率和死亡率的主要原因，初级保健医生是预防保健的主要来源。然而，不知道新病人的就诊是否受到对预防性护理表示兴趣的影响。在2015年的审计中，我们致电美国初级保健医生办公室，要求提供有关模拟患者新患者体检的预约信息。模拟患者根据吸烟问题（N= 907）、体重问题（N= 867）或无健康问题（“健康”患者;N= 3561）进行区分。此外，患者特征因人种/种族、性别和保险类型而异。我们还研究了在根据《平价医疗法案》扩大医疗补助的州，获得医疗补助的机会是否不同。我们发现，与健康患者相比，医生办公室不太可能为吸烟患者提供预约（54% vs. 55%; p值= 0.56），并且吸烟患者的预约次数少于体重患者（54% vs. 62%，p值< 0.01）。在协变量调整后的分析中，吸烟问题没有改善任何患者群体的预约服务，并且相对于健康患者，医疗补助扩展州的医疗保险患者的预约服务减少了9个百分点（95% CI：-16，-2）。健康问题在统计学上没有显著影响等待任命。我们的研究结果表明，与没有健康问题的患者相比，有吸烟问题的患者不太可能获得新的患者预约。对于一些有体重问题的患者来说，预约的可能性更大，这对肥胖预防和管理是令人鼓舞的。
Tobacco smoking and obesity are leading causes of preventable morbidity and mortality in the US, and primary care physicians are the main source of preventive care. However, it is not known whether access for new patients is affected by an expression of interest in preventive care. In a 2015 audit, we called US primary care physicians' offices to request appointment information regarding new patient physicals for simulated patients. Simulated patients were differentiated by smoking concerns (N= 907), weight concerns (N= 867), or no health concerns (“healthy” patients;N= 3561). Additionally, patient profiles varied by race/ethnicity, sex, and insurance type. We also examined whether access differed in states that expanded Medicaid under the Affordable Care Act. We found that physicians' offices were no more likely to offer appointments to patients with smoking concerns than to healthy patients (54% vs. 55%;p-value = 0.56), and patients with smoking concerns were offered fewer appointments than patients with weight concerns (54% vs. 62%,p-value < 0.01). In analyses adjusted for covariates, smoking concerns did not improve appointment offers for any patient group, and reduced Medicare patients' offers in Medicaid expansion states by 9 percentage points relative to healthy patients (95% CI: −16, −2). Health concerns did not statistically significantly affect waits-to-appointment. Our results suggest that patients with smoking concerns are no more likely to be offered new patient appointments than those with no health concerns. The greater likelihood of appointment offers for some patients with weight concerns is encouraging for obesity prevention and management.