Healthcare access and utilization by patients infected with human immunodeficiency virus: Does gender matter?
Healthcare access and utilization by patients infected with human immunodeficiency virus: Does gender matter?
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DOI：
10.1089/154099903765448907
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发表时间：
2003-05-01
期刊：
影响因子：
--
通讯作者：
Keitz, SA
中科院分区：
文献类型：
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作者：
Box, TL;Olsen, M;Keitz, SA
目的：调查初级卫生保健服务的获取和利用情况。更大的家庭和育儿责任可能是感染艾滋病毒的妇女获得和利用保健服务的障碍。方法：本研究是一项前瞻性、随机、对照试验的一部分，该试验评估了杜克大学医学中心（DUMC）三级医疗中心对hiv感染患者的初级保健。受试者为214名艾滋病毒感染者、未参保者或公共参保者。结果指标包括门诊就诊、急诊室使用率、住院率、住院时间、预防和筛查措施以及抗逆转录病毒药物的使用。结果：参与研究的女性（n = 83）和男性（n = 131）在种族、教育水平、婚姻状况和就业状况方面相似。感染艾滋病毒的女性比男性更有可能生育孩子（80%对25%，p = 0.001），并且把时间花在照顾孩子上（22%对0.8%,p = 0.001）。女性有较高的CD4（+）细胞计数（378 +/- 287 vs. 243 +/- 252细胞/ ml， p = 0.0002），基线时女性艾滋病患者比例小于男性（41% vs. 62%, p = 0.002）。女性和男性的初级保健就诊次数、急诊室就诊次数、年住院率和住院时间相似。卡氏肺囊虫肺炎预防、肺炎球菌疫苗接种和结核病筛查在男女之间也相似。女性比男性更有可能服用过抗逆转录病毒药物（88.0%比71.8%,p = 0.005）。结论：妇女比男子承担更大的家庭责任，但这并不是获得或利用保健服务的障碍。尽管妇女感染艾滋病毒的程度较低，但她们得到了类似的护理，并利用了类似的保健服务。
Objective: To examine access to and utilization of primary healthcare services with respect to gender. Greater family and child-rearing responsibilities are possible barriers to healthcare access and utilization for women with HIV infection.Methods: This study was part of a prospective, randomized, controlled trial evaluating primary care for HIV-infected patients at Duke University Medical Center (DUMC), a tertiary care medical center. Subjects were 214 HIV-infected, uninsured or publicly insured participants. Ambulatory care visits, emergency room utilization, hospitalization rates, length of stay, preventive and screening measures, and antiretroviral use were the outcome measures.Results: Women (n = 83) and men (n = 131) enrolled in the study were similar with respect to race, educational level, marital status, and employment status. Women with HIV were more likely than men to have children (80% vs. 25%, p = 0.001) and spend their time as primary caregivers for their children (22% vs. 0.8%, p = 0.001). Women had higher CD4(+) cell counts (378 +/- 287 vs. 243 +/- 252 cells/mul, p = 0.0002), and a smaller proportion of women than men had AIDS at baseline (41% vs. 62%, P = 0.002). Women and men had similar numbers of primary care visits, emergency room visits, annual admission rates, and lengths of stay for hospitalizations. Pneumocystis carinii pneumonia prophylaxis, pneumococcal vaccination, and tuberculosis screening were also similar between women and men. Women were more likely than men to have ever been prescribed an antiretroviral agent (88.0% vs. 71.8%, p = 0.005).Conclusions: Women had greater familial responsibilities than men, but this was not a barrier to access or utilization of healthcare services. Despite less advanced HIV disease, women received similar care and had similar utilization of health services.