Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors
Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors
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DOI：
10.1093/hsw/36.2.129
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发表时间：
2011-05-01
影响因子：
1.5
通讯作者：
Rhodes, Karin V.
中科院分区：
文献类型：
--
作者：
Bisgaier, Joanna;Rhodes, Karin V.
本文调查了1,506名城市急诊科(ED)患者的累积不良经济状况与患者健康之间的关系。研究参与者在2009年5月至10月期间完成了先前有效的社会健康调查。研究了五类经济剥夺：食品不安全、住房问题、就业问题、与成本相关的药物不依从性以及获得医生护理的成本障碍。在调整了人口统计学因素(年龄、性别、种族、教育)的影响后，Logistic回归检验了不利经济状况的累积数量(范围：0到5)与患者的健康状况(自评健康、压力水平、抑郁情绪)和健康行为(吸烟和滥用药物)之间的关系。约48%的受访者报告了一项或多项财务问题，31%的受访者报告了两项或两项以上的财务问题。研究发现，不良经济状况的数量与患者较差/一般的自我评价健康、抑郁情绪、高压力、吸烟和非法药物使用之间存在显著的等级关系。研究结果表明，在当今急迫的医疗安全网中，患者对经济不安全的担忧与患者的健康非常相关。这凸显了以医院为基础的社会工作者必须设计日常社会健康风险筛查和系统干预的模式，以解决急诊科患者的经济状况。
This article examines associations between cumulative adverse financial circumstances and patient health in a sample of 1,506 urban emergency department (ED) patients. Study participants completed a previously validated Social Health Survey between May and October 2009. Five categories of economic deprivation were studied: food insecurity, housing concerns, employment concerns, cost-related medication nonadherence, and cost barriers to accessing physician care. Logistic regression that adjusted for the effects of demographics (age, gender, race, education) tested the association between the cumulative number of adverse financial circumstances (range:0 to 5) and patients' health status (self-rated health, stress level, depressed mood) and health behaviors (smoking and substance abuse). Approximately 48 percent of respondents reported one or more financial concern, and 31 percent reported two or more financial concerns. A significant graded relationship was found between the number of adverse financial circumstances and patients' poor/fair self-rated health, depressed mood, high stress, smoking, and illicit drug use. Findings suggest that in today's acute health safety net, patients' concerns related to financial insecurity are very relevant to patient health. This underscores the imperative for hospital-based social workers to design models of routine social health risk screening and system interventions that address patient financial well-being in the ED.