Usual source of care as a health insurance substitute for U.S. adults with diabetes?
Usual source of care as a health insurance substitute for U.S. adults with diabetes?
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DOI：
10.2337/dc09-0025
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发表时间：
2009-06
期刊：
影响因子：
16.2
通讯作者：
Wallace LS
中科院分区：
文献类型：
--
作者：
DeVoe JE;Tillotson CJ;Wallace LS
本研究的目的是检查健康保险和/或常规护理来源（USC）对美国糖尿病成年人接受糖尿病特定服务和保健障碍的影响。对2002年至2005年全国代表性医疗支出小组调查中6562名年龄≥18岁的糖尿病患者的数据进行了二次分析。结果测量包括接受7项糖尿病服务和5项护理障碍。在美国，超过84%的糖尿病患者有全年覆盖和USC；2.3%的人两者都没有。在多变量分析中，与有USC的有保险的糖尿病患者相比，无USC的无保险患者接受A1C筛查的几率为1 / 5（优势比0.23 [95% CI 0.14-0.38]），接受血压检查的几率为1 / 10（0.08[0.05-0.15]）。同样，与有USC的人相比，没有USC的人没有保险，未满足医疗需求的可能性是有USC的人的5.5倍（5.51[3.49-8.70]），延迟的紧急护理是有USC的人的3倍（3.13[1.53-6.38]）。在有保险或有USC的两组中，只有USC的糖尿病个体的糖尿病特异性护理率与有USC的有保险的个体更相似。相比之下，那些只有保险的人更接近参考组，治疗障碍更少。有USC的有保险的糖尿病人比只有USC、只有保险或两者都没有的糖尿病人更富有。政策改革必须以融资和提供系统为目标，以实现增加糖尿病服务的接受和减少获得护理的障碍。
The purpose of this study was to examine the effects of health insurance and/or a usual source of care (USC) on receipt of diabetic-specific services and health care barriers for U.S. adults with diabetes. Secondary analyses of data from 6,562 diabetic individuals aged ≥18 years from the nationally representative Medical Expenditure Panel Survey from 2002 to 2005 were performed. Outcome measures included receipt of seven diabetic services plus five barriers to care. More than 84% of diabetic individuals in the U.S. had full-year coverage and a USC; 2.3% had neither one. In multivariate analyses, the uninsured with no USC had one-fifth the odds of receiving A1C screening (odds ratio 0.23 [95% CI 0.14–0.38]) and one-tenth the odds of a blood pressure check (0.08 [0.05–0.15]), compared with insured diabetic individuals with a USC. Similarly, being uninsured without a USC was associated with 5.5 times the likelihood of unmet medical needs (5.51 [3.49–8.70]) and three times more delayed urgent care (3.13 [1.53–6.38]) compared with being insured with a USC. Among the two groups with either insurance or a USC, diabetic individuals with only a USC had rates of diabetes-specific care more similar to those of insured individuals with a USC. In contrast, those with only insurance were closer to the reference group with fewer barriers to care. Insured diabetic individuals with a USC were better off than those with only a USC, only insurance, or neither one. Policy reforms must target both the financing and the delivery systems to achieve increased receipt of diabetes services and decreased barriers to care.
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影响因子：
12.7
作者：
HAYWARD, RA;BERNARD, AM;COREY, CR
通讯作者：
COREY, CR
影响因子：
12.7
作者：
Zhang, James X.;Huang, Elbert S.;Chin, Marshall H.
通讯作者：
Chin, Marshall H.
影响因子：
16.2
作者：
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通讯作者：
Romero, Raquel L.
影响因子：
9.7
作者：
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通讯作者：
Landon, Bruce E.
影响因子：
39.2
作者：
Wilper, Andrew P.;Woolhandler, Steffie;Himmelstein, David U.
通讯作者：
Himmelstein, David U.