Doctor shopping by overweight and obese patients is associated with increased healthcare utilization.
Doctor shopping by overweight and obese patients is associated with increased healthcare utilization.
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DOI：
10.1002/oby.20189
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Clark JM
中科院分区：
文献类型：
--
作者：
Gudzune KA;Bleich SN;Richards TM;Weiner JP;Hodges K;Clark JM
与医疗保健提供者的负面互动可能会导致患者更换医生或“医生商店”。我们假设超重和肥胖患者更有可能去看医生购物，因此，与正常体重的非购物者相比，急诊科（艾德）就诊率和住院率增加。我们将一个州健康计划的索赔数据与受益人健康风险评估的信息相结合。主要结局是“医生购物”，我们将其定义为在24个月期间向≥5名不同的初级保健医生（PCP）进行门诊索赔。自变量为标准NIH体重分类（BMI）。我们进行了多变量逻辑回归，以评估体重类别和医生购物之间的关联。我们进行了多变量零膨胀负二项回归，以评估体重医生购物类别与艾德就诊次数和住院次数之间的关联。在20，726名受益人中，平均BMI为26.3 kg/m2（SD 5.1），平均年龄为44.4岁（SD 11.1），53%为女性。与正常体重受益人相比，超重受益人的医生购物调整后几率高23%（OR 1.23，95%CI 1.04-1.46），肥胖受益人的医生购物调整后几率高52%（OR 1.52，95%CI 1.26-1.82）。与正常体重的非购物者相比，超重和肥胖的购物者有更高的艾德就诊率（IRR 1.85，95%CI 1.37-2.45; IRR 1.83，95%CI 1.34-2.50），在体重组内比较期间持续存在（超重IRR 1.50，95%CI 1.10-2.03;肥胖IRR 1.54，95%CI 1.12-2.11）。频繁更换PCP可能会损害连续性，并导致医疗保健利用率增加。
Negative interactions with healthcare providers may lead patients to switch physicians or “doctor shop.” We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight non-shoppers. We combined claims data from a health plan in one state with information from beneficiaries’ health risk assessments. The primary outcome was “doctor shopping,” which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations. Of the 20,726 beneficiaries, the mean BMI was 26.3 kg/m2 (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04–1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26–1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37–2.45; IRR 1.83, 95%CI 1.34–2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10–2.03; Obese IRR 1.54, 95%CI 1.12–2.11). Frequently changing PCPs may impair continuity and result in increased healthcare utilization.
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