The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States
The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States
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DOI：
10.1097/00005650-199912000-00010
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发表时间：
1999-12-01
期刊：
影响因子：
3
通讯作者：
Shapiro, MF
中科院分区：
文献类型：
--
作者：
Cunningham, WE;Andersen, RM;Shapiro, MF
目标。使用自我报告的数据，检查相互竞争的生存需求和其他障碍是否与人类免疫缺陷病毒(HIV)感染者获得医疗保健的机会较差有关。设计：对2864名接受艾滋病毒护理的成年人进行的具有全国代表性的样本调查。因为需要钱买吃、穿或住而无人照顾；因为没有交通工具而推迟护理；无法离开工作岗位；以及病得太重。这是主要的结果衡量标准。过去6个月就诊次数少于3次、未住院就诊、从未接受抗逆转录病毒药物治疗、高危人群在过去6个月内没有卡氏肺孢子虫肺炎的预防措施，以及在六项量表中报告的总体可获得性较低。结果：超过三分之一的人(代表全国8.3万人)由于我们研究的四个原因之一而没有或推迟护理。在多元Logistic回归分析中，拥有四个相互竞争的需求中的任何一个或多个自变量与去急诊室而不住院、从未接受抗逆转录病毒药物治疗以及总体报告的可获得性较低的几率显著相关。结论：在美国，相互竞争的生存需求和其他障碍在接受艾滋病毒护理的人中普遍存在，它们是获得所需医疗服务的有力制约。对于艾滋病毒感染者来说，为了更充分地受益于最近的医疗进步，政策制定者可能需要解决非医疗需求，如食物、衣服和住房，以及交通、家庭护理和就业支持。
OBJECTIVES. TO examine whether competing subsistence needs and other barriers are associated with poorer access to medical care among persons infected with human immunodeficiency virus (HIV), using self-reported data.DESIGN. Survey of a nationally representative sample of 2,864 adults receiving HIV care.MAIN INDEPENDENT VARIABLES. Going without care because of needing the money for food, clothing or housing; postponing care because of not having transportation; not being able to get out of work; and being too sick.MAIN OUTCOME MEASURES. Having fewer than three physician visits in the previous 6 months, visiting an emergency room without being hospitalized; never receiving antiretroviral agents, no prophylaxis far Pneumocystis carinii pneumonia in the previous 6 months for persons at risk, and low overall reported access on a six-item scale.RESULTS. More than one third of persons (representing >83,000 persons nationally) went without or postponed care for one of the four reasons we studied. In multiple logistic regression analysis, having any one or more of the four competing needs independent variables was associated with significantly greater odds of visiting an emergency room without hospitalization, never receiving antiretroviral agents, and having low overall reported access.CONCLUSIONS. Competing subsistence needs and other barriers are prevalent among persons receiving care for HIV in the United States, and they act as potent constraints to the receipt of needed medical care. For persons infected with HIV tol benefit more fully from recent advances in medical therapy, policy makers may need to address nonmedical needs such as food, clothing, and housing as well as transportation, home care, and employment support.