Primary care-public health linkages: Older primary care patients with prediabetes & type 2 diabetes encouraged to attend community-based senior centers.
Primary care-public health linkages: Older primary care patients with prediabetes & type 2 diabetes encouraged to attend community-based senior centers.
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DOI：
10.1016/j.pmedr.2016.06.023
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发表时间：
2016-12
影响因子：
2.8
通讯作者：
Hazuda HP
中科院分区：
文献类型：
--
作者：
Noël PH;Parchman ML;Finley EP;Wang CP;Bollinger M;Espinoza SE;Hazuda HP
医学研究所 (IOM) 认为，初级保健与公共卫生一体化可以改善弱势患者的健康结果，但正式联系在多大程度上可以增强患者对社区资源的使用，或者可能影响提供者鼓励患者使用这些资源的因素，仍不清楚。我们在 2014 年至 2015 年对 149 名患有前驱糖尿病或糖尿病的老年人进行了基线评估，他们最近加入了与德克萨斯州圣安东尼奥初级保健诊所网络相关的三个老年人中心。除了收集社会人口统计和临床特征外，我们还要求会员确定他们的初级保健来源以及医疗保健提供者是否鼓励他们去老年中心。我们还询问会员为什么加入老年人中心以及他们对哪些项目最感兴趣。会员的初级保健来源与医疗保健专业人员鼓励他们去老年中心无关。多变量分析表明，家庭年总收入为 20,000 美元或以下的参与者 [OR = 2.78； 95% CI = (1.05, 7.14)] 以及报告受教育年限为 12 年或以下的人 [OR = 3.57； 95% CI = (1.11, 11.11)] 更有可能表示被医疗保健提供者鼓励去老年中心。意识到社区资源可支持患者自我管理的提供者可能会像与老年中心有更正式合作伙伴关系的提供者一样，鼓励社会经济上处于弱势的糖尿病前期或糖尿病患者使用这些资源。加入这些中心的常见原因是活跃社交和身体活动。大约 20% 的会员被鼓励去看医疗保健提供者。社会经济地位较低的会员更有可能报告提供者的鼓励。初级保健与中心的联系与提供者的鼓励无关。
The Institute of Medicine (IOM) suggests that primary care-public health integration can improve health outcomes for vulnerable patients, but the extent to which formal linkages may enhance patients' use of community resources, or the factors that may influence providers to encourage their patients to use these resources, remain unclear. We conducted baseline assessments in 2014–2015 with 149 older adults with prediabetes or diabetes who had recently joined three senior centers linked to a network of primary care clinics in San Antonio, Texas. In addition to collecting sociodemographic and clinical characteristics, we asked members to identify their source of primary care and whether a health care provider had encouraged them to go to the senior center. We also asked members why they had joined the senior centers and which programs interested them the most. Members' source of primary care was not associated with being encouraged to attend the senior centers by a health care professional. Multivariable analysis indicated that participants with total annual household incomes of $20,000 or less [OR = 2.78; 95% CI = (1.05, 7.14)] and those reporting 12 years of education or less [OR = 3.57; 95% CI = (1.11, 11.11)] were significantly more likely to report being encouraged to attend the senior center by a health care provider. Providers who are aware of community-based resources to support patient self-management may be just as likely to encourage their socioeconomically vulnerable patients with prediabetes or diabetes to use them as providers who have a more formal partnership with the senior centers. Common reasons for joining the centers were to be socially and physically active. Approximately 20% of members were encouraged to go by a health care provider. Members with lower SES were more likely to report provider encouragement. Primary care linkage to the centers was not associated with provider encouragement.