在 COVID-19 大流行期间,医疗保险受益人中的优先病症与获得护理、正在进行的病症治疗以及获得处方药的能力之间的关系

COVID Pub Date : 2023-12-20 DOI:10.3390/covid4010002
Matthew C. Dickson, Grant H. Skrepnek
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摘要

据观察,一些合并症与 COVID-19 诊断后不良后果风险增加有关。本调查的目的是评估美国医疗保险和医疗补助服务中心(CMS)指定的优先病症与 COVID-19 大流行期间美国医疗保险受益人无法获得护理、治疗持续病症和获取处方药之间的关联。对具有全国代表性的 CMS 医疗保险当前受益人调查(MCBS)COVID-19 补充公共使用文件(PUF)进行了分析,通过二变量、二项式广义线性模型对三个时间段进行了分析:(1) 2020 年夏季;(2) 2020 年秋季;(3) 2021 年冬季。在约 5530-5740 万名医疗保险受益人中,约有五分之一的人表示在大流行开始时无法获得至少一种类型的护理。据观察,在不同时期,无法获得护理的几率明显降低,其中包括免疫紊乱、癌症、抑郁症、骨质疏松症、糖尿病、关节炎以及多种心血管和肺部疾病。在报告无法获得医疗服务的人群中,约有三分之一涉及到正在进行的疾病治疗,不到十分之一涉及到处方药。为了确定可改变的风险因素并制定积极的干预措施,今后的工作应继续评估结果、获得医疗服务的机会、合并症、不断发展的医疗基础设施、计算机化和各种公共卫生倡议之间的复杂关联。
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Association between Priority Conditions and Access to Care, Treatment of an Ongoing Condition, and Ability to Obtain Prescription Medications among Medicare Beneficiaries during the COVID-19 Pandemic
Several comorbid conditions have been observed to be associated with an increased risk of poor outcomes following a diagnosis of COVID-19. The purpose of this investigation was to assess associations between Centers for Medicare and Medicaid Services (CMS) designated priority conditions and an inability to access care, treat ongoing conditions, and obtain prescription medications among Medicare beneficiaries in the United States during the COVID-19 pandemic. Nationally representative CMS Medicare Current Beneficiary Survey (MCBS) COVID-19 Supplement Public Use Files (PUF) were analyzed via bivariable, binomial generalized linear models across three time periods: (1) Summer 2020; (2) Fall 2020; and (3) Winter 2021. Across an estimated 55.3–57.4 million Medicare beneficiaries, approximately one-fifth reported an inability to access at least one type of care at the onset of the pandemic. Significantly worse odds of an ability to get care across various time periods was observed among several priority conditions including immune disorders, cancer, depression, osteoporosis, diabetes, arthritis, and numerous cardiovascular and pulmonary conditions. Among those reporting an inability to access care, approximately one-third involved treatment of an ongoing condition, and under one-tenth involved prescription medications. To identify modifiable risk factors and to develop active interventions, future work should continue to assess the complex associations between outcomes, access to care, comorbidities, evolving healthcare infrastructures, computerization, and various public health initiatives.
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