全民医疗系统中长期 COVID-19 患者获得医疗服务的障碍和促进因素:来自奥地利的定性证据。

IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International Journal for Equity in Health Pub Date : 2024-10-23 DOI:10.1186/s12939-024-02302-4
Peter Gamillscheg, Agata Łaszewska, Stefanie Kirchner, Kathryn Hoffmann, Judit Simon, Susanne Mayer
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引用次数: 0

摘要

背景:长 COVID-19 在全球范围内对卫生和社会系统构成挑战。国际研究发现,在患病率和医疗保健利用率方面存在严重的不平等,患者描述了获得医疗保健的困难。为了改善长期疗效,了解任何潜在的就医障碍至关重要,而在奥地利这样的全民医疗体系中,迄今为止还缺乏有关长 COVID-19 的相关证据。本研究旨在全面识别奥地利长期 COVID-19 患者所面临的就医障碍和促进因素,并探索医疗和社会护理就医方面潜在的社会经济和人口驱动因素:采用探索性定性方法,我们对 15 名专家(包括医疗专业人员和高级卫生官员)进行了半结构化访谈,并对 18 名确诊为长 COVID-19 的患者进行了焦点小组讨论(2023 年 7 月至 11 月),这些访谈反映了不同的参与者特征(年龄、性别、城市化程度、职业、教育程度、保险状况)。数据分析采用主题框架法,借鉴了全面的 "获得医疗服务 "模式:根据专家和患者的经验,在该模型的所有维度上都出现了一些获得医疗服务的障碍和促进因素。主要的主题包括:医疗专业人员的怀疑和污名化、难以找到知识渊博的医生、非住院治疗部门的专家能力有限、等待专家治疗的时间过长、法定医疗保险的治疗范围有限导致自付费用过高。患者认为不断自我组织患者治疗路径是一种压力,强调了多学科护理和集中协调的必要性。促进因素包括支持性的社会环境、远程医疗以及由全国患者领导的支持小组提供的非正式信息。患者的经历出现了差异,其中女性和年轻患者面临着基于性别和年龄的污名化。补充医疗保险减轻了患者的经济压力,但并没有缓解患者的能力限制,这对生活在农村地区的患者来说尤其具有挑战性:这项研究的结果表明,需要采取行动改善奥地利 COVID-19 长期存在的状况,通过提供更多信息、加强跨学科治疗结构、提供远程医疗服务以及提供研究资金来增强医疗服务提供者和患者的能力。我们对造成就医障碍的潜在相关社会经济和人口驱动因素的见解,为未来的定量不平等研究奠定了必要的基础。
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Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria.

Background: Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.

Methods: Applying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model.

Results: Based on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.

Conclusions: The findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.

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来源期刊
CiteScore
7.80
自引率
4.20%
发文量
162
审稿时长
28 weeks
期刊介绍: International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.
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