美国人口中严重头痛和合并症抑郁症成人的医疗保健利用

Horoko Takaki, I. Ieiri, Hidetoshi Shibuta, D. Onozuka, A. Hagihara
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摘要

基本原理、目的和目的:医生和严重头痛患者之间的关系对医疗保健利用有影响。然而,与头痛合并抑郁患者的医疗保健利用相关的证据不足。本研究旨在比较和确定美国成人严重头痛和共病抑郁症患者的医疗保健利用障碍。方法:我们使用了2012年全国健康访谈调查的数据,包括34,525名成年人的样本。使用多元逻辑回归模型,并根据社会人口统计学和几种慢性疾病进行调整。结果:患有严重头痛和共病抑郁症的成年人就诊次数、医院急诊次数和寻找医疗服务提供者的困难明显多于没有这两种情况的成年人。对于有通常护理地点的成年人,有这两种情况的成年人改变他们通常护理地点的几率明显高于没有任何情况的成年人。此外,患有这两种疾病的成年人在没有常规护理场所的情况下,利用医疗保健的障碍与以下方面显著相关:“不喜欢/信任/相信医生”和“太贵/没有保险/费用”。结论:本研究的结果表明,头痛合并抑郁的患者与没有任何症状的成年人相比,与医生有更多的困难。医疗保健利用的障碍不是便利,而是对医生的不信任或医疗保健的成本。医师与头痛合并抑郁患者关系的发展可以使患者定期就诊,改善其健康结果,减轻痛苦负担,这是以人为本的医疗保健方法的重要指标。
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Healthcare utilization among adults with serious headache and comorbid depression in the US population
Rationale, aims and objectives: A relationship between physicians and patients with serious headache has an influence on healthcare utilization. However, there is insufficient evidence related to healthcare utilization among headache patients with comorbid depression. The present study aimed to compare and identify barriers to healthcare utilization among US adults with serious headache and comorbid depression. Methods: We used data from the 2012 National Health Interview Survey, comprising a sample of 34,525 adults. Multivariate logistic regression models were used and adjusted by sociodemographics and several chronic conditions. Results: Adults with serious headache and comorbid depression had significantly more healthcare visits, hospital emergency visits and trouble finding a healthcare provider than adults with neither condition. Regarding adults with a usual place of care, adults with both conditions had significantly higher odds of changing their usual place of care than adults with neither condition. Further, barriers to healthcare utilization in adults with both conditions, without a usual place of care, were significantly associated with the following aspects: “Doesn’t like /trust /believe in doctors” and “Too expensive /no insurance /cost.” Conclusions: The results of this study indicate that headache patients with comorbid depression had more difficulties with physicians compared to adults with neither condition. The barriers to healthcare utilization were not convenience, but distrust of doctors or the cost of healthcare. Developments of the relationship between physicians and headache patients with comorbid depression could enable the patients to have regular healthcare visits, improve their health outcomes and reduce the burden of suffering, important indices as part of the person-centered healthcare approach.
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