摘要
背景:急性心肌梗死(AMI)患者接受卫生保健服务和药物治疗时经济障碍的发生率及其结局尚未明确。目的:确定AMI后患者中自报告对保健服务和药物治疗存在经济障碍(定义为因费用高而避免使用)的基线发生率及其与随后的保健结局的相关性。设计、机构和参与者:PREMIRE(前瞻性心肌梗死注册评估:事件和康复)研究是一项在美国开展的为期逾12个月的多中心观察研究,该研究在2003年1月至2004年6月间募集了2498例AM I患者。
Context: The prevalence and consequences of financial barriers to health care services and medications are not well documented for patients with an acute myocardial infarction(AMI). Objective: To measure the baseline prevalence of self-reported financial barriers to health care services or medication(as defined by avoidance due to cost) among individuals following AMI and their association with subsequent health care outcomes. Design, Setting, and Participants: The Prospective Registry Evaluating Myocardial Infarction: Event and Recovery(PREMIER), an observational, multicenter US study of patients with AMI over 12 months in 2498 individuals enrolled from January 2003 through June 2004. Main Outcome Measures: Health status symptoms(Seattle Angina Questionnaire[SAQ]), overall health status function(Short Form-12), and rehospitalization. Results: The prevalence of self-reported financial barriers to health care services or medication was 18.1% and 12.9% , respectively. Among individuals who reported financial barriers to health care services or medication, 68.9% and 68.5% , respectively, were insured. At 1-year follow-up, individuals with financial barriers to health care services were more likely to have lower SAQ quality-of-life score(77.9 vs 86.2; adjusted mean difference=- 4.0; 95% confidence interval[CI], - 6.3 to - 1.8), and increased rates of all-cause rehospitalization(49.3% vs 38.1% ; adjusted hazard ratio[HR], 1.3; 95% CI, 1.1- 1.5) and cardiac rehospitalization(25.7% vs 17.7% ; adjusted HR, 1.3; 95% CI, 1.0- 1.6). At 1-year follow-up, individuals with financial barriers to medication were more likely to have angina(34.9% vs 17.9% ; adjusted odds ratio, 1.55; 95% CI, 1.1- 2.2), lower SAQ quality-of-life score(74.0 vs 86.1; adjusted mean difference=- 7.6; 95% CI, - 10.2 to - 4.9), and increased rates of all-cause rehospitalization(57.0% vs 37.8% ; risk-adjusted HR, 1.5; 95% CI, 1.2- 1.8) and cardiac rehospitalization(33.7% vs 17.3% ; adjusted HR, 1.7; 95% CI, 1.3- 2.2). Conclusion: Financial barriers to hea
