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首页> 外文期刊>Journal of public health management and practice: JPHMP >Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS
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Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS

机译：医疗保健接入和接收到临床糖尿病预防患有型糖尿病患者的糖尿病患者，患有医疗补助的糖尿病：2013年和2015年BRFSS的结果

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Objective: This study aimed to assess whether the recent Medicaid expansion, as a natural experiment, was associated with better access to care and, as a consequence, better receipt of clinical diabetes care services. Methods: Data were from the Behavioral Risk Factor Surveillance System (BRFSS). The analytical sample included 20 708 working-age adults with diabetes aged 18 to 64 years from 22 states. The outcome variables included 4 measures of access to care and 4 measures of receipt of clinical diabetes care services. A difference-in-difference logistic regression model was used to compare changes in outcomes between respondents in Medicaid expansion and nonexpansion states. Data from the 2013 survey provided pre-Medicaid expansion information, and data from the 2015 survey provided postexpansion information. Analyses were conducted using Stata 13 using survey commands to account for the complex survey design of BRFSS. Results: A significant increase was observed in health insurance coverage for people with diabetes from 2013 to 2015 ( P < .05) in both Medicaid expansion and nonexpansion states, with a larger increase in the Medicaid expansion states. The Time by Medicaid expansion interaction term was significant for 2 measures of access to care: health insurance coverage (adjusted odds ratio [AOR] = 1.43, 95% confidence interval: 1.04-1.96) and having an annual checkup (AOR = 1.30, 95% confidence interval: 1.00-1.71). Respondents in expansion states were more likely to have a personal doctor and more likely to be able to afford a physician visit than those in nonexpansion states. The Time by Medicaid expansion was close to significance for one of the measures of clinical diabetes care: getting flu shots (AOR = 1.20, P = .08). Conclusions: Medicaid expansion did improve health care access but no significant improvement was found for receipt of clinical diabetes care for people with diabetes. Resources provided through Medicaid are vital for diabetes control and management.
机译：目的：这项研究旨在评估最近的医疗补助商作为一种自然实验，与更好地进行护理，以及更好地收到临床糖尿病护理服务。方法：数据来自行为风险因素监测系统（BRFSS）。分析样品包括20名708名劳动年龄成年人，糖尿病从22个州患者18至64岁。结果变量包括4种疗程的护理措施和4种临床糖尿病护理服务的4个措施。差异差异逻辑回归模型用于比较医疗补助扩张和非派对国家的受访者之间结果的变化。 2013年调查的数据提供了预防医疗补助商扩展信息，以及2015年调查提供的数据提供了蛋解信息。使用STATA 13使用STARMA 13进行分析，以考虑BRFSS的复杂调查设计。结果：在2013年至2015年的糖尿病患者中观察到患有糖尿病患者（P <0.05）的健康保险覆盖率显着增加（P <.05），医疗补助扩张态度较大。医疗补助扩展互动项的时间对于2个护理措施有重要意义：健康保险覆盖率（调整的赔率比[AOR] = 1.43,95％置信区间：1.04-1.96）并拥有年度检查（AOR = 1.30,95 ％置信区间：1.00-1.71）。扩张国家的受访者更有可能拥有一个个人医生，并且更有可能能够提供医生的访问，而不是非不注目的国家。医疗补助扩张的时间对临床护理措施之一的措施接近意义：流感镜头（AOR = 1.20，P = .08）。结论：医疗补助扩张确实改善了医疗保健访问，但没有发现对糖尿病患者的临床糖尿病护理没有重大改进。通过医疗补助提供的资源对于糖尿病控制和管理至关重要。

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