PubMed · 11636629
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H U Dapp. 1994. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11636629/
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OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services. METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study. RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services. CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.
BACKGROUND: Although previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL), is less well defined. METHODS: A retrospective incident cohort study was conducted to determine if pre-dialysis clinic attendance was a predictor of better QOL scores measured within the first six months of hemodialysis (HD) initiation. Inclusion criteria were HD initiation from January 1 1998 to January 1 2000, diagnosis of chronic renal failure, and completion of the QOL questionnaire within six months of HD initiation. Patients receiving HD for less than four weeks were excluded. An incident cohort of 120 dialysis patients was identified, including 74 patients who attended at least one pre-dialysis clinic and 46 patients who did not. QOL was measured using the SF 36-Item Health Survey. Independent variables included age, sex, diabetes, pre-dialysis clinic attendance and length of attendance, history of ischemic heart disease, stroke, peripheral vascular disease, heart failure, malignancy, and chronic lung disease, residual creatinine clearance at dialysis initiation, and kt/v, albumin and hemoglobin at the time of QOL assessment. Bivariate and multivariate linear regression analyses were used to identify predictors of QOL scores. RESULTS: Multivariate analysis suggested that pre-dialysis clinic attendance was an independent predictor of higher QOL scores in four of eight health domains (physical function, p < 0.01; emotional role limitation, p = 0.01; social function, p = 0.01; and general health, p = 0.03), even after statistical adjustment for age, sex, residual renal function, kt/v, albumin, and co-morbid disease. Pre-dialysis clinic attendance was also an independent predictor of the physical component summary score (p = 0.03). CONCLUSIONS: We conclude that pre-dialysis clinic attendance favourably influences patient-perceived quality of life within six months of dialysis initiation.
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