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Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, Stranges S, Fortin M, Mangin D. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e287-e296. [PMID: 38452787 DOI: 10.1016/s2666-7568(24)00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024] Open
Abstract
Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
| | - Winnie Liu
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daire Fitzpatrick
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kate Anne Hardacre
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Roberts
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of General Practice, University of Otago, Christchurch, New Zealand
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Sawik B, Tobis S, Baum E, Suwalska A, Kropińska S, Stachnik K, Pérez-Bernabeu E, Cildoz M, Agustin A, Wieczorowska-Tobis K. Robots for Elderly Care: Review, Multi-Criteria Optimization Model and Qualitative Case Study. Healthcare (Basel) 2023; 11:healthcare11091286. [PMID: 37174828 PMCID: PMC10178192 DOI: 10.3390/healthcare11091286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
This paper focuses on three areas: the first is a review of current knowledge about social and service robots for elderly care. The second is an optimization conceptual model aimed at maximizing the efficiency of assigning robots to serve the elderly. The proposed multi-criteria optimization model is the first one proposed in the area of optimization for robot assignment for the elderly with robot utilization level and caregiver stress level. The third is the findings of studies on the needs, requirements, and adoption of technology in elderly care. We consider the use of robots as a part of the ENRICHME project for long-term interaction and monitoring of older persons with mild cognitive impairment, to optimize their independence. Additionally, we performed focus group discussions (FGD) to collect opinions about robot-related requirements of the elderly and their caregivers. Four FDGs of six persons were organized: two comprising older adults, and two of the other formal and informal caregivers, based on a detailed script. The statements of older participants and their caregivers were consistent in several areas. The analysis revealed user characteristics, robot-related issues, functionality, and barriers to overcome before the deployment of the robot. An introduction of the robot must be thoroughly planned, include comprehensive pre-training, and take the ethical and practical issues into account. The involvement of future users in the customization of the robot is essential.
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Affiliation(s)
- Bartosz Sawik
- Department of Business Informatics and Engineering Management, AGH University of Science and Technology, 30-059 Krakow, Poland
- Institute of Smart Cities, Department of Statistics, Computer Science and Mathematics, Public University of Navarre, 31006 Pamplona, Spain
- Haas School of Business, University of California at Berkeley, Berkeley, CA 94720, USA
| | - Sławomir Tobis
- Occupational Therapy Unit, Chair of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, ul. Swiecickiego 6, 60-781 Poznan, Poland
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Aleksandra Suwalska
- Department of Mental Health, Chair of Psychiatry, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572 Poznan, Poland
| | - Sylwia Kropińska
- Geriatrics Unit, Chair of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 55, 61-245 Poznan, Poland
| | - Katarzyna Stachnik
- Geriatrics Unit, Chair of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 55, 61-245 Poznan, Poland
| | - Elena Pérez-Bernabeu
- Department of Applied Statistics and Operations Research, Universitat Politècnica de València, Plaza Ferrandiz y Carbonell, sn, 03801 Alcoy, Spain
| | - Marta Cildoz
- Institute of Smart Cities, Department of Statistics, Computer Science and Mathematics, Public University of Navarre, 31006 Pamplona, Spain
| | - Alba Agustin
- Institute of Smart Cities, Department of Statistics, Computer Science and Mathematics, Public University of Navarre, 31006 Pamplona, Spain
| | - Katarzyna Wieczorowska-Tobis
- Geriatrics Unit, Chair of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 55, 61-245 Poznan, Poland
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Dios-Guerra C, Carmona-Torres JM, Morales-Cané I, Rodríguez-Borrego MA, López-Soto PJ. Evolution in the use of health services by older people in Spain (2009-2017). HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e11-e20. [PMID: 33211360 DOI: 10.1111/hsc.13229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/26/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
As people age, they tend to increase their use of health services. For this, the aims of this study were to analyse the frequency and variability in the use of different health services by people over 65 years, their evolution from 2009 to 2017 and the factors associated it. We carried out a cross-sectional study with 25,465 people over 65 years who participated in the National Health Survey in Spain in 2011/2012 and 2017 and the European Health Survey in Spain in 2009 and 2014. A descriptive analysis was performed using the attendance records of family/general physicians, nurse consultations, or both over the last 12 months as well as these data over the following years of study. Our findings show that approximately 93.2% of the participants had consulted with a family/general physician over the last year, and women were almost twice as likely to do so compared with men (61.2% vs. 38.8%). The use of health services gradually increased from 2009 to 2017, being the visits to nursing that more increased their frequency. Being a woman and a widower as well as having no higher education, a low social class, a serious or long-term illness, obesity and bed restraint were associated with a greater use of health services. Findings suggested that the increased health services due to ageing and comorbidities associated with it present new challenges. It is necessary to determine realistic plans that can meet future healthcare demands and not lead to a collapse of the health system. For this it is very important the primary prevention of chronic diseases, functional limitations, obesity and disability.
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Affiliation(s)
- Caridad Dios-Guerra
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- UGC Occidente. Distrito Sanitario Córdoba y Guadalquivir, Córdoba, Spain
| | - Juan Manuel Carmona-Torres
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Ignacio Morales-Cané
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Pablo Jesús López-Soto
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Área de Enfermería, Universidad de Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
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González Silva Y, Abad Manteca L, Fernández Gómez MJ, Martín Vallejo J, De la Red Gallego H, Pérez Castrillón JL. Utilidad del índice de comorbilidad de Charlson en personas ancianas. Concordancia con otros índices de comorbilidad. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2021. [DOI: 10.55783/rcmf.140205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objetivo. El objetivo principal de nuestro estudio fue evaluar la utilidad actual del índice de comorbilidad de Charlson (CCI) para predecir la mortalidad en personas mayores y la concordancia entre varios índices.
Diseño. Estudio observacional, cohorte concurrente.
Emplazamiento. Servicio de Medicina Interna de un hospital terciario, pacientes ambulatorios de un centro de salud y residentes de cuatro hogares de ancianos.
Participantes. 375 individuos ≥ 65 años, con supervivencia esperada ≥ 6 meses, sin deterioro cognitivo.
Mediciones principales. Se realizaron tres índices: CCI, el índice geriátrico de comorbilidad (GIC) y el índice de Kaplan-Feinstein (KF). A los 12 meses, se registró mortalidad. Los datos se analizaron con IBM SPSS Statistics® versión 23.0.
Resultados. Edad media: 81,4 años. El CCI mostró comorbilidad baja-media en el grupo ambulatorio de 65-75 años (43 [75,4%]); moderada-alta más común en hospitalizados (19 [61,3%]) y en hogares de ancianos (5 [62,5%]). Al año fallecieron 59 (16,1%) individuos: con CCI: 10 (6,4%) comorbilidad baja-media y 49 (23,3%) moderada-alta, odds ratio (OR) 3,63 (intervalo de confianza [IC] 95% 1,76-7,51); con KF: 27 (13,3%) baja-media y 32 (19,5%) moderada-alta, OR 1,38 (IC 95% 0,78-2,44), y con GIC: 45 (14,1%) baja-media y 14 (29,2%) moderada-alta, OR 2,47 (IC 95% 1,21-5,06). La concordancia entre CCI-KF fue: 65-75 años: K = 0,62, 76-85 años: K = 0,396, y ≥ 86 años: K = 0,255. La concordancia entre CCI-GIC: 65-75 años: K = 0,202, 76-85 años: K = 0,069, y ≥ 86 años: K = 0,118.
Conclusión. El CCI es el mejor predictor de mortalidad después de 1 año de seguimiento. Concordancia considerable entre CCI y KF en los individuos de 65-75 años, en el resto de las franjas etarias la correlación con GIC fue insignificante.
Palabras clave: comorbilidad, mortalidad, anciano frágil.
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Affiliation(s)
| | - Laura Abad Manteca
- Servicio de Medicina Interna. Hospital Universitario Río Hortega. Valladolid (España)
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Naz L, Ghimire U, Zainab A. Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey. BMC Geriatr 2021; 21:42. [PMID: 33435874 PMCID: PMC7802143 DOI: 10.1186/s12877-021-02005-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population. METHODS This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson's Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital. RESULTS Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital. CONCLUSIONS Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.
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Affiliation(s)
- Lubna Naz
- Department of Economics, University of Karachi, Karachi, 75270, Pakistan
| | - Umesh Ghimire
- New ERA, Rudramati Marga, Bagmati, Kalopul, Kathmandu, 44600, Nepal.
| | - Abida Zainab
- Poverty Alleviation and Social Safety Division, Centre for Social Entrepreneurship, Islamabad, 46000, Pakistan
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Haraldseide LM, Sortland LS, Hunskaar S, Morken T. Contact characteristics and factors associated with the degree of urgency among older people in emergency primary health care: a cross-sectional study. BMC Health Serv Res 2020; 20:345. [PMID: 32321500 PMCID: PMC7178956 DOI: 10.1186/s12913-020-05219-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/13/2020] [Indexed: 01/06/2024] Open
Abstract
Background As the proportion of older people increases, so will the consumption of health services. The aim of this study was to describe the contact characteristics among older people and to identify factors associated with the degree of urgency at the Norwegian out-of-hours (OOH) emergency primary health care services. Methods Inhabitants aged ≥70 years who contacted the OOH service during 2014–2017 in seven OOH districts in Norway were included. We investigated the variables sex, age, time of contact, mode of contact, ICPC-2 based reason for encounter (RFE), priority degree and initial response. We also performed frequency analyses, rate calculations and a log-binomial regression. Results A total of 38,293 contacts were registered. The contact rate/1000 inhabitants/year was three times higher in the oldest age group (≥90 years) compared to the youngest age group (70–74 years). Direct attendance accounted for 8.4% of the contacts and 32.8% were telephone contacts from health professionals. The most frequent RFE chapter used was “A General and unspecified” (21.0%) which also showed an increasing rate with higher age. 6.0% of the contacts resulted in a home visit from a doctor. Variables significantly associated with urgent priority degree were RFEs regarding cardiovascular (Relative risk (RR) 1.85; CI 1.74–1.96), neurological (RR 1.55; CI 1.36–1.77), respiratory (RR 1.40; CI 1.30–1.51) and digestive (RR 1.22; CI 1.10–1.34) issues. In addition, telephone calls from health professionals (RR 1.21; CI 1.12–1.31), direct attendance (RR 1.13; CI 1.04–1.22), contacts on weekdays (RR 1.13; CI 1.06–1.20) and contacts from men (RR 1.13; CI 1.09–1.17) were significantly associated with urgent priority degree. Conclusions This study provides important information about the Norwegian older inhabitants’ contact with the OOH emergency primary health care services. There are a wide variety of RFEs, and the contact rate is high and increases with higher age. Telephone contact is most common. The OOH staff frequently identify older people as having “general and unspecified” reasons for encounters. OOH nursing staff would benefit from having screening tools and enhanced geriatric training to best support this vulnerable group when these individuals call the OOH service.
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Affiliation(s)
- Lisa Marie Haraldseide
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway.
| | - Linn Solveig Sortland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway
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Ren J, Ding D, Wu Q, Liu C, Hao Y, Cui Y, Sun H, Ning N, Li Y, Kang Z, Shan L, Zhao M, Liu B. Financial Affordability, Health Insurance, and Use of Health Care Services by the Elderly: Findings From the China Health and Retirement Longitudinal Study. Asia Pac J Public Health 2020; 31:510-521. [PMID: 31610715 DOI: 10.1177/1010539519877054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The rapidly growing aging population has attracted global attention. This study explores the associations between 3 basic health insurances, and it identifies factors associated with health care services among the elderly populations. This study is based on multistage stratified cluster sampling method from the 2013 China Health and Retirement Longitudinal Study (CHARLS) resulting in 7589 participants. Medical Insurance for Urban Employees (MIUE) members were more likely to use inpatient health care services. Health insurance programs were associated with inpatient services usage but not outpatient services usage. There are significant disparities in medical costs and health care service usage among the 3 insurance programs. Health insurance program is only associated with inpatient care. These findings may provide some suggestions to support improvements to the Chinese health care system.
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Affiliation(s)
- Jiaojiao Ren
- Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Ding Ding
- Dalian Medical University, Dalian, China
| | - Qunhong Wu
- Harbin Medical University, Harbin, China
| | - Chaojie Liu
- La Trobe University, Melbourne, Victoria, Australia
| | - Yanhua Hao
- Harbin Medical University, Harbin, China
| | - Yu Cui
- Harbin Medical University, Harbin, China
| | - Hong Sun
- Harbin Medical University, Harbin, China
| | - Ning Ning
- Harbin Medical University, Harbin, China
| | - Ye Li
- Harbin Medical University, Harbin, China
| | - Zheng Kang
- Harbin Medical University, Harbin, China
| | | | | | - Baohua Liu
- Harbin Medical University, Harbin, China
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Yiğitbaş Ç, Deveci SE. Health perceptions of elderly people aged over 65 age. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.553282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Li JW, Hsieh HM, Weng SF, Lee IC. Polypharmacy and Utilization of Health Care Services: A Cohort Study of People Aged Over 50 Years in Taiwan. Asia Pac J Public Health 2019; 31:257-266. [PMID: 30803259 DOI: 10.1177/1010539519828077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aimed to understand the changes and correlation in the long-term trends of polypharmacy and the utilization of health care services in a population over the age of 50 years through the use of a national database. A total of 2813 subjects who participated in surveys in 1999, 2003, and 2007 were selected as the samples. Each subject was followed-up for the period of 9 years. From 1999 to 2007, the proportion of mild and severe polypharmacy cases increased from 41.5% (1999) to 51.3% (2003) and 57.1% (2007), respectively. This study found that the more severe the polypharmacy was, the higher the risk of health care service utilization would be. The Generalized Estimating Equation model of multivariate analysis showed that the incidence rate ratio of medical utilization increased with the severity of polypharmacy, as did the use of advanced medical resources (ie, the number of hospitalizations). In particular, the increase in incidence rate ratio was more significant in 3 aspects: (1) number of pharmacy visits; (2) number of emergency room admissions; and (3) number of hospitalizations. The government should establish policies and guidance for the safe use of medicines to ensure reduced risk for older people.
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Affiliation(s)
- Ji-Wen Li
- 1 Kaohsiung Medical University, Kaohsiung
| | | | | | - I-Chen Lee
- 1 Kaohsiung Medical University, Kaohsiung
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Madyaningrum E, Chuang YC, Chuang KY. Factors associated with the use of outpatient services among the elderly in Indonesia. BMC Health Serv Res 2018; 18:707. [PMID: 30200949 PMCID: PMC6131867 DOI: 10.1186/s12913-018-3512-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Elderly people tend to have greater healthcare utilization because of their health status. However, with the 4th largest population in the world, little is known concerning the use of services among the Indonesian elderly. Hence, this study aimed to identify factors related to the use of outpatient services among the Indonesian elderly. Methods This is cross sectional study using data from the Indonesian Family Life Survey 5 (IFLS 5), conducted in 2014 and 2015. Only those who were 60 years or older were included in the analyses. We used a logistic regression analysis to determine factors associated with use of outpatient services. Results Among 2912 participants, only 22.7% of respondents had visited health workers or doctors within the previous 4 weeks before the survey. After controlling for other variables, factors associated with the use of outpatient services were socioeconomic status, insurance status, regions of residence, self-rated health, and the number of chronic conditions. Conclusion Inequality in outpatient services was observed among the elderly in Indonesia. More effort is need to expand insurance coverage for the elderly, particularly for those in the lower economic status, and to improve access to outpatient services in rural regions by allocating the needed resources.
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Affiliation(s)
- Ema Madyaningrum
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11014, Taiwan.,School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Farmako Street, Sekip Utara, Yogyakarta, 55281, Indonesia
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11014, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11014, Taiwan.
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Lopez-de-Andres A, de Miguel-Diez J, Hernandez-Barrera V, Jiménez-Trujillo I, Martinez-Huedo MA, Del Barrio JL, Jimenez-Garcia R. Effect of the economic crisis on the use of health and home care services among elderly Spanish diabetes patients. Diabetes Res Clin Pract 2018; 140:27-35. [PMID: 29601915 DOI: 10.1016/j.diabres.2018.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/03/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
Abstract
AIMS To describe the utilization of health and home care services among older people (≥65 years) with diabetes during the economic crisis; to identify the factors associated with changes in the utilization of these services; and to study the time trends (2009-2014). METHODS We used the European Health Interview Surveys for Spain (EEHSS) for 2009/10 and 2014. The dependent variables included self-reported hospitalizations; general practitioner (GP) visits; 'other healthcare services' (OHS) used; and home care services (HCS) used. RESULTS We identified 6026 and 6020 diabetic patients (EEHSS2009 and EEHSS2014, respectively). A significant decrease in the number of GP visits (OR 0.94; 95% CI 0.91-0.98) and the use of HCS (OR 0.95; 95% CI 0.91-0.99) was found; however, we found an increase in the use of OHS (OR 1.06; 95% CI 1.02-1.10). Multivariate models showed that factors associated with an increased use included chronic conditions, worse self-rated health, pain and mental disorders. Physical activity was a strong predictor of lower hospitalizations and HCS use. Female gender was associated with significantly lower hospitalizations and a higher use of OHC and HCS. CONCLUSION We found a decrease in the number of GP visits and the use of HCS among elderly diabetic adults; however, we also observed an increase in the use of OHS, which may partly explain this decrease in the figures. Significant differences in the use of health services were found according to gender. The effect of the economic crisis, if any, seems to have had a small magnitude.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
| | - Javier de Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Comunidad de Madrid, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Maria-Angeles Martinez-Huedo
- Preventive Medicine and Public Health, Unidad de Docencia, Hospital Universitario La Paz, Madrid, Comunidad de Madrid, Spain
| | - José Luis Del Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
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de Miguel-Diez J, Lopez-de-Andres A, Herandez-Barrera V, Jimenez-Trujillo I, Puente-Maestu L, Cerezo-Lajas A, Jimenez-Garcia R. Effect of the economic crisis on the use of health and home care services among Spanish COPD patients. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29535513 PMCID: PMC5836665 DOI: 10.2147/copd.s150308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014. Methods We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles. Results We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p<0.001). No changes were found for hospitalizations, GP visits, and home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58-0.89). Conclusion We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of small magnitude.
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Affiliation(s)
- Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentin Herandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Luis Puente-Maestu
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Alicia Cerezo-Lajas
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Hernández-Aceituno A, Pérez-Tasigchana RF, Guallar-Castillón P, López-García E, Rodríguez-Artalejo F, Banegas JR. Combined Healthy Behaviors and Healthcare Services Use in Older Adults. Am J Prev Med 2017; 53:872-881. [PMID: 28774549 DOI: 10.1016/j.amepre.2017.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Data on the combined impact of healthy behaviors on healthcare use in older adults are limited. METHODS Study with community-dwelling individuals aged ≥60 years from the Spanish Seniors-ENRICA cohort, recruited in 2008-2010, followed through 2012-2013, and analyzed in 2016 (N=2,021). At baseline, the following healthy behaviors were self-reported: three traditional (never smoking, being physically active, having a healthy diet) and three emerging (sleeping 7-8 hours/day, sitting <8 hours/day, not living alone). Outcomes were self-reported polypharmacy (five or more drugs per day), primary care physician visits (one or more per month), medical specialist visits (more than one per year), and hospitalization (one or more in the last year). The associations between baseline healthy behaviors and healthcare services used in 2012-2013 were summarized with ORs and 95% CIs from multiple logistic regression, adjusting for demographics, lifestyles, comorbidities, and baseline health services used. RESULTS Most single healthy behaviors were associated with lower use of most health services. Compared with participants with zero or one healthy behavior, those with five or six healthy behaviors showed lower risk of polypharmacy (OR=0.46, 95% CI=0.24, 0.85, p-trend=0.001), visits to the primary care physician (OR=0.50, 95% CI=0.26, 0.96, p-trend=0.013), and hospitalization (OR=0.50, 95% CI=0.24, 1.01, p-trend=0.016). No association was found with visits to the medical specialist. CONCLUSIONS The combination of five to six healthy behaviors in older adults is associated with half the risk of polypharmacy and using several healthcare services. In an era of constrained resources in most countries, this information may help inform health policy to control healthcare spending in the future.
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Affiliation(s)
- Ana Hernández-Aceituno
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Raúl F Pérez-Tasigchana
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Palacios-Ceña D, Hernández-Barrera V, Jiménez-Trujillo I, Serrano-Urrea R, Fernández-de-Las-Peñas C, Carrasco-Garrido P. Time trends in antibiotic consumption in the elderly: Ten-year follow-up of the Spanish National Health Survey and the European Health Interview Survey for Spain (2003-2014). PLoS One 2017; 12:e0185869. [PMID: 29186144 PMCID: PMC5706724 DOI: 10.1371/journal.pone.0185869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022] Open
Abstract
Background The purposes of this study were: firstly, to estimate time trends in the prevalence of prescription antibiotic consumption between 2003 and 2014; secondly, to identify the factors associated with the probability of consuming antibiotics during this period in elderly persons in Spain. Methods We analyzed data collected from the Spanish National Health Survey in 2003 (n = 21,650), 2006 (n = 29,478), and 2012 (n = 20,007) and from the European Health Interview Survey for Spain in 2009 (n = 22,188) and 2014 (n = 22,842). Antibiotic consumption was the dependent variable. We also analyzed sociodemographic features, self-perceived health status, lifestyle habits, comorbid diseases, and disabilities using logistic regression models. Results The prevalence of antibiotic consumption increased from 2003 to 2014 in both sexes. The variables that predicted antibiotic consumption (men; women) were secondary education (OR 1.38; OR 1.31), visits to a general practitioner (OR 2.05; OR 2.15), hospitalization (OR 1.91; OR 1.83), therapy with > 4 non-antibiotic drugs (OR 3.36; OR 5.84), instrumental activities of daily living (OR 1.50; OR 1.24), and activities of daily living (OR 1.39; OR 1.35). In contrast, age > 85 years was associated with low antibiotic consumption in both men (OR 0.81) and women (OR 0.88). Conclusions The prevalence of antibiotic prescription has increased in Spain in the last decade. Our study identified several factors that appear to affect antibiotic consumption in elderly persons, with potential implications for healthcare providers.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
| | - Valentín Hernández-Barrera
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. Universidad Rey Juan Carlos. Alcorcón, Madrid
| | - Isabel Jiménez-Trujillo
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. Universidad Rey Juan Carlos. Alcorcón, Madrid
| | - Ramón Serrano-Urrea
- Department of Mathematics. Faculty of Computer Science Engineering. University of Castilla-La Mancha. Albacete, Castilla la Mancha. Spain
| | - César Fernández-de-Las-Peñas
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
| | - Pilar Carrasco-Garrido
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
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Araujo MEA, Silva MT, Galvao TF, Pereira MG. Prevalence of health services usage and associated factors in the Amazon region of Brazil: a population-based cross-sectional study. BMJ Open 2017; 7:e017966. [PMID: 29151052 PMCID: PMC5701988 DOI: 10.1136/bmjopen-2017-017966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of healthcare use and associated factors in the Manaus metropolitan region and to describe the reasons for lack of access. DESIGN Cross-sectional population-based study. SETTING A survey conducted between May and August of 2015 in eight cities from Manaus metropolitan region, Amazonas, Brazil. PARTICIPANTS 4001 adults ≥18 years of age. PRIMARY OUTCOMES MEASURES Physician visits, dentist visits and hospitalisations in the last 12 months were the primary outcomes. Associated factors were investigated through the calculation of prevalence ratio (PR) obtained by hierarchical Poisson regression modelling. RESULTS 4001 adults were included in the study, 53% of whom were women. The self-reported prevalence of medical visits was 77% (95% CI 75% to 77%); dentist visits, 36% (95% CI 34% to 37%) and hospital admission, 7% (95% CI 6% to 7%). Physician visits were higher in women PR=1.18 (95% CI 1.14 to 1.23), the elderly PR=1.18 (95% CI 1.10 to 1.26) and people with health insurance PR=1.14 (95% CI 1.10 to 1.19). Dentist visits declined with older age PR=0.38 (95% CI 0.30 to 0.49), lower education level PR=0.62 (95% CI 0.51 to 0.74) and lower economic class PR=0.65 (95% CI 0.57 to 0.75). Hospitalisations were found to be twice as frequent for women than for men and three times as frequent among those who reported very poor health status. Among the individuals who did not receive medical attention in the previous 2 weeks, 58% reported lack of facilities or appointment unavailable and 14% reported lack of doctors. CONCLUSION While more than half visited the doctor in the last year, a lower proportion of people with socioeconomic inequities visited the dentist. Organisational and service policies are needed to increase equity in health services in the region.
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Affiliation(s)
- Maria Elizete A Araujo
- Post-Graduate Program Health Sciences, University of Brasilia, Brasilia, Federal District, Brazil
- Getulio Vargas University Hospital, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Marcus T Silva
- Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao Paulo, Brazil
| | - Tais F Galvao
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Mauricio G Pereira
- Faculty of Medicine, University of Brasilia, Brasilia, Federal District, Brazil
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Gan Y, Li W, Cao S, Dong X, Li L, Mkandawire N, Chen Y, Herath C, Song X, Yin X, Yang T, Li J, Deng J, Lu Z. Patients' Willingness on Community Health Centers as Gatekeepers and Associated Factors in Shenzhen, China: A Cross-sectional Study. Medicine (Baltimore) 2016; 95:e3261. [PMID: 27057877 PMCID: PMC4998793 DOI: 10.1097/md.0000000000003261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The gate-keeping function of primary healthcare facilities has not been fully implemented in China. This study was aiming at assessing the willingness on community health centers (CHCs) as gatekeepers among a sample of patients and investigating the influencing factors.A cross-sectional survey was conducted in 2013. A total of 7761 patients aged 18 to 90 years from 8 CHCs in Shenzhen (China) were interviewed using a structured questionnaire. Descriptive and multivariable logistic regression analyses were used to analyze the characteristics of patients, their willingness on the gatekeeper policy, and identify the associated factors.On willingness of patients to select CHCs as gatekeepers, 70.03% of respondents were willing, 18.95% were neutral, and 9.02% were unwilling. Multivariable analysis indicated that female patients (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.02-1.30); patients with health insurance (OR = 1.21, 95% CI: 1.07-1.36); patients who lives near CHC (OR = 1.89, 95% CI: 1.17-3.05); and patients who were more familiar with the gatekeeper policy (OR = 2.09, 95% CI: 1.85-2.36), had higher level of willingness on the policy. Conversely, reporting with good health status was independently associated with the decreased willingness on gatekeeper policy (OR = 0.69, 95% CI: 0.53-0.90).The findings indicated that patients' willingness on CHCs as gatekeepers is high. More priority measures, such as expanding medical insurance coverage of patients, strengthening the propaganda of gatekeeper policy, and increasing the access to community health service, are warranted to be taken. This will help to further improve the patients' willingness on CHCs as gatekeepers. It is thus feasible to implement the gatekeeper policy among patients in China.
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Affiliation(s)
- Yong Gan
- From the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei (YG, WL, SC, XD, LL, NM, YC, CH, XY, XS, TY, JL, ZL); Department of Management, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi (LL); and Center of Community Health Service Management, Fuyong People's Hospital, Shenzhen, Guangdong, China (JD)
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Aguilar-Palacio I, Carrera-Lasfuentes P, Solsona S, Sartolo MT, Rabanaque MJ. [Health-care utilization in elderly (Spain 2006-2012): Influence of health status and social class]. Aten Primaria 2015; 48:235-43. [PMID: 26388467 PMCID: PMC6877833 DOI: 10.1016/j.aprim.2015.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/18/2014] [Accepted: 01/22/2015] [Indexed: 11/30/2022] Open
Abstract
Objetivo Conocer la utilización de servicios sanitarios de Atención Primaria (AP), Atención Especializada (AE), hospitalizaciones, Hospital de Día y Urgencias, y la hiperfrecuentación en ancianos en España, analizando la influencia del estado de salud, sexo, clase social y evolución temporal. Diseño Estudio transversal en 2 fases. Emplazamiento España. Participantes Personas encuestadas en la Encuesta Nacional de Salud 2006 y 2011-12. Mediciones principales Como variables de salud se utilizaron la salud percibida y diagnosticada (número y tipo de diagnósticos). La clase social se obtuvo a partir de la última ocupación del sustentador principal (clases manuales y no manuales). Se realizaron análisis de regresión logística, ajustando por sexo, edad, nivel de salud, clase social y año, calculando su capacidad predictiva. Resultados El porcentaje de población mayor que utiliza consultas médicas descendió en el periodo estudiado. Las mujeres trabajadoras manuales presentaron la mayor prevalencia de mala salud (mala salud percibida en el 2006: 70,6%). La mala salud se asoció a mayor utilización de servicios sanitarios. La salud percibida fue mejor predictor de utilización de servicios y de hiperfrecuentación que la diagnosticada, con la mayor capacidad predictiva para AE (C = 0,676). Los ancianos de clases sociales bajas utilizaron con más frecuencia AP y Urgencias, mientras que la utilización de AE y Hospital de Día fue mayor en clases altas. Conclusiones Existen diferencias en salud y utilización de servicios sanitarios en mayores según clase social. Resulta necesario prestar atención a la salud percibida como predictor de la utilización de servicios sanitarios y revisar la accesibilidad-equidad de nuestros servicios.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Santa Eulalia del Campo, Teruel, España.
| | - Patricia Carrera-Lasfuentes
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España
| | - Sofía Solsona
- Servicio de Geriatría, Hospital San José, Teruel, España
| | | | - M José Rabanaque
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Santa Eulalia del Campo, Teruel, España
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de Miguel Díez J, Jiménez García R, Hernández Barrera V, Puente Maestu L, Del Cura González MI, Méndez Bailón M, Carrasco Garrido P, López de Andrés A. Trends in self-rated health status and health services use in COPD patients (2006-2012). A Spanish population-based survey. Lung 2014; 193:53-62. [PMID: 25549895 DOI: 10.1007/s00408-014-9682-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients often have a significant impairment in their health status, which is an independent predictor of health services use. OBJECTIVES To describe the self-rated health status and the prevalence of health services use among COPD Spanish patients; to identify which factors are independently associated with a worse health status and a higher use of health services; and to study the time trends in the health status and prevalence of use of health services (2006-2012). METHODS Observational study: We analyzed data from the Spanish National Health Surveys conducted in 2006 and 2012. We included responses from adults aged 40 years or over. Subjects described their health status as very good, good, fair, poor, or very poor, which was dichotomized into very good/good or fair/poor/very poor self-perceived health status. RESULTS We identified 2,321 COPD patients. The percentage of patients with health status fair, poor, or very poor was 76.8 % in 2006 and 74.8 % in 2012 (p > 0.05). Regarding the health resources use, we observed a significant decrease in the number of visits to primary care over time in women (67.8 vs. 57.2 %, p < 0.05) and men (62.2 vs. 54.0 %, p < 0.05). However, we did not find improvement in the prevalence of emergency department visits or hospitalizations. Associated factors with a worse self-rated health status and a higher use of health services in women and men included: having three or more chronic diseases, presence of mental disorders, and absence of leisure time physical activity. CONCLUSIONS The current study revealed a decrease in the general practitioner visits, without changes in use of other health care services in the COPD Spanish population from 2006 to 2012. The self-rated health status did not changed significantly during this period.
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Affiliation(s)
- Javier de Miguel Díez
- Department of Respiratory Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, C/Doctor Esquerdo 46, 28007, Madrid, Spain,
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