The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points

Internet use and frailty in middle-aged and older adults: findings from developed and developing countries

BACKGROUND

With increasing trend of internet use in all age groups, whether internet use can prevent frailty in middle-aged and older adults remains unclear.

METHODS

Five cohorts, including Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Aging (ELSA), and Mexican Health and Aging Study (MHAS), were used in this study. Internet use, social isolation, and frailty status was assessed using similar questions. The Generalized estimating equations models, random effects meta-analysis, COX regression, and mediation analysis were utilized.

RESULTS

In the multicohort study, a total of 155,695 participants were included in main analysis. The proportion of internet use was varied across countries, ranging from 5.56% in China (CHARLS) to 83.46% in Denmark (SHARE). According to the generalized estimating equations models and meta-analysis, internet use was inversely associated with frailty, with the pooled ORs (95%CIs) of 0.72 (0.67,0.79). The COX regression also showed that participants with internet use had a lower risk of frailty incidence. Additionally, the association was partially mediated by social isolation and slightly pronounced in participants aged 65 and over, male, not working for payment, not married or partnered, not smoking, drinking, and not co-residence with children.

CONCLUSIONS

Our findings highlight the important role of internet use in preventing frailty and recommend more engagements in social communication and activities to avoid social isolation among middle-aged and older adults.

The Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits: Quasi-Experimental Study

BACKGROUND

Overcrowding in public hospitals, a common issue in many countries, leads to a range of negative outcomes, such as insufficient access to medical services and patient dissatisfaction. Prior literature regarding solutions to reducing hospital overcrowding primarily focuses on organizational-level operational efficiency. However, few studies have investigated the strategies from the individual patient perspective. Specifically, we considered using mobile health and fitness apps to promote users' health behaviors and produce health benefits, thereby reducing hospital visits.

OBJECTIVE

This study estimated the causal effect of health and fitness app adoption on hospital visits by exploiting the staggered timing of adoption. We also investigated how the effect varied with users' socioeconomic status and digital literacy. This study provides causal evidence for the effects of health apps, extends the digital health literature, and sheds light on mobile health policies.

METHODS

This study used a data set containing health and fitness app use and hospital-related geolocation data of 267,651 Chinese mobile phone users from January to December 2019. We used the difference-in-differences and difference-in-difference-in-differences designs to estimate the causal effect. We performed a sensitivity analysis to establish the robustness of the findings. We also conducted heterogeneity analyses based on the interactions of postadoption indicators with users' consumption levels, city tiers, and digital literacy.

RESULTS

The preferred model (difference-in-difference-in-differences) showed a significant decrease in hospital visits after the adoption of health and fitness apps. App adoption led to a 5.8% (P<.001), 13.1% (P<.001), and 18.4% reduction (P<.001) in hospital visits 1, 2, and 3 months after adoption, respectively. In addition, the moderation analysis shows that the effect is greater for users with high consumption levels, in high-tier cities, or with high digital literacy.

CONCLUSIONS

This study estimated the causal effect of health and fitness app adoption on hospital visits. The results and sensitivity analysis showed that app adoption can reduce users' hospital visits. The effect varies with users' consumption levels, city tiers, and digital literacy. These findings provide useful insights for multiple stakeholders in the Chinese health care context.

Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study

BACKGROUND

Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age.

OBJECTIVE

This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use.

METHODS

We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ≥50 years) with a sampling error of 2.04%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year.

RESULTS

We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95%) and obtained information from peers (348/442, 78.7%) the most; followed by web-based self-tracking related to health issues (305/442, 69%), and only a few (52/442, 11.3%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters.

CONCLUSIONS

Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients.

Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies

Background

Older people are more likely to be excluded from the digital world, and this has been linked to poor health outcomes. The extent and direction of the influence of digital exclusion on functional dependency is, however, not well understood. We aimed to investigate the association between digital exclusion and functional dependency among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs).

Methods

In this multicohort study, we pooled individual-level data from five longitudinal cohort studies that included nationally representative samples of older adults across 23 countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). The digital exclusion was recorded as an absence from internet use by self-reported. We assessed basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and we used interval-of-need methods to categorize the functional dependency. We applied generalized estimating equations models fitting Poisson model to investigate the association of digital exclusion with difficulties in BADL or IADL and functional dependency, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age level, labour force status, education, household wealth level, marital status, and co-residence with children.

Findings

We included 108,621 participants recruited between 2010 and 2018 with a median follow-up of 3 phrases. Digital exclusion in older adults varied across countries, ranging from 23.8% in Denmark (SHARE) to 96.9% in China (CHARLS). According to the crude model, digital exclusion was significantly associated with functional dependency. In the MSAS-adjusted model, those associations remained statistically significant: HRS (incidence rate ratio [IRR] = 1.40, 95% confidence interval [CI] 1.34-1.48 for BADL; 1.71 [1.61-1.82] for IADL), ELSA (1.31 [1.22-1.40] in BADL and 1.37 [1.28-1.46] in IADL), SHARE (1.69 [1.61-1.78] in BADL and 1.70 [1.63-1.78] in IADL), CHARLS (2.15 [1.73-2.67] in BADL and 2.59 [2.06-3.25] in IADL), and MHAS (1.15 [1.09-1.21] in BADL and 1.17 [1.09-1.25] in IADL). In the subgroup analyses, the associations were more pronounced in the oldest-old (aged ≥ 80 years old).

Interpretation

There is a substantial proportion of older adults who are excluded from the Internet, especially those in LMIC. Older people excluded from the Internet regardless of whether they live in HICs or LMICs are more likely to develop functional dependency. It should be made a priority to remove barriers to Internet access in order to assist older people in maintaining their independence and, consequently, to reduce the care burden associated with the ageing population worldwide.

Funding

The National Natural Science Foundation of China (No. 71904004).

Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey

BACKGROUND

The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.

OBJECTIVE

We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.

METHODS

Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.

RESULTS

Age (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).

CONCLUSIONS

This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.

Older Women Living Alone in the UK: Does Their Health and Wellbeing Differ from Those Who Cohabit?

With an increased prevalence of people living alone in later life, understanding the health and wellbeing of older women living alone in the UK is an important area of research. Little is known about health and wellbeing in this population and whether they differ from those who cohabit. This paper fills this research gap. Analysis was undertaken of Wave 8 of the Understanding Society Household Panel Survey, including variables such as internet use and volunteering. Differences were found between those who live alone and cohabit. Volunteering was a predictor of better health outcomes for those who lived alone but not for those who cohabit, despite similar rates of volunteering. Internet use predicted some better health outcome for those who cohabit but poorer for those who live alone. This suggests lifestyle factors vary in how they affect the health and wellbeing of older women, depending on cohabitation status.

Information and Communication Technology Use in Older Adults: A Unidirectional or Bi-directional Association with Cognitive Function?

Previous research on older adults' information and communication technology (ICT) use has shown that cognitive function is linked with ICT use; however, the direction of influence has been yet to be determined. The current study examined the temporal sequence of ICT use and cognitive performance. Using three waves (2013, 2015, and 2017) from the National Health and Aging Trends Study, a total of 3,904 community-dwelling older adults aged 65 and above were selected for the analysis. Two cognitive domains were considered: episodic memory and executive function. Reciprocal 4-year lagged associations between ICT use and each cognitive domain were examined, controlling for covariates (age, gender, education, race/ethnicity, and depression). Greater use of ICT was significantly associated with memory performance, B (SE) = .19 (.01), p < .001, and executive function, B (SE) = .26 (.01), p < .001, in following years. Reciprocally, episodic memory predicted ICT use, B (SE) = .02 (.01), p < .001, 2 years later. However, the cross-lagged effect of executive functioning on ICT use was not significant, B (SE) = .00 (.01), p = .14. These results suggest the direction of the association between ICT use and cognitive performance might vary depending on the cognitive domain.

The association between Internet use and health-related outcomes in older adults and the elderly: a cross-sectional study

Background

Older adults and elderly persons can experience a significant digital divide. However, there are many studies reporting that the use of the Internet has benefits related to a person’s health status and social inclusion. It is not fully clear if Internet use and health-related outcomes share common antecedents or if using the Internet may have a favourable effect on the determinants responsible for good health. The main aim of this study was to assess the relationship between the use of the Internet and health-related outcomes in older adults and elderly people in Poland.

Methods

The effect of the use of the Internet was analysed with regression models after adjusting for sociodemographic factors. The data used for the analysis were obtained through a telephone-based survey on a representative sample of Polish adults at least 50 years of age.

Results

By categorising the frequency of Internet use by the respondents, it was found that some categories were significantly related to less favourable health behaviours. Rare Internet users were less likely to undertake physical activity than nonusers (odds ratio, OR, 95% confidence interval, 95%CI 0.48, 0.28–0.83). Those using the Internet every day less frequently consumed fruit and vegetables (OR, 95%CI 0.64, 0.42–0.99). Internet use was also associated with more frequent consumption of alcohol (OR, 95%CI 1.65, 1.09–2.50 comparing nonusers with those accessing the Internet several times a week). Persons rarely using the Internet, but not those who accessed it at least a few times a week, possessed a lower health literacy than nonusers (OR, 95%CI 0.71, 0.52–0.97). Internet users were also more likely to assess their health status as unsatisfactory (OR, 95%CI 0.59, 0.42–0.82 comparing nonusers with those using the Internet daily). Finally, the use of the Internet was consistently associated with a lower prevalence of chronic conditions and disability, as well as less frequent visits to health care facilities.

Conclusions

In conclusion, in contrast to earlier findings, Internet use is not associated with favourable patterns of lifestyle or higher self-rated health in older Polish adults. However, persons with chronic conditions or disabilities less frequently declare the use of the Internet. It was also revealed that older adults and the elderly who make use of the Internet are less likely to utilise health services.

Supply and Demand-Related Decisive Factors in the Utilization of Non-Medical Community Healthcare Services among Elderly Chinese

There is little research on the utilization of non-medical community healthcare services among the elderly, compared with that of medical community healthcare services. From the perspective of both supply and demand, based on the survey data from Shaanxi province, this study examined supply-related factors (including service supply, service quality, service charge and service accessibility) and demand-related factors (including service need, individual financial status, family care support and knowledge of service) affecting the utilization of non-medical community healthcare services among the elderly in China by using Poisson regression. The findings show that service supply, service quality, service need and knowledge of service are positively associated with the utilization of non-medical community healthcare services among elderly Chinese, but the other factors identified in previous studies are not significant predictors for the utilization of the services among the elderly in the context of China. To our knowledge, this is the first study to examine both supply-related factors and demand-related factors affecting the utilization of non-medical community healthcare services among elderly Chinese.

Internet and Health Information Technology Use and Psychological Distress Among Older Adults With Self-Reported Vision Impairment: Case-Control Study

BACKGROUND

The number of older adults with vision impairment (VI) is growing. As health care services increasingly call for patients to use technology, it is important to examine internet/health information technology (HIT) use among older adults with VI.

OBJECTIVE

This study aimed to examine (1) the rates of internet/HIT use among older adults with VI compared with a matched sample of their peers without VI, (2) associations of VI with internet/HIT use, and (3) association of HIT use with psychological distress, assessed with the Kessler-6 screen.

METHODS

Data were obtained from the 2013 to 2018 US National Health Interview Survey. Older adults (aged ≥65 years) with self-reported VI were matched with older adults without VI, in a 1:1 ratio, based on age, sex, number of chronic medical conditions, and functional limitations (N=2866). Descriptive statistics and multivariable logistic regression models, with sociodemographic factors, health conditions, health insurance type, and health care service use as covariates, were used to examine the research questions.

RESULTS

In total, 3.28% of older adults (compared with 0.84% of those aged 18-64 years) reported VI, and 25.7% of them were aged ≥85 years. Those with VI were significantly more socioeconomically disadvantaged than those without VI and less likely to use the internet (adjusted odds ratio [aOR] 0.64, 95% CI0.49-0.83) and HIT (aOR 0.74, 95% CI 0.56-0.97). However, among internet users, VI was not associated with HIT use. HIT use was associated with lower odds of mild/moderate or serious psychological distress (aOR 0.62, 95% CI 0.43-0.90), whereas VI was associated with greater odds of mild/moderate or serious distress (aOR 1.84, 95% CI 1.36-2.49). Health care provider contacts were also associated with higher odds of internet or HIT use.

CONCLUSIONS

Compared with their matched age peers without VI, older adults with VI are less likely to use HIT because they are less likely to use the internet. Socioeconomically disadvantaged older adults experiencing a digital divide need help to access information and communication technologies through a fee waiver or subsidy to cover internet equipment and subscription and ensure continuous connectivity. Older adults with VI who do not know how to use the internet/HIT but want to learn should be provided instruction, with special attention to accessibility features and adaptive devices. Older adults with a low income also need better access to preventive eye care and treatment of VI as well as other health care services.

Expansion of Parson's sick role into cyberspace: Patient information consumerism and subjective health in a representative sample of U.S. internet users

The self-help culture, in the context of the U.S. medical system, demands proactive patient behavior as more responsibility for good health falls on the patient. The presence of health/medical information online alters the dynamics of medical encounters and transforms patients into reflexive consumers or consumer-patients who are engaged in personal health management. This paper examined whether using health information obtained from the Internet to manage personal health care (referred as e-health information consumerism) is associated with subjectively reported negative health outcomes in a representative sample of Internet users in the U.S. These outcomes are conceptualized as experiencing (a) adverse affect (feeling worried and anxious) and (b) health problem due to using Internet information. An online survey (n = 710) was conducted with study participants who were recruited from the largest online probability U.S. research panel developed by a non-profit academic research firm, Knowledge Networks. Analyses included multivariate regressions that included the statistical interactions between e-health information consumerism and the communicational and interactional aspects of medical encounters. Parallel models were tested in the gender-stratified subsamples. Results indicate that robust associations exist between e-health information consumerism and patient-reported health outcomes. Respondents who indicated greater satisfaction with medical communication reported lower averages on experiencing worry and a health problem due to e-health information consumerism. While e-health information consumerism is significantly associated with experiencing a self-reported health problem in both men and women, the association with adverse affect is significant only among women. The moderating role of patient satisfaction with medical communication is stronger among women. Interestingly, the moderating role of patient satisfaction with a medical interaction is stronger among respondents who reported higher averages on experiencing a health problem due to e-health information consumerism. e-Health information consumerism can translate into health benefits if the Internet information is deployed to promote a satisfactory medical partnership.

Exploring Older Adults' Beliefs About the Use of Intelligent Assistants for Consumer Health Information Management: A Participatory Design Study

BACKGROUND

Intelligent assistants (IAs), also known as intelligent agents, use artificial intelligence to help users achieve a goal or complete a task. IAs represent a potential solution for providing older adults with individualized assistance at home, for example, to reduce social isolation, serve as memory aids, or help with disease management. However, to design IAs for health that are beneficial and accepted by older adults, it is important to understand their beliefs about IAs, how they would like to interact with IAs for consumer health, and how they desire to integrate IAs into their homes.

OBJECTIVE

We explore older adults' mental models and beliefs about IAs, the tasks they want IAs to support, and how they would like to interact with IAs for consumer health. For the purpose of this study, we focus on IAs in the context of consumer health information management and search.

METHODS

We present findings from an exploratory, qualitative study that investigated older adults' perspectives of IAs that aid with consumer health information search and management tasks. Eighteen older adults participated in a multiphase, participatory design workshop in which we engaged them in discussion, brainstorming, and design activities that helped us identify their current challenges managing and finding health information at home. We also explored their beliefs and ideas for an IA to assist them with consumer health tasks. We used participatory design activities to identify areas in which they felt IAs might be useful, but also to uncover the reasoning behind the ideas they presented. Discussions were audio-recorded and later transcribed. We compiled design artifacts collected during the study to supplement researcher transcripts and notes. Thematic analysis was used to analyze data.

RESULTS

We found that participants saw IAs as potentially useful for providing recommendations, facilitating collaboration between themselves and other caregivers, and for alerts of serious illness. However, they also desired familiar and natural interactions with IAs (eg, using voice) that could, if need be, provide fluid and unconstrained interactions, reason about their symptoms, and provide information or advice. Other participants discussed the need for flexible IAs that could be used by those with low technical resources or skills.

CONCLUSIONS

From our findings, we present a discussion of three key components of participants' mental models, including the people, behaviors, and interactions they described that were important for IAs for consumer health information management and seeking. We then discuss the role of access, transparency, caregivers, and autonomy in design for addressing participants' concerns about privacy and trust as well as its role in assisting others that may interact with an IA on the older adults' behalf.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1145/3240925.3240972.

Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions

Background

Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective

The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions.

Methods

The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years.

Results

The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users.

Conclusions

Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources.

Which factors lead to frequent attendance in the outpatient sector among individuals in the second half of life? Evidence from a population-based longitudinal study in Germany

BACKGROUND

Despite only constituting a small percentage of the population, frequent attenders place a tremendous burden on the healthcare system in Germany. Whilst there are some cross-sectional studies that examine the correlates of frequent attendance among older adults, there are only a few longitudinal studies that analyze the factors that lead to frequent attendance among middle-aged or older adults. Thus, the aim of this study was to investigate the factors leading to frequent attendance in the outpatient sector longitudinally.

METHODS

Data was drawn from three waves of a large, population-based sample of community-dwelling individuals aged 40 and above in Germany (n = 1049 in fixed effects regression). Individuals were classified as frequent attenders (GP visits) if they had, on average, visited a GP every second month in the previous 12 months. The same logic was applied for specialist visits.

RESULTS

Conditional FE logistic regressions showed that the onset of frequent attendance (GP visits) was negatively associated with age [OR: 0.91, 95% CI: 0.87-0.95], a change in employment status from employed to unemployed [OR: 2.26, 1.17-4.39], decreases in physical functioning [OR: 0.98, 0.97-0.99], worsening self-rated health [OR: 1.40, 1.11-1.78], and increases in physical illnesses [OR: 1.18, 1.06-1.32]. Similarly, the onset of frequent attendance (specialist visits) was associated with age [OR: 0.95, 0.92-0.98], decreases in physical functioning [OR: 0.99, 0.98-1.00], worsening self-rated health [OR: 1.50, 1.25-1.79], and increases in physical illnesses [OR: 1.24, 1.13-1.35].

CONCLUSIONS

Need factors in particular were associated with the onset of frequent attendance. This relation did not vary by gender nor education, which may indicate that individuals only start to use health services more frequently when their needs increase.