Association of time elapsed since the last coronary event with health services utilization

Abstract

Patients with chronic illness use health services more often but little is known about the use that coronary heart disease patients make of primary care. To determine whether the time elapsed and the perceived quality of life following a major acute coronary event are associated with utilization rate of primary care services. Cross-sectional, multicentre study. Twenty-three primary care health centres in Catalonia (Spain). Patients aged 30-80 years who had suffered a major coronary event in the previous 6 years. The number of consultations with the general practitioner during the year before the beginning of the study was noted and patients who consulted nine or more times were considered frequent attenders. The time elapsed since the last major coronary event was categorized using the median (2 years) as a cut-off value. The SF-12 quality of life questionnaire was administered. A total of 1022 patients with coronary heart disease were included. The median number of consultations with a general practitioner within the previous year was 5 (range 0 - 36). Patients with a shorter time elapsed since the last coronary event were seen more often by their general practitioner. The probability of being frequent attender was 24% Iower among patients with less recent coronary events (adjusted odds ratio: 0.76, 95% confidence interval: 0.69 - 0.85, p < 0.001). Quality of life scores were similar in frequent and non-frequent attenders. No relationship between comorbidity and frequent attendance was found. The shorter time elapsed since the last coronary event was an important factor related with frequent attendance in coronary heart disease patients regardless of cardiovascular comorbidity, and perceived quality of life.