Abstract
BackgroundFrequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire population covered by a universal health system.MethodsUsing a linkage of administrative databases, we conducted a population-based cohort study of all adults in Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in the total population during the 2014–15 fiscal year. We used ajusted logistic regressions to model the association between frequent use of health services and multimorbidity, depending on socioeconomic status.ResultsFrequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency departments and general practitioners. Socioeconomic status modified the association between multimorbidity and frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general practitioner.ConclusionEven in a universal healthcare system, the gap between socioeconomic groups widens as a function of multimorbidity with regard to visits to the specialist physicians. Further studies are needed to better understand the differential use of specialized care by the most deprived individuals.
Highlights
Frequent healthcare users place a significant burden on health systems
While it is well known that a low socioeconomic status (SES) is associated with a greater use of emergency departments (ED) and general practitioners (GP) whereas a high SES is associated with a greater use of specialized physicians (SP) [11, 21], our findings demonstrate that the least deprived individuals are more likely to be frequent users of ambulatory care services
We showed that the proportion of visits to each category of services increased with the number of medical conditions [19, 34,35,36]
Summary
Frequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). Multimorbidity is often managed with an inappropriate use of healthcare services, reflected in fragmented and less efficient care leading to higher costs for health care systems [5]. Multimorbid individuals make a greater use of primary care services such as general practitioners (GP) and emergency departments (ED). They visit specialized physicians (SP) more often and have more frequent unplanned hospital admissions [3, 6]
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