Abstract
BackgroundPrimary care in the United States and most countries in Asia are provided by a variety of doctors. However, effectiveness of such diversified primary care in gate-keeping secondary medical services is unknown. This study aimed to evaluate health services utilization rates of hospital emergency and admission services among people who used different primary care doctors in Hong Kong.MethodThis study was a population-based cross-sectional telephone survey using structured questionnaire on health services utilization rates and pattern in Hong Kong in 2007 to 2008. Information on the choice of primary care doctors, utilization rates and patterns of primary care service were collected. Poisson and logistic regression analyses were used to explore any differences in service utilization rates and patterns among people using different types of primary care doctors.ResultsOut of 3148 subjects who completed the survey, 1896 (60.2%) had regular primary care doctors, of whom 1150 (60.7%) regarded their regular doctors as their family doctors (RFD). 1157 (36.8%) of them did not use any regular doctors (NRD). Only 4.3% of the RFD group (vs 7.8% of other regular doctors (ORD) and 9.6% of NRD) visited emergency service and only 1.7% (vs 3.6% of ORD and 4.0% of NRD) were admitted to hospital for their last episode of illness. Regression analyses controlling for sociodemographics and health status confirmed that respondents having RFD were less likely to use emergency service than people who had NRD (OR 0.479) or ORD (OR 0.624) or being admitted to hospital (OR 0.458 vs NRD and 0.514 vs ORD) for their last episode of illness.ConclusionPrimary care is the most effective in gate-keeping secondary care among people with regular family doctors. People without any regular primary care doctor were more likely to use emergency service as primary care. The findings supported a family doctor-led primary care model.Trial registration numberClinicalTrials.gov ID: NCT01422031.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0705-7) contains supplementary material, which is available to authorized users.
Highlights
Primary care in the United States and most countries in Asia are provided by a variety of doctors
Regression analyses controlling for sociodemographics and health status confirmed that respondents having regular doctors as their family doctors (RFD) were less likely to use emergency service than people who had not use any regular doctors (NRD) or Other Regular Doctor group” (ORD) or being admitted to hospital for their last episode of illness
The remaining 106 subjects (8.4%) who said they had a family doctor but their family doctors were not their regular primary care doctors were excluded from analysis for our study purpose because these subjects did not fit into any of our pre-set three subject groups
Summary
Primary care in the United States and most countries in Asia are provided by a variety of doctors. This study aimed to evaluate health services utilization rates of hospital emergency and admission services among people who used different primary care doctors in Hong Kong. Like the United States, primary care in many countries in Asia is provided by a variety of Western and Chinese medicine practitioners. Fung et al BMC Health Services Research (2015) 15:42 doctor in the community, some people in Hong Kong use emergency service of the hospital as the main provider of primary care for various reasons [21]. No known research has been done to investigate the effectiveness in safeguarding the utilization rates of other health care service by this kind of pluralistic primary care service, and how having a family doctor makes any difference
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