Ecology Of Medical Care Research Articles

The ecology of medical care in Korea: the association of a regular doctor and medical care utilization

BackgroundsThere is no registered regular doctor system in Korea, but people voluntarily select regular doctors for medical services. This study aims to study the ecology of medical care in Korea according to the presence and type of a regular doctor.MethodsThis study was conducted using Korean Health Panel survey in 2018. The proportion of people who had health problems and received medical care in various settings was analyzed per 1,000 people according to the following groups: without a regular doctor, having a clinic physician as a regular doctor, and having a hospital physician as a regular doctor. The adjusted odds ratio for usage of medical services was calculated.ResultsHealth problems and medical care use increased in the groups in this order: group without a regular doctor, group with a clinic physician as a regular doctor, the group with a hospital physician a regular doctor. Having a hospital physician as a regular doctor was associated with higher odds of inpatient care and emergency room visits, and having a clinic physician as a regular doctor was not associated with odds of inpatient care and emergency room visits when adjusting demographic and health-related variables.ConclusionDepending on whether having a regular doctor and a regular doctor’s type, different ecology of medical care was observed. The position and role of a regular doctor in the context of the Korea health care system should be considered from the perspective of primary care.

The ecology of medical care in Shanghai

BackgroundTo better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai.MethodsThe data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence.ResultsThis paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery.ConclusionsAge is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.

Cardiovascular health in China: Low level vs high diversity

Cardiovascular health in China: Low level vs high diversity

The ecology of medical care in Switzerland: prevalence of illness in the community and healthcare utilisation in Switzerland.

The allocation and equal distribution of healthcare resources is one of the major challenges of today. Therefore, a framework to analyse the prevalence of illness in the community and the use of various sources of healthcare is crucial. The aim of the study was to evaluate the health-seeking behaviour of 1025 individuals in Switzerland in a 2-month period in 2018. Population-based, cross-sectional health survey with a multistage, stratified cluster design. The LINK Institute (Luzern, Switzerland, https://www.link.ch/) interviewed a representative sample of the adult Swiss population (age ≥18 years, stratified by language region: German-, French- and Italian-speaking, 70, 25 and 5%, respectively) by telephone. There were two interview rounds to account for potential seasonal variations, in May (n = 506) and November 2018 (n = 516). The health-seeking behaviour of these individuals during the previous 2 months was analysed. In total, data of 1025 individuals were analysed: 51% females, median age 52 years (range 1885). During the preceding 2 months, per 1000 adults, 546 had at least one symptom, 184 reported several symptoms, 243 sought medical advice, 164 first contacted their general practitioner, 81 directly contacted a specialist in a private practice, 16 were self-admitted to an accident and emergency department, 17 firstly contacted a pharmacy and 6 contacted an alternative medicine healthcare provider. In total, 21 persons were admitted to a hospital, of whom 8 underwent surgical procedures, 18 were at first transferred to a regular ward and 3 required intensive care unit services. Because of their current health problem, 387 individuals took medication and 259 bought their medication themselves. The vast majority (95%) of subjects was registered with a general practitioner. This study represented an attempt to map the healthcare utilisation of the Swiss population. These results may be useful for further delineation of healthcare policies and medical education to meet the demand and needs of people in Switzerland. They indicate that general practitioners are the most important healthcare resource in Switzerland. Compared with specialists, they provide twice as much health advice at less costs. To optimise the health care system in Switzerland, we suggest to allocate resources where they are most needed.

The ecology of medical care for adults in Alberta, 2002/03 to 2016/17: a retrospective cohort study.

If we are to improve the patient experience, knowing where and with whom people receive professional health advice and treatment (the ecology of medical care) is the first step. We designed this study to define the ecology of medical care in Alberta and to examine whether province-wide implementation of 5 policy changes between 2003 and 2012 changed patterns of care among adults in the province. This was a retrospective cohort study of adults (age ≥ 18 yr) in Alberta using routinely collected data from 6 linked administrative health databases, the 2016 Canadian Community Health Survey and the Alberta Health Link teletriage system. We collected data on all encounters with pharmacists, primary care physicians, specialists, emergency departments and hospitals in 2002/03, 2009/10 and 2016/17. Between 2002/03 and 2016/17, the community-dwelling adult population of Alberta increased from 2.66 million to 3.84 million; the median age increased from 41 to 43 years, and the proportion with at least 1 ambulatory-care-sensitive condition increased from 20.6% to 27.8%. The proportion who saw a primary care physician decreased significantly (from 70.8% to 68.2%, p < 0.001), as did the proportion who visited an emergency department (from 20.6% to 19.2%, p < 0.001); the declines were seen in all subgroups examined. The proportion who saw a specialist as an outpatient increased from 31.9% to 33.2% (p < 0.001), and the proportion who received at least 1 medication dispensation increased from 54.9% to 60.2% (p < 0.001). The proportion admitted to an acute care hospital (5.6%-6.5%) or academic hospital (1.2%) was relatively stable over time. Despite implementation of 5 system-wide changes designed to affect the delivery of primary and specialty medical care as well as the use of pharmacist and nursing services in Alberta, patterns of health care delivery changed little between 2002/03 and 2016/17. Rather than searching for a policy "magic bullet," health care planners may be better served by focusing on upscaling and implementing interventions proven to be efficacious.

The ecology of medical care: access points to the health care system in Austria and other developed countries

Objective: This study aimed to analyze the Austrian health care system using the ecology of care model. Our secondary aim was to compare data from Austria with those available from other countries.Design: 3508 interviews employing a 30-item questionnaire related to the utilization of the health care system including demographic factors were conducted. Participants were chosen by a Random Digital Dialing procedure. Further, a literature review of studies of other countries use of the ecology of care model was conducted.Main outcome measures: Austria has one of the highest utilization of health care services in any of the assessed categories. The comparison with the literature review shows that Austria has the highest utilization of specialists working in the outpatient sector as well as the highest hospitalization rates. Taiwan and Korea have comparable utilization patterns. Canada, Sweden, and Norway are countries with lower utilization patterns, and the U.S. and Japan are intermediate.Conclusion: In Austria and similarly organized countries, high utilization of all health care services can be observed, in particular, the utilization of specialists and hospitalizations. The over-utilization of all levels of health care in Austria may be due to the lack of a clear demarcation line between the primary and secondary levels of care, and the presence of universal health coverage, which also allows for unrestricted and undirected access to all levels of care. Previous studies have shown that comparable countries lack the health benefits of a strong primary care system with its coordination function.Key pointsIn Austria and similarly organized countries, there appears to be high utilization of health care in general, as well as with particular utilization of specialists and hospitalizations.The high utilization of all levels of care in Austria may be the result of competition, lack of a clear demarcation line between the primary and secondary level of care, and the presence of universal health coverage.Pathways between primary and secondary care should be strengthened as previous studies have shown that comparable countries lack the health benefits of strong primary care and its function for health care coordination.

Reassessing the Ecology of Medical Care in Japan

Studies on ecology of medical care can provide valuable information on how people seek healthcare in a specific geographic area. The objective of this study was to update a 2003 report on the ecology of medical care in Japan, identifying relevant changes in healthcare patterns. We collected information based on a prospective health diary recorded for a month in 2013 (n = 4548; 3787 adults and 797 children) using a population-weighted random sample from a nationally representative panel. We compared our overall and stratified findings with a similar study conducted in 2003. During a one-month period, per 1000 adults and children living in Japan, we estimated that 794 report at least one symptom, 447 use an over-the-counter (OTC) drug, 265 visit a physician's office, 117 seek help from a professional provider of complementary or alternative medicine (CAM), 70 visit a hospital outpatient clinic (60 community-based and 10 university-based), 6 are hospitalized, and 4 visit a hospital emergency department. After adjusting for demographic variables, we found that healthcare seeking behaviors were influenced by age, gender and area of living. Compared with the 2003 study, participants in this study had fewer symptoms, fewer physician and emergency room visits, and less OTC use, but reported higher frequency of CAM use (p < .01 for all). Compared with 2003, reported symptoms, physician visits and OTC use has decreased, while CAM use has increased. Our findings may be useful to policymakers in Japan in a context where healthcare expenditure and a rapidly aging population are two challenging issues.

The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study

BackgroundWe aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island’s primary care clinic through comparison with a previous nationwide survey.MethodsWe conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island’s clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003.ResultsIheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0–369.7). Of these, 18.4 (16.3–20.5) were referred off-island, with 4.1 (3.1–5.1) referrals to emergency departments and 3.6 (2.6–4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study.ConclusionsThis suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting.

The Ecology of Medical Care Among Israeli Military Aviators.

The ecology of medical care model has been used in various populations with varying results. We aimed to apply this model in the population of Israeli Air Force (IAF) aviators. An anonymous questionnaire was presented to all Israeli Air Force aviators during their mandatory yearly check-up over 1 yr starting on November 26th, 2012. The questionnaire contained items on demographic, personal, and military details, as well as items on the presence of clinical symptoms, and various health care contacts in the previous month. We assessed the differences between career and reserve personnel using a X2 test. There were 325 aviators who completed the questionnaire (2 women, 132 reserves). Clinical symptoms were reported by 62.5% of the responders. Over half (52.6%) had any health care encounter: 23.7% with a dentist, 17.9% with non-MD therapists, 12.6% with a specialist, and 11.7% with a primary physician. A significant difference between reserve and career personnel was found only in primary care visits. Out of the aviators who reported having clinical symptoms, 70.9% did not visit a physician. Of those who did not seek medical care, 42.4% reported that the symptoms were viewed as unimportant, 41% thought they would disappear by themselves, 40.3% could not find time for treatment. Aviators in the IAF have similar rate of clinical symptoms as in other unselected populations. Those who report symptoms usually do not visit a physician for treatment. When they do seek advice it is mostly from non-MD practitioners.Gordon B, Levy Y, Yemini T, Carmon E, Erlich Y, Hermoni D. The ecology of medical care among Israeli military aviators. Aerosp Med Hum Perform. 2016; 87(12):1036-1040.

Person Centered Primary Heath Care: The Role and Positionof the Family Physician-Generalist and Implications for Research

Aim. This paper analyses how the role and function of family physicians in primary health care relates to person centeredness. Method. Based on the model of the Ecology of Medical Care the interaction of individuals with health care has been deduced and from this were identified main implications for the provision of care. Results. Individuals experience a large variety of health problems over time, of which only a minority is presented to health care professionals, with care in the direct vicinity (community) the most likely place of contact. From this, common health problems and their prognosis, self-care and autonomy, reasons for contact, multi-morbidity and community related social determinants of health define the conditions to provide health care for all health problems in all individuals.Discussion and Conclusions. The variety of health problems presented over time for individual-specific expectations, make the person with the health problem the self-evident focus of care. The person-centered approach serves to relate the patient’s agenda to professional considerations of the nature and prognosis of the health problem identified and the risks and benefits of treatment. From this, the importance can be established of continuity of care, shared decision making, individual prognostication and ascertaining individual risks from community-specific determinants of health. Priorities of research are to come to a better understanding of the mechanisms of continuity of care and the building of professional relations of trust. Other priorities of research are to strengthen the knowledge base of diagnosis, prognostication and interventions of frequent health problems in the community.

Blending Community and Big Hospital Experiences for Residents-Does It Add Value?

My first visit to North America was last century when I was a youngish family physician on sabbatical in Canada. I spent a wonderful year reading and thinking about education. One of the articles I read was the interesting study on the ecology of medical care by White and colleagues,1 which told us what we all suspected, that most patient interactions with the health care system did not happen in the hospital. During that sabbatical, my Canadian colleagues reminded me that “you can't teach forestry in the lumber yard.” This metaphor was somewhat lost on me, coming from Scotland, where centuries of felling, burning, and overgrazing had reduced the native forest to a few forlorn fragments. This metaphor makes more sense now that I live in British Columbia near pulp and saw mills and surrounded by forest. During this time we taught medical students and residents primarily in the hospital and in tertiary care settings—tantamount to the lumberyard in our analogy—which meant they were largely missing experiences in the community settings, where illness arises and is often managed, and from where some patients are sent to the tertiary institutions, often for very specific services. Even though the study of White and colleagues1 was conducted more than 50 years ago, it was repeated by Green et al2 more recently with similar results. If I ask myself whether things have changed much with respect to how and where we train our future physicians, my thoughts would be “maybe, a bit.”

The Ecology of Medical Care in Japan Revisited.

The Ecology of Medical Care in Japan Revisited.

PHP44 - The Ecology of Medical Care in Poor Settings: Self Reported Health Care Utilization in Santiago Del Estero, Argentina

Health services utilization in poor provinces in Argentina is poorly known, due to data poor environments. We utilized a population based health care survey to analyzed the ecology of medical care, and to estimate self reported health care services utilization (SRHCU) patterns among adults (≥18 years old). A health Survey was performed, with probabilistic, stratified, polyetapic sampling, adding health utilization questions to the National Risk Factor Survey of Argentina (ENFR 2009) questionnaire. We obtained SRHCU stratified as ambulatory visits, emergency, hospitalizations, stratified into age, sex, rural, urban, health status and prior health problem. Analysis was performed with SPSS 17, 95%CI for single proportions was obtained. Among 2064 persons that responded de survey, 78,9% were urban-21,1% rural, 41,2% males, mean age was 39,9% (SD 15,8) years old, age range 18-93. The General Health Status was regular or bad (16,08%) (95%CI 14,5-17,7%). Likert scale of health status provided Mean = 86,65 (SD 104,35); Median 80 (25P =70; 75P =90). Acute illness events in prior 4 weeks occurred in 24,8% (95%CI 22,9-26,7%). 70,4% had an ambulatory visit in the prior 6 months (95%CI 68,4-72,4%), while, in prior month 17,0% (95%CI 15,4-18,7%) consulted a physician office [generalist 10,36% (95%CI 9,1-11,7%) and 6,7% specialist (95%CI 5,6-7,8%)]. Office visits rate was 261 per 100 persons per year [increased with age 65+ (305), regular or bad health (458), and rurality (289), decreased for males (197)]. Emergency visits occurred in 106 persons (5,1%) (95%CI 4,18-6,09%); Hospitalization was 10,6% during prior year (95%CI 9,3-11,9%), 78% admitted once and 20% readmitted to the hospital in the same period. Results provide an estimate of SRHCU data, and show lower ambulatory and emergency visit rates, while hospitalization admissions and readmissions is similar to other ecology of medical care studies in other areas of the world.

The Ecology of Medical Care in Norway: Wide Use of General Practitioners may not Necessarily Keep Patients out of Hospitals.

BackgroundOur aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway.Design and MethodsWith data from the cross-sectional Tromsø Study (2007-8), we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender.ResultsIn this study 12,982 persons aged 30-87 years participated, constituting 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers.ConclusionsAlmost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.Acknowledgmentsthe authors would like to thank Tor Anvik for a significant contribution in developing the idea for the study, Tom Wilsgård for useful discussions about the statistical analyses and Jarl-Stian Olsen for graphic design of the figures. They would also thank the people of Tromsø and The Tromsø Study for giving data to this study. Northern Norway Regional Health Authority and The University of Tromsø funded this research.

The ecology of medical care in Taiwan

Background In regular administrative statistics for medical services, utilization data are usually presented as aggregate data and lack an individual perspective. The aim of this study was to provide an overview of medical care utilization in Taiwan using a long-established analytical framework, the so-called ecology model. Methods Claims data for a cohort of one million people from the National Health Insurance (NHI) Research Database were used to estimate the yearly and monthly prevalence of health care utilization in Taiwan in 2005. Analyses were extended to different types of healthcare settings and were stratified by age and sex. Results are presented per 1000 of the population. Results Per 1000 people, 74 did not utilize any NHI services during the year. In a month, 503 people on average utilized at least once NHI service of any kind, 329 visited a physician’s clinic (Western medicine), 152 visited a hospital-based outpatient clinic, 19 visited an emergency department, 10 were hospitalized and 3 were hospitalized in an academic medical center. Women were more likely to utilize NHI services than men (274/504 vs. 229/496 in a month). In a month on average, 40.3% (146/362) of young people, 52.2% (166/318) of middle-aged people, 53.3% (121/227) of children and 75.0% (70/93) of elderly people utilized NHI services. Over the whole year, 22.0% (21/93) of elderly people were hospitalized and nearly one-third of them were hospitalized in academic medical centers. Conclusion People in Taiwan utilized NHI services frequently and tended to seek medical help in hospitals. Although these features might reflect the higher availability and accessibility of medical care within the NHI in Taiwan, the possibility of overuse deserves further attention.

Ecology of medical care in a publicly funded health care system: A registry study in Sweden

Objective. To explore the influence of sociodemographic factors on access to appointments with physicians in primary, secondary, and tertiary health care in a publicly funded health care system. Design. A population-based registry study. Setting. Different health care settings in Västernorrland county, Sweden. Subjects. All residents in the county at the end of 2006. Main outcome measures. The number of people per 1000 residents who had at least one appointment with a physician in an average month in different health care settings. Results. A total of 87 people had appointments with a physician in primary health care, 44 in outpatient clinics at a regional hospital, 20 in an emergency department, 14 in home care, and two in a university hospital outpatient clinic. Twelve were hospitalized at a regional hospital and <1 at the university hospital. Being young or elderly, female, divorced, widowed, and having a contractor as usual source of care were all independently associated with higher odds of receiving primary care. Conclusions. The physician's office in primary care is the setting that has the potential to affect the largest number of people. The extent of the use of health care was independently influenced by all sociodemographic characteristics studied, which highlights the importance of individual factors in future resource allocation. Regarding availability the ecology model provides superior information as compared with the absolute number of physicians' appointments. The prerequisites in Sweden of high-quality registries and unique personal identification numbers encourage future research on the ecology model to optimize accessibility of health care.

Hospitalizations in a southern rural community: an application of the 'ecology model'.

The purpose of this study is to re-examine the concepts of health services utilization presented by White and his colleagues in 'The Ecology of Medical Care'. We re-test their model in a rural population in the southern United States using longitudinal instead of cross-sectional data and find that the general principles of the 'Ecology' model do, indeed, apply to rural populations like Rougemont/Bahama. Use of this model has implications for modifying and improving the organization of the health care delivery system and for a fundamental change of emphasis in medical education.

The ecology of medical care.

CURRENT discussions about medical care appear largely concerned with two questions: Is the burgeoning harvest of new knowledge fostered by immense public investment in medical research being delive...