Model Of Health Services Utilization Research Articles

Utilization of Public Long-Term Care Services and Burden Alleviation of Service Recipients and Their Families: Home Care and Institutional Care for Older Adults in South Korea

South Korea launched national long-term care insurance in 2008, and about one in ten older adults currently receives public long-term care (LTC) services. However, little research using nationally representative data has examined the factors related to LTC services and burden alleviation. Using Andersen’s health service utilization model, this study aims to explore the factors associated with the utilization of LTC services (i.e., home care services and institutional care services) in South Korea. Further, the alleviation of the burden (i.e., emotional, financial, and physical) among the service recipients and their family members are studied. We performed logistic regressions using national data: the 2019 Long-Term Care Survey (N=3,601). The results showed that living in urban areas and having fewer mobility limitations were associated with higher emotional and physical burden alleviation of home care service users. Moreover, living in urban and having longer geographic distances from the families were associated with more elevated financial burden alleviation. In terms of institutional care services, when the service recipient had fewer children, more chronic diseases, and lived in urban areas, the financial burden alleviation was higher. Based on the findings, we discussed the policy implications of the factors related to service utilization which varied by service and burden types.

Health Need Factors Are the Key Drivers of Hospitalization among the Elderly Living Alone: An Analysis of Longitudinal Data.

Elderly people living alone are a large and growing proportion of the population of many developed economies. The elderly, particularly those living alone, are more likely to be hospitalized overnight, with consequent substantial health and financial costs. A widely used model of health service utilization is augmented with social issues that may specifically delineate some of the issues associated with living alone. A longitudinal survey of elderly (aged 65 and over) living alone in Australia with three time points over four years was analyzed using logistic regressions for overnight hospitalization. The main set of data (n = 672) had an average age of 75.91 years and was 70.2% female. The health need factors of self-rated general health and illness severity, along with comorbidity, were the key drivers of hospitalization. There were some individuals with prioritized access to hospitalization due to forms of health funding. The social issues did not independently stand out as drivers of overnight hospitalization, but the complexity of the inter-relationships between issues when studying the health of the elderly began to arise. The results enhance our understanding of health services utilization, within the context of a relatively universal health care system.

Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study

ObjectivePatient delay was defined as an interval between the discovery of the initial symptoms and diagnosis, which was longer than 90 days. This study aimed to determine the patient delay rate and related factors in women with cervical cancer in Hunan province, South-Central China. MethodsA cross-sectional study was conducted among 140 women with cervical cancer aged < 35 years from October, 2019 to March, 2021. Assumptions in Andersen Behavioral Model of Health Services Utilization were used to measure the factors influencing patient delay. Logistic regression models were used to identify factors associated with patient delay. A P-value of < 5% was considered significant. ResultsA total of 57 (40.71%) young women with cervical cancer had patient delay, and the median delay time was 134 (90-375) days. Predisposing factors, such as religion, unemployment, health beliefs related to cancer screening, and a history of cervical cancer screening within 2 years or more (P ​< ​0.05), were associated with patient delay. Enabling factors, such as distance to the nearest medical facility and type of the nearest medical facility, were associated with a reduced likelihood of patient delay. With the need-for-care factor, young women who experienced vaginal pain after or during intercourse had a higher risk (adjusted odds ratio, 33.48; 95% confidence interval, 3.22–348.68, P ​= ​0.003) of patient delay. ConclusionsThese findings reinforce the need for programs to enhance knowledge and awareness about cervical cancer screening and the importance of early diagnosis in women to help eliminate cervical cancer in China by 2050.

Behavioral Risk Factor and Primary Healthcare Utilization in South Africa.

(1) Background: An effective and efficient primary healthcare service is one of the reforms designed to achieve universal healthcare coverage. The success of the reform however depends on the ability to identify factors that could undermine through avoidable use, the effectiveness of various deployed scarce resources. The prevalence of unhealthy lifestyle risk factors that have been identified as a critical public health issue, which stimulate vulnerability and mortality through the development of non-communicable diseases, also have implications for government health spending through healthcare utilization. (2) Objective: This study aims to investigate the effect of behavioral risk factors on primary healthcare utilization in South Africa. (3) Methods: Using the NIDS wave 4 data set and a binary logistic estimation technique, the study is premised on a modified Anderson model of health service utilization. (4) Results: The binary logistic regression estimation results clearly show the intercepting effect of smoking in public primary healthcare utilization. Equally, the effect of these lifestyle behavior risk factors on public PHC is evident in urban communities. (5) Conclusion: This study suggests that there is a need to intensify awareness on the health effect of smoking; strengthen and broaden law that bans smoking; and introduce the screening of smoking patients for recurring counselling sessions and intervention at primary healthcare facilities in the country's urban communities.

고혈압 환자의 미충족 의료 관련 요인

Objectives This study was conducted to examine the prevalence of unmet healthcare needs and to identify related factors in adults with hypertension. Methods This study was performed using the data from the eighth Korea National Health and Nutrition Examination Survey 2019. The participants included 1,416 people over the age of 19 with hypertension. The data was analyzed by logistic regression analysis using complex samples based on Andersen’s model of health services utilization. Results Unmet healthcare needs were experienced by 9.0% of adults with hypertension. The factors associated unmet healthcare needs of adults with hypertension were living alone, activity limitation, lower perceived health status, and lower health-related quality of life. Conclusions In order to effectively manage the symptoms and diseases of adults with hypertension, it is important to use the health service when it is needed. In particular, the development of education and intervention to prevent unmet healthcare needs should consider need factors.

Psychological distress, structural barriers, and health services utilization among U.S. adults: National Health interview survey, 2011–2017

Undertreatment of mental illness is associated with greater acute care and costs and worse mental and physical outcomes. Structural barriers may contribute to worse care. National Health Interview Survey data for 2011–2017 were used to examine associations of psychological distress and nine structural barriers with four health services, guided by the Andersen Behavioral Model of Health Services Utilization. Per the Kessler-6 Scale, United States adults 18–64 years of age (sample size = 172,209, estimated annual population = 189.4 million) were categorized as: no or low psychological distress (NLPD: 79.2%), moderate (MPD: 17.1%), and serious (SPD: 3.7%). Those with MPD and SPD had higher likelihoods of any mental health visit (Adjusted Odds Ratio: 3.53; 8.36, respectively), hospitalization (AOR: 1.16; 1.55), emergency room/department visit (AOR: 1.62; 2.23), and lower likelihood of office visits (AOR: 0.42; 0.64) in the past 12 months compared to NLPD (all p < 0.001). Psychological distress was the largest contributor of explained variation for mental health visits (67%), hospitalization (37%), and ER/ED usage (47%). Adults with SPD and MPD faced structural barriers at higher proportions. For example, reports of “had trouble finding general doctor” were: NLPD (2.2%), MPD (6.0%), and SPD (11.8%). Eight structural barriers were positively associated with ER/ED use and five barriers negatively associated with office visits. Barriers significantly associated with all four outcomes were: “Told health care coverage not accepted” and “Delayed care, couldn’t get appointment soon.” Innovative policy solutions coupled with comparable innovations in care delivery for complex patient populations could ensure equitable access to health services for individuals with psychological distress.

'They can stigmatize you': a qualitative assessment of the influence of school factors on engagement in care and medication adherence among adolescents with HIV in Western Kenya.

School-related factors may influence retention in care and adherence to antiretroviral therapy (ART) among adolescents with human immunodeficiency virus (HIV). We analyzed data from in-depth interviews with 40 adolescents with HIV (aged 14 -19 years), 40 caregivers of adolescents with HIV, and 4 focus group discussions with healthcare workers to evaluate contextual factors affecting adherence to ART and clinic attendance among adolescents, with a focus on the school environment. Informed by Anderson's Model of Health Services Utilization, transcripts were systematically coded and synthesized to identify school-related themes. All groups identified the school environment as a critical barrier to engagement in HIV care and medication adherence for adolescents with HIV. Adolescent participants reported inflexible school schedules and disclosure to school staff as the biggest challenges adhering to clinic appointments and ART. Adolescents described experiencing stigma and discrimination by peers and school staff and would adjust when, where and how often they took ART to avoid inadvertent disclosure. Boarding school students faced challenges because they had limited private space or time. Caregivers were often instrumental in navigating school permissions, including identifying a treatment supporter among school staff. Additional research engaging school staff may guide interventions for schools to reduce stigma and improve adherence and retention.

Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey

Introduction During the COVID-19 pandemic, health care shifted to virtual interactions with health professionals. The aim of this study was to examine the determinants of telehealth use in a nationally representative sample of the United States adult population. Methods The study used data from the 2020 National Health Interview Survey of 17,582 respondents aged ≥18. Andersen’s model of health services utilization was employed to examine predisposing, enabling, and needs factors associated with past-year telehealth use. Multivariable logistic regression was conducted to examine statistical associations. Results 32.5% of adults (n = 6402; mean age 51.6, SE = 0.4) reported telehealth use. Predisposing factors: Women and married/partnered adults and those with higher levels of education had greater odds of using telehealth. Adults living in Midwest and South and adults living in medium-small and non-metropolitan areas had decreased odds of using telehealth. Enabling factors: Income and having a usual source of care were positively associated with telehealth use. A negative association was found for those with no insurance and telehealth use, whereas a positive association was found for military insurance. Needs factors: Odds of using telehealth were increased for adults who had well-visits and ER visits in the past 12 months. Mental health services quadrupled the odds of telehealth use. Odds of using telehealth increased with each additional chronic disease, including COVID-19. Conclusion There are disparities in telehealth use according to sex, education, rurality, access to care, and health needs. Tackling these disparities is pivotal to ensure barriers to telehealth use are not exacerbated post-pandemic.

A model for the uptake of advance care planning in older cancer adults: a scoping review

Advance care planning (ACP) might assist older cancer patients in expressing their goals, values, and care preferences; yet, the ACP uptake rates in this group are low. The goal of this study is to discover factors that influence ACP uptake in older cancer adults and to construct a model that integrates these factors. Using Arksey and O' Malley's methodology, we systematically searched seven electronic databases of ACP literature in older cancer adults from inception to March 2022. To identify factors linked to ACP uptake in elderly cancer patients, researchers used a pre-piloted extraction form. There were two phases to the thematic analysis of the labeled factors. First, factors were grouped into one of three categories using a directed content analysis approach: patient context, provider context, or mechanism. Second, we took both a deductive and inductive thematic approach to identifying and coding contributing factors in each category to identify themes and subthemes. Deductive coding was undertaken using the Andersen's Behavioral Model of Health Services Utilization. Finally, results were visualized into a conceptual model. In the including 37 articles, 131 factors were extracted. Thematic analysis of patient context factors (n = 72) showed that ACP uptake in older cancer adults is associated with predisposing characteristics, enabling resources and need. Factors attributed to provider context (n = 28) concerned predisposing characteristics and enabling resources. Mechanism factors (n = 31) are related to perceived value and patient trust, and the C-ACP uptake model was created. ACP uptake in older cancer patients is commonly influenced by patient-provider-related contextual factors, and highlights the fact that ACP uptake is more likely to be mediated through both perceived value and patient trust. This review serves as a resource for providers exploring ACP implementation options in older cancer adults.

Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson’s model of health service utilization

BackgroundAlthough universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka.MethodsA representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression.ResultsParticipants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level.ConclusionsDoctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.

Predictors of Healthcare Utilization Among Older Adults with Moderate to Severe Cognitive Limitations in Ghana: A Cross-Sectional Analysis of the WHO Study on Global Ageing and Adult Health (SAGE) Wave 1.

As the number of older adults in Ghana keeps increasing, so does the prevalence of aging-related diseases and conditions that tend to lead to cognitive decline. However, knowledge on the predicting factors of healthcare utilization among older adults with cognitive limitations is still scarce. This study examines the predictive factors of healthcare-seeking behavior among older adults with moderate-to-severe cognitive limitations in Ghana. Based on Andersen's behavioral model of health service utilization, the study analyzed data from 3106 older adults with moderate to severe cognitive limitations in Ghana aged 50+ using Bivariate Probit Regression and the Heckman Selection Model. Results showed that individuals who were aged 75+, living in urban settlements, educated, higher income levels and parents who had some level of education, pension benefits, and both mandatory and voluntary health insurance were more likely to seek inpatient care. Enabling resources such as the national health insurance scheme and other types of medical insurance, household income, pension benefits, and predisposition factors like education influenced outpatient and inpatient healthcare consumption for older adults with moderate to severe cognitive limitations but had little influence on the choice of healthcare facility except for health insurance. Since the healthcare-seeking behavior of older adults with moderate-to-severe cognitive limitations is driven by an amalgamation of several internal and external factors, there is a need for policy change to understand and cautiously incorporate these factors into the decision to improve equitable access to healthcare services for these individuals, as not all sizes fit all in providing quality care for them.

Dental utilization among aging immigrants in Canada

Objective: To compare the dental-care utilization of elderly immigrants to that of non-immigrants in Canada. Materials and Methods: This is a secondary data analysis of publicly available data from the 2008/09 Canadian Community Health Survey: Healthy Aging (CCHS-HA) component. The target population consisted of 30,865 people aged 45 years and above. A modified Andersen’s health-service utilization model was used as the framework for analysis, grouping predisposing (age, sex, marital status, immigrant status, time since immigration, smoking, alcohol use), enabling (Education, household income, dental insurance, social support), need (Self-reported health and self-reported oral health) and behavioural factors (Brushing and physician visit), to compare the dental care utilization between elderly immigrants and non-immigrants. Descriptive statistics and binary and multivariable logistic regressions were performed. Results: Results for the entire population indicate age, sex, marital status, level of education and income, dental insurance, physician visit, smoking and self-reported oral health as significant predictors of dental visits. Predictors for utilization among immigrant seniors were: age, sex, marital status, social interaction, and level of education. Predictors for non-immigrant seniors included: age, level of education, household income, dental insurance, smoking, and self-reported oral health. Conclusion: By comparing elderly immigrants and non-immigrants, this study draws attention to what influences dental care utilization in each group. Implications for oral health policy include integrating oral health insurance into Canada’s universal healthcare system, changes in legislation that improve the availability and access to dental insurance, and better utilization of existing dental public-health resources by including targeted services to elderly immigrants.

Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai.

The purpose of this study was to analyze the health status and unmet healthcare needs, and the impact of related factors, of unwell migrants in Shanghai. A total of 10,938 respondents, including 934 migrants and 10,004 non-migrants, were interviewed in Shanghai’s Sixth Health Service Survey. Descriptive statistics were utilized to present the prevalence of health status and unmet healthcare needs. Binary logistic regression analysis was performed to explore the relationships between predisposing factors, enabling factors, need factors, and health-related behavior and unmet healthcare needs in the Anderson health service utilization model. This study indicated the percentages of migrants having a fair or poor self-evaluated health status (21.09%) and suffering from chronic diseases (72.91%) were lower than those of non-migrants (28.34% and 88.64%, respectively). Migrants had higher percentages of unmet hospitalization needs (88.87%), unmet outpatient care needs (44.43%), and self-medication (23.98%) than those of non-migrants (86.24%, 37.95%, 17.97%, respectively). Migrants enrolled in Urban Employee Basic Medical Insurance were more likely to utilize hospitalization services (OR = 1.457) than those enrolled in other health insurances or uninsured. Need factors had impacts on unwell migrants’ unmet healthcare needs. Other factors, including age and health behavior, were also found to significantly affect unwell migrants’ unmet health service needs. Specific gaps continue to exist between unwell migrants and non-migrants regarding the accessibility of local health services. Flexible policies, such as enhancing the health awareness of migrants and eliminating obstacles for migrants to access medical services, should be implemented to provide convenient and affordable healthcare services to unwell migrants.

Correlates of antiretroviral therapy (ART) initiation among HIV-positive men who have sex with men (MSM) in China

Background Men who have sex with men (MSM) are disproportionately affected by HIV globally and in China. Early antiretroviral therapy (ART) can reduce HIV-related illness, improve quality of life, and decrease HIV incidence rates. Given the high vulnerability of and limited research on ART coverage in China, we describe the ART initiation rate and correlates of ART initiation using Anderson’s health service utilization model. Methods We conducted a cross-sectional survey and collected blood samples for HIV and HCV testing and CD4 count among MSM recruited in Chengdu and Shanghai, China (N= 1,633). Using stepwise logistic regression, we explored factors associated with ART initiation postulated by Anderson’s health service utilization model. Results More than half of the participants had not started ART (53.5%). Older age and Han ethnicity were associated with a higher probability of ART initiation. Being married, higher monthly income (&gt; US$464.35), retirement, depression, and condomless anal sex predicted a lower probability of ART initiation. Conclusions The ART initiation rate among MSM in this study is lower than the national level of ART coverage among all people living with HIV (PLWH) in China. ART initiation is best predicted by demographic characteristics such as age and ethnicity. Participants who are retired, married, reported depressive symptoms, and sexual risk behavior are less likely to have initiated ART. Future studies could examine whether integrating mental health and sexual health services into the current HIV care continuum is beneficial to ART initiation among MSM. Strategies should be developed to promote ART initiation among certain populations such as young MSM and ethnic minorities in China.

Study on the utilization factors of oral health services of children aged 7-8 years in Weifang.

This study aims to determine factors influencing the oral health service utilization behavior of children aged 7-8 years in Weifang based on Anderson health services utilization model. Based on the National Comprehensive Oral Disease Intervention Project, 1 826 children aged 7-8 years were selected from 10 elementary schools in four districts of Weifang City by whole-group random sampling as the study population. The modified Anderson model was used as the theoretical framework to explore the effects of situational characteristics, population characteristics, and medical behavior on children ' s oral health service utilization. The oral visit rate of children within 1 year was 39.8% (726 cases), of which 47.2% (342 cases) were curative visits, 20.9% (152 cases) were consultative visits, and 10.7% (78 cases) were preventive visits. Multi-factor logistic regression analysis showed that frequent parental supervision during tooth brushing, frequent parental observation of dental health, parental education level of college and above, experience of dental pain or discomfort in the last year, and poor oral health evaluated by physician were the main factors that influenced the utilization of oral health services among children (P<0.05). The rate of preventive dental visits of children is low, and parents' awareness of children ' s oral health care affects the utilization rate of oral health services. Hence, parents should be taught more about children ' s oral health care to improve the utilization of children ' s health services.

Delays in Follow-up Care for Abnormal Mammograms in Mobile Mammography Versus Fixed-Clinic Patients.

Mobile mammographic services (MM) have been shown to increase breast cancer screening in medically underserved women. However, little is known about MM patients' adherence to follow-up of abnormal mammograms and how this compares with patients from traditional, fixed clinics. To assess delays in follow-up of abnormal mammograms in women screened using MM versus fixed clinics. Electronic medical record review of abnormal screening mammograms. Women screened on a MM van or at a fixed clinic with an abnormal radiographic result in 2019 (N = 1,337). Our outcome was delay in follow-up of an abnormal mammogram of 60days or greater. Guided by Andersen's Behavioral Model of Health Services Utilization, we assessed the following: predisposing (age, ethnicity, marital status, preferred language), enabling (insurance, provider referral, clinic site), and need (personal breast cancer history, family history of breast/ovarian cancer) factors. Only 45% of MM patients had obtained recommended follow-up within 60days of an abnormal screening compared to 72% of fixed-site patients (p < .001). After adjusting for predisposing, enabling, and need factors, MM patients were 2.1 times more likely to experience follow-up delays than fixed-site patients (CI: 1.5-3.1; p < .001). African American (OR: 1.5; CI: 1.0-2.1; p < .05) and self-referred (OR: 1.8; CI: 1.2-2.8; p < .01) women were significantly more likely to experience delays compared to Non-Hispanic White women or women with a provider referral, respectively. Women who were married (OR: 0.63; CI: 0.5-0.9; p < .01), had breast cancer previously (OR: 0.37; CI: 0.2-0.8; p < .05), or had a family history of breast/ovarian cancer (OR: 0.76; CI: 0.6-0.9; p < .05) were less likely to experience delayed care compared to unmarried women, women with no breast cancer history, or women without a family history of breast/ovarian cancer, respectively. A substantial proportion of women screened using MM had follow-up delays. Women who are African American, self-referred, or unmarried are particularly at risk of experiencing delays in care for an abnormal mammogram.

Predictors of HIV testing among youth aged 15-24 years in The Gambia.

BackgroundWorldwide, an estimated 38.0 million people lived with the human immunodeficiency virus in 2019, and 3.4 million young people aged 15~24 years were living with HIV. Sub-Saharan Africa carries a significant HIV burden with West and Central Africa most affected with HIV. Among the young people living with HIV in West and Central Africa, an estimated 810,000 were aged 15~24 years. This study aimed to assess predictors that influence the uptake of HIV testing among youth aged 15~24 years in The Gambia.MethodsThe 2013 Gambia Demographic and Health Survey data for youth aged 15~24 years was used. The Andersen behavioral model of health service use guided this study. A cross-sectional study design was used on 6194 subjects, among which 4730 were female. The analysis employed Chi-squared tests and hierarchical logistic regression.ResultsLess than one-quarter of the youth 1404 (22.6%) had ever been tested for HIV. Young people aged 20~24 years (adjusted odds ratio (aOR): 1.98), who were females (aOR: 1.13), married youth (aOR: 3.89), with a primary (aOR: 1.23), secondary or higher education (aOR: 1.46), and who were from the Jola/Karoninka ethnic group (aOR: 1.81), had higher odds of having been tested for HIV. Those with adequate HIV knowledge and those who were sexually active and had aged at first sex ≥15 years (aOR: 3.99) and those <15 years (aOR: 3.96) were more likely to have been tested for HIV compared to those who never had sex.ConclusionThis study underscores the low level of model testing on HIV testing among youth (15~24 years) in The Gambia. Using Anderson’s Model of Health Service Utilization, the predisposing factors (socio-demographic and HIV knowledge) and the need-for-care factors (sexual risk behaviors) predict healthcare utilization services (HIV testing) in our study; however, only socio-demographic model explained most of the variance in HIV testing. The low effect of model testing could be related to the limited number of major variables selected for HIV knowledge and sexual risk behavior models. Thus, consideration for more variables is required for future studies.

Residential Segregation and Emergency Department Utilization Among an Underserved Urban Emergency Department Sample in North Carolina.

BACKGROUND Residential segregation is a spatial manifestation of structural racism. Racial disparities in emergency department (ED) utilization mirror social inequity in the larger community. We evaluated associations between residential segregation and ED utilization in a community with known disparities and geographically concentrated social and health risk.METHODS Cross-sectional data were collected from electronic medical records of 101 060 adult ED patients living in Mecklenburg County, North Carolina in 2017. Community context was measured as residential segregation using the dissimilarity index, categorized into quintiles (Q1-Q5) using 2013-2017 American Community Survey estimates, and residency in a public health priority area (PHPA). The outcome was measured as total ED visits during the study period. Associations between community context and ED utilization were modeled using Anderson's behavioral model of health service utilization, and estimated using negative binomial regression, including interaction terms by race.RESULTS Compared to areas with the lowest proportions of Black residents (Q1), living in Q4 was associated with higher rates of ED utilization among Black/Other (AME = 0.11) and White (AME = 0.23) patients, while associations with living in Q5 were approximately equivalent (AME = 0.12). PHPA residency was associated with higher rates of ED utilization among Black/Other (AME = 0.10) and White patients (AME = 0.22).LIMITATIONS Associations should not be interpreted as causal, or be generalized to the larger community without ED utilization. Health system leakage is possible but limited.CONCLUSIONS Residential segregation is associated with higher rates of ED utilization, as are PHPA residency and other individual-level determinants.

Outpatient visit among elderly in Indonesia

Population aging has become an important issue mostly discussed in many countries in the world. The proportion of the older population is getting better in both developed and developing countries. Elderly tend to need more health care as they are more susceptible to chronic diseases. The purpose of this study was to determine the factors affecting outpatient visit among elderly in Indonesia. This study employed a cross-sectional study design with a sample of ≥60-year-old individual with a total sample of 5,325 elderly. The data used to be analyzed were from the Indonesian Family Life Survey 2014 representing 83% of the population in Indonesia. The theory used was Andersen health service utilization model. In analyzing the data, bivariate analysis were used, with Chi-square and multivariate test using multiple logistic regression test prediction model. Elderly who utilize health service for outpatient was 18.6%. Variables that have significant relationships with outpatient utilization on elderly were female, high education, formal job, Java and Bali, urban, health insurance ownership, economic status, the perception of ill, smoking habit, history of chronic disease, fat, and obesity. Predictor for the most dominant outpatient utilization is influenced by chronic disesase after controlled by other variables. Chronic disesase greatly affect the elderly in utilizing health services for outpatient. To overcome this, the government is expected to provide policies on health facilities to better emphasize promotive and preventive efforts among the elderly.

The willingness to attend the first dental visit within 1 year of age: An analysis applying Andersen's behavioral model of health service utilization.

BackgroundThe first dental visit (FDV) within 1 year of age is important for establishing good oral health behaviors for young children, but delayed FDVs are common.AimThis study aimed to investigate the predisposing, enabling, and need factors of maternal willingness to attend the FDV for infants.DesignA cross‐sectional survey was conducted among mothers of infants aged 11‐14 months. A questionnaire was developed based on Andersen's behavioral model of health service utilization. Data regarding the FDV, FDV willingness, and reasons for not attending the FDV were collected. Logistic regression models were used to investigate the associated factors.ResultsOf 658 infants, only 2.7% (18) had a Thirty percent (191/640) of mothers reported their willingness to attend the FDV in the next 3 months. Nearly two‐thirds of mothers reported not attending the FDV since their children's teeth were healthy. Maternal perceptions of their infants’ oral health status were negatively associated with willingness to undergo the FDV, whereas family social support was positively associated with willingness to undergo the FDV.ConclusionsNeed factors play a key role in the utilization of FDV. Improving parental awareness of FDV might help parents voluntarily attend the FDV, and offering support from the family and healthcare system levels enables access to paediatric dental care.