Use Of Primary Health Services Research Articles

The impact of community Men's Sheds on the physical health of their users.

With men more susceptible than women to illness and mortality, and less likely to access primary healthcare services, there have been calls for more male friendly spaces within communities to engage 'hard to reach' men in physical health improvement. Research has shown that Men's Shed (Shed) activity can provide localised support for the mental health and social wellbeing of men within communities, yet less is known about Sheds' impacts on physical health. Drawing on qualitative interviews with 62 Sheds users, this study conceptualises proposed pathways from which Shed activity can lead to positive physical health outcomes. Findings showed that in attending a community Men's Shed and taking part in activities users reported (i) increased mobility and decreased sedentary behavior, (ii) increased ability to overcome physical illness or injury, (iii) improved diet, (iv) decreased alcohol use, and (v) improved physical health knowledge. These findings support wider recommendations for community-based male friendly approaches to physical health improvement, and stress the importance of health and care service delivery beyond boundaries of 'standard' NHS settings, especially when targeting those viewed as 'hard to reach'. While initiatives like Sheds do not offer a replacement of primary healthcare services, they have the potential to fit within existing health and social care practices as an alternative local health-engagement space for men.

The Effect of Health Literacy Level on The Use of Primary Health Services in Adult Patients

The Effect of Health Literacy Level on The Use of Primary Health Services in Adult Patients

The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study.

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.

Neighbourhood variation and inequity of primary health service use by mothers from London-Middlesex, Ontario.

Primary health service use (P-HSU) may be influenced by contextual characteristics and is equitable when driven by need. Contextual effects and inequity of maternal P-HSU were determined. Participant data from a London-Middlesex, Ontario, prenatal cohort were linked by residential address to contextual characteristics. Multilevel logistic regression estimated contextual effects and tested for effect measure modification of need factors. Maternal P-HSU varied between neighbourhoods. The effect of obesity was different for rural mothers living in low- (OR = 0.26) and middle-income households (OR = 0.15) and for urban mothers living in high-income households (OR = 2.82). The effect of having a health condition was greatest in mothers with three or more children (OR = 2.41). Differences in maternal P-HSU exist between neighbourhoods, and enabling factors modified need factors' effects, identifying subgroups of mothers with inequitable P-HSU. RESULTS have the potential to inform Canadian health policy with regard to contextual effects and inequity of P-HSU.

SAT-250 ARDAC KIDNEY HEALTH STUDY - SOCIAL DETERMINANTS SURVEY

Chronic conditions are one of the key drivers behind the inequity in health outcomes for Aboriginal Australians. The ARDAC (Antecedents of Renal Disease in Aboriginal Children) Kidney Health Study is a New South Wales (NSW) based prospective cohort study which commenced in 2002. It aims to follow the early markers of chronic kidney and cardiovascular disease from childhood to early adulthood in urban, regional and remote Aboriginal and non-Aboriginal young people. The main outcome is to understand why the rate of kidney and cardiovascular disease in Aboriginal Australians is so high and help identify strategies to prevent it. Initially the focus of data collection was on 2 yearly measurements of height, weight, waist circumference, blood pressure, and urine albumin/creatinine ratio. Analysis of the data in 2013 showed risk factors for chronic disease were transient but not different in Aboriginal and non-Aboriginal participants. There was also no relationship between the biomedical risk factors and socio-economic status using their SEIFA scores. Based on these results and knowing social determinants influence health outcomes, a survey was initiated in Phase III of the study to address this gap. The survey was a voluntary, self-administered instrument which asked participants about family health history, level of education, employment, lifestyle, income and housing. Participants had the option to complete either a paper-based version or electronic application. Data were entered into an Excel spread-sheet and grouped according to Aboriginal status. Of the 354 surveys analysed 197 (56%) were completed by Aboriginal participants. There were 178 male and 176 female participants with an average age of 16-years (12 – 27 years). Just over half (55%) were still at high school while 72% of non-Aboriginal participants finished Year 12 compared to 53% of Aboriginal participants. For parents or main caregivers of the participant, 20% of non-Aboriginal and 3% of Aboriginal had completed Tertiary Education and 44% of non-Aboriginal and 30% Aboriginal were in full time employment. Housing showed Aboriginal households had similar number of bedrooms to non-Aboriginal households but more family members, potentially causing overcrowding and pressure on household net income. Variance in health was most striking in the number of participants or immediate family members who had been diagnosed with diabetes or chronic kidney disease (CKD). For instance, diabetes in an immediate relative was reported by 60% of Aboriginal compared to 44% of non-Aboriginal participants and CKD in an immediate relative was reported by 12% of Aboriginal compared to 8% of non-Aboriginal participants. Slightly more non-Aboriginal participants had visited a health service in the past 12 months (86% vs 74%) and 78% saw their GP or family doctor whereas 47% of Aboriginal participants went to an Aboriginal Medical Service. This survey provides unique data and strengthens the evidence for inclusion of the socio-economic determinates of health. These results suggest Aboriginal people can be more disadvantaged in education and employment and this affects their income, housing and use of primary health services.

Does caregiver participation in decision making within child welfare agencies influence children's primary and mental health care service use?

Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency. In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals (P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non-PDM children (P = 0.004). Group differences were not significant for mental health services. Lower-risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use.

Socioeconomic status and primary health service use for mental health problems among immigrants with short and long lengths of stay

Purpose – High socioeconomic status (SES) is associated with better health and lower use of health care services in the general population. Among immigrants, the relationship appears less consistent. The purpose of this paper is to determine if the relationship between income level (a proxy for SES) and use of primary health care services for mental health problems differs for natives and five immigrant groups in Norway. It also explores the moderating effect of length of stay (LoS) among immigrants. Design/methodology/approach – Using data from two registers with national-level coverage, logistic regression analyses with interactions were carried out to determine the association between income level and having used primary health care services for mental health problems. Findings – For Norwegian men and women there was a clear negative relationship between income and service use. Interaction analyses suggested that the relationship differed for all immigrant groups compared with Norwegians. When stratifying by LoS, income was not associated with service use among recently arrived immigrants but was negatively associated among immigrants staying more than two years (with the exception of Pakistani and Iraqi women). Research limitations/implications – Country of origin and LoS should be considered when applying measures of SES in immigrant health research. Social implications – There may be an initial transition period for recently arrived immigrants where competing factors mask the association between SES and service use. Originality/value – This study benefits from nationwide coverage, eliminating self-selection biases. It demonstrates the complexity of the relationship between SES and health care use.

Simultaneous effect of disabling conditions on primary health care use through a capability approach

There is evidence of social disparities in the use of primary health services in most European countries, and these disparities particularly affect people with disabilities. Many determinants of disabilities interact to limit access to health care (e.g. impairments, functional limitations, educational level). However, these determinants have typically been examined separately. We adopted a capabilities perspective to define multidimensional disability. Capabilities refer to individuals' real opportunities to achieve possible outcomes. In this context, we aimed to assess disability through latent capabilities (shaped by personal, social and environmental variables) and to simultaneously analyze their effects on primary health care use (GP and nurse care; cervical, breast, and colorectal cancer screenings). We used a structural equation modeling framework, which allowed complete and simultaneous tests of relationships taking into account measurement errors. The data source was the 2008 French Health and Disability Survey (29,931 individuals). Potential disability-related determinants were selected to measure five latent variables: health condition and cognitive, physical, societal, and socioeconomic capabilities. All things being equal, we did not identify any specific barriers to GP care use. We found a lower likelihood of nursing care use among people with lower cognitive capabilities. Unlike usual findings, we did not observe a significant influence of either cognitive or physical capabilities for any type of cancer screening use. However, cancer screening participation was mainly affected by societal and socioeconomic capabilities. Considering the capability approach, which suggests public action oriented toward restoring capabilities of individuals, future programs should seek to increase societal support to compensate for disability. This approach could be helpful in reducing inequalities in health care access.

Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland

ObjectivesTo study the role of distance in public primary health service use in rural and urban local residential areas (1 km² grids) among the young adults of the Northern Finland Birth Cohort 1966 (N = 4503). Study designCross-sectional study of a cohort born in Northern Finland in 1966. MethodsUse of local health centres was surveyed by postal questionnaire in 1997, and distance from study subjects' home to health centre was calculated along road network. The crude and adjusted incidence rate ratios (IRR) and their 95% confidence intervals were calculated for distance, predisposing and illness-level variables. Distance-related health inequity indices were calculated. ResultsThe IRRs indicated 1.5-fold higher rate of health centre visits among subjects living farther than 10 km compared to subjects living within 2 km from health centre in urban areas. In rural areas, IRRs indicated no significant association with distance and health centre use. No distance-related inequity in the use of health centre services was found. ConclusionsDistance does not seem to be major barrier in health service use among these 31-year old adults. However, closer study of some groups, such as the rural unemployed, might be valuable.

Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34-44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.

Immunization Coverage Among Young Children of Urban Immigrant Mothers: Findings from a Universal Health Care System

To investigate access to effective primary health care services in children of new immigrants to Canada by assessing immunization coverage at age 2. We used multiple linked administrative data sets to analyze primary health service use and immunizations of children born between July 1, 1997, and June 30, 1998, in Ontario, Canada. These children were linked via their mothers' records to a federal Landed Immigrant Database. We used logistic regression to assess the effect on up-to-date (UTD) status at age 2 of having an immigrant mother, controlling for patient and physician characteristics. We examined the relationship of region of origin, period of immigration, and refugee status on coverage. The study population comprised 98 123 children, of whom 66.5% had complete immunization coverage. Children of immigrant mothers were more likely to be UTD (adjusted odds ratio, 1.15; 95% confidence interval, 1.10, 1.19) than children born to nonimmigrant mothers. Within the group of children of immigrant mothers, those whose mothers were refugees had the lowest rates of coverage (66.6%), but when adjusting for maternal age, sex, neighborhood income quintile, and health services characteristics, region of origin was the most important predictor of coverage. Those from the region of Southeast and Northeast Asia were most likely to be UTD (odds ratio, 1.63; 95% confidence interval, 1.46, 1.81). Period of immigration was not associated with coverage. Contrary to expectations, immigrant mothers are accessing immunizations at least as well as nonimmigrants for their young children in Ontario. There is variation by region of origin and socioeconomic status. Universal access to care reduces disparities in immunization coverage, but overall rates are too low.

General practice consultation rates for mothers and babies in the first year after birth according to place of birth. A descriptive study in one general practice

Maternal and infant health in primary care following childbirth is an important area which has recevied little research attention. Very little is known about primary health service use following childbirth and its determinants. The aim of this exploratory study was to test the hypothesis that place of birth is independently associated with mother and baby consultation patterns in the first year of life. This is a descriptive study of 453 pregnancies of 338 mothers from an inner city general practice between 1987 and 1996. There were 86 intended home births, 126 intended domino births and 240 intended hospital births, with one woman unbooked. Of these, 69 women had home births, 97 had domino births, 286 women had hospital deliveries and one baby was born in an ambulance. The outcome of interest was mother and baby consultation rates in the year following birth. In an attempt to control for pre-existing ill health we also calculated the women's consultation rate in the year prior to conception and substracted this from the mother and baby consultation rate in the year following birth. We analysed the data according to both intended and actual place of birth. Women intending a home birth had fewer mother and baby consultations in the year following birth compared to women intending domino births, who in turn had fewer consultations than women intending hospital care during labour (P &lt; 0.001). This gradient persisted when pre-existing maternal ill health was accounted for. A similar gradient of increasing consultation rates through home births, domino birth, normal vaginal delivey in hospital and assisted delivery in hospital was demonstrated when data were analysed according to actual place of birth. Other maternal characteristics independently associated with increased mother and baby consultation patterns were: primiparity, manual occupational class, not breastfeeding, maternal smoking, infertility prior to pregnancy, and recorded anxiety, depression or life events before or after birth. Women intending and having a home birth were older (P &lt; 0.001) and less likely to be primiparous (P = 0.055) or of manual occupational class (P &lt; 0.001). Babies born at home were heavier (P &lt; 0.001), and women experienced less perineal trauma (P &lt; 0.001) and were more likely to breastfeed at birth (P &lt; 0.001). The conclusion we draw from this cohort of births, is that there is an association between women intending a home birth and women who actually have home births and lower mother and baby consultation rates postnatally, when compared with women having normal vaginal domino or hospital births. This is independent of maternal age, parity, smoking during pregnancy, occupational class, a history of infertility or miscarriage in the year prior to conception, anxiety, depression or life events in the year prior to conception or after birth, breastfeeding, sex of baby and birth weight.

Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician.

To examine the extent to which people consult health centre doctors about various musculoskeletal symptoms and to identify those groups of patients who are responsible for the main workload in primary health care caused by musculoskeletal complaints. A cross sectional investigation based on case records of people who visited health centre physicians. The population of six Finnish health centre districts (93,000 inhabitants, 64 physicians' posts in primary care centres). 6526 patients (7634 visits) who consulted a physician at any of six health centres during a two week period, of which 1380 consulted for musculoskeletal symptoms. The reasons for the visits were abstracted from the case records and were analysed by cross tabulation. The rate of people visiting for musculoskeletal symptoms during a two week period was on average 15 per 1000 inhabitants. It was highest in men aged 45-54 years (25/1000) and in women aged 55-64 years (26/1000); the rate fell to the average in men over 54 and women over 64 years. Patients with musculoskeletal symptoms accounted for 21% of all patients and 27% of those over 15 years of age. Low back pain was the most common reason for consultation in men aged 25-54 years, while for women aged 35-74 years, the most common reason was neck and shoulder pain. Over one quarter of adults visiting a health centre doctor do so because of musculoskeletal disorders. This fact must be considered when developing health care services and organising basic education and further in-service training for doctors.