Utilization Of Primary Care Services Research Articles

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

BackgroundIn ageing populations, multimorbidity is a complex challenge to health systems, especially when the individuals have both mental and physical morbidities. Although a regular source of primary care (RSPC) is associated with better health outcomes, its relation with health service utilisation in elderly patients with mental-physical multimorbidity (MP-MM) is scarce.ObjectiveThis study explored the relations among health service utilisation, presence of RSPC and MP-MM among elderly Brazilians.MethodsA national cross-sectional study performed with data from national representative samples from the Brazilian National Health Research (PNS, in Portuguese; Pesquisa Nacional de Saúde) carried out in 2013 with 11,177 elderly Brazilian people. MP-MM was defined as the presence of two or more morbidities, including at least one mental morbidity, and was evaluated using a list of 16 physical and mental morbidities. The RSPC was analysed by the presence of regular font of care in primary care and health service utilisation according to the demand for health services ≤ 15 days, medical consultation ≤ 12 months, and hospitalisation ≤ 1 year. Frequency description of variables and bivariate association were performed using Stata v.15.2 software.ResultsThe majority of individuals was female (56.4%), and their mean age was 69.8 years. The observed prevalence of MP-MM was 12.2%. Individuals with MP-MM had higher utilisation of health services when compared to those without MP-MM. RSPC was present at 36.5% and was higher in women (37.8% vs. 34.9%). There was a lower occurrence of hospitalisation ≤ 1 year among MP-MM individuals with RSPC and without a private plan of health.ConclusionOur findings demonstrate that RSPC can be an important component of care in elderly individuals with MP-MM because it was associated with lower occurrence of hospitalisation, mainly in those that have not a private plan of health. Longitudinal studies are necessary to confirm these findings.

Measles, mumps, and rubella vaccination coverage: an ecological study of primary health care and socio-economic factors in Catalonia, Spain.

This study examined the association of socio-economic factors and the structure of primary care centres (PCCs) with measles, mumps, and rubella (MMR) vaccination coverage among the 8-year-old population in Catalonia, Spain. We conducted an ecological study to retrospectively assess the MMR vaccination-recorded status of children born in 2012, using public health data extracted in December 2020. For each of 300 PCCs serving 70,498 children, we calculated vaccination coverage rates from electronic health records and linked these rates to a composite deprivation index corresponding to the territory served by each PCC. We identified a relationship between unfavourable socio-economic factors and higher recorded vaccination coverage. On average, directly managed PCCs had higher vaccination coverage rates than indirectly managed PCCs. Greater utilisation of primary care services by the population was also associated with higher vaccination coverage rates. Further research is needed to generate knowledge valuable for informing more equitable child-vaccination service delivery models.

Equity and unmet need of non-communicable diseases services in Saudi Arabia using a National Household Survey (2019).

Saudi Arabia is implementing a comprehensive health system transformation in health services provision, governance, and financing. Given the high burden of non-communicable diseases (NCD), a key objective of the transformation is to integrate NCD prevention and treatment into primary care. The study objectives were to assess primary care service use for treatment of NCDs, to quantify existing inequities in preventive services utilization, and to identify regional and sociodemographic factors associated with these inequities. Using the 2019 Kingdom of Saudi Arabia World Health Survey, multivariable logistic regression models were conducted to identify predictors of utilization of primary care services for NCD prevention and treatment, unmet need among those with a diagnosis of diabetes, hypertension, or dyslipidemia, and unmet need in breast and cervical cancer screening. Among those with an NCD diagnosis, living in a high-income household was associated with a lower probability of having an unmet need compared to those in low-income households. Furthermore, rural residents were less likely to have an unmet need compared to urban residents (OR 0.58, p=0.029). Individuals without a perceived need for healthcare within the last 12 months had three times the probability of unmet need in comparison to those with such a perceived need (p<0.001). Women in all regions had a lower probability of ever having a mammogram compared to women in the central regions around Riyadh. Women with an education above a secondary level had five times the odds of undergoing cervical cancer screening and three times the likelihood of ever having a mammogram (P=0.012, p=0.02) than other women. Compared to women in low-income households, those in middle (OR 1.99, P=0.026), upper middle (OR 3.47, p<0.001), or high-income households (OR 2.59, p<0.001) had a higher probability of having had cervical cancer screening. Inequities in NCD treatment and prevention services' utilization in Saudi Arabia are strongly associated with region of living, population density, wealth, income, education and perceived need for health care. More research is needed to better understand the extent of unmet primary care needs for NCD and how to address the underlying contributing factors to access inequities.

Perceptions and Factors affecting Utilization of Primary Health Care Services in a predominantly Urban Community in South-South Nigeria

Background: Primary Health Care is the cornerstone of a sustainable national health system for the attainment of universal health coverage. There is poor demand for health services at the primary level of care. This study assessed the perceptions and factors affecting the utilization of primary health care services in a predominantly urban community in South-South Nigeria.&#x0D; Methods: This descriptive cross-sectional study was done in Egor, Benin City, Southern Nigeria. A structured, and interviewer administered questionnaire was distributed to 371 heads of household who were selected using multistage sampling method. The data were analyzed using IBM SPSS version 25.&#x0D; Results: Majority of the respondents were males 191 (51.6%). More than half, 195 (52.5%) were in the age group of 35-49 years. Less than half, 171 (46.1%)of the respondents had utilized primary health care services. Only, 42 (24.6%) perceived the services utilized were satisfactory. Immunization, 45 (26.3%), child, 39 (22.8%) and maternal, 32 (18.7%) health care services were the most utilized. Sex (OR = 0.599; CI = 0.38-0.94, p = 0.027), religion (OR = 2.246; CI = 1.066-4.735, p = 0.033), and occupation (OR = 2.437; CI = 1.106-5.367, p = 0.027) were factors associated with the utilization of health services in the study locale.&#x0D; Conclusions: The utilization of the primary health care services was low, and the perception of services utilized was not satisfactory. The Local Government Health Authority needs to strengthen the primary health care system. Also, improved community engagement and participation could enhance health services access and uptake.

Barriers to Elderly Health Care in the Occupied Palestinian Territories.

This study examined different barriers to the access and utilization of primary health care services by the elderly in the occupied Palestinians territories. We collected quantitative data from a larger convenience sample of a national survey of 1299 persons in the occupied Palestinian territories (oPt) that examined the effects of Israel's colonization and its effects on health care delivery between October 2021 and February 2022. The research tool was based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire. The data was obtained from 76 elderly participants with a mean age of 68.33 years standard deviation (SD = 7.09 years). The majority (75%) reported having at least one chronic health issue and having limited access to health care. They had all finished at least six years of education. The participants claimed having health insurance, while 47.4 percent reported paying for out-of-pocket expenses and medical care was a burden. Access and affordability of health care was a problem for 70 percent of participants. Older persons and their families face access to care issues created by political, geographic, and economic barriers. Poor incomes, war-like conditions, a weak health care system, and a lack of comprehensive care delivery all impact their health.

Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk.

Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.

Patient pathways for rare diseases in Europe: ataxia as an example

BackgroundProgressive ataxias are rare and complex neurological disorders that represent a challenge for the clinicians to diagnose and manage them. This study explored the patient pathways of individuals attending specialist ataxia centres (SAC) compared with non–specialist settings. We investigated specifically how diagnosis was reached, the access to healthcare services, treatments, and care satisfaction. The focus of this study was on early intervention, coordination of treatment to understand the care provision in different countries.MethodsA patient survey was done in the UK, Germany and Italy to gather information about diagnosis and management of the ataxias in specialist (SAC) and non-specialist settings, utilisation of other primary and secondary health care services, and patients’ satisfaction of received treatment.ResultsPatients gave positive feedback about the role of SAC in understanding their condition, ways to manage their ataxia (p < 0.001; UK) and delivering care adapted to their needs (p < 0.001; UK), in coordinating referrals to other healthcare specialists, and in offering opportunities to take part in research studies. Similar barriers for patients were identified in accessing the SACs among the selected countries, UK, Germany, and Italy.ConclusionsThis study provides crucial information about the ataxia patients care pathways in three European countries. Overall, the results showed a trend in patients’ satisfaction being better in SAC compared to non-SAC. The outcomes can be used now for policy recommendations on how to improve treatment and care for people with these very rare and complex neurological diseases across Europe.

Primary health care service utilisation before and after entry into long-term care in Australia

ObjectivesTo examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia. MethodsA retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0–3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models. Results235,217 residents were included in the study with a median age of 84 years (interquartile range 79–89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10–1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70–1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81–1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission. ConclusionThere is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents’ increasingly complex care needs are adequately met.

Utilisation of primary healthcare services by Sjögren's syndrome patients in the Community of Madrid and associated factors: a population-based cross-sectional study.

To describe the utilisation of primary health care (PHC) services and factors associated with its use by patients diagnosed with Sjögren's syndrome (SS). Population-based cross-sectional cohort of SS patients in Madrid, Spain (SIERMA). Sociodemographic, diagnostic, clinical and PHC service utilisation variables were studied by bivariate analyses and regression models. A total of 4,778 SS patients were included, 65.2% classified as primary SS (pSS), while 34.8% associated with another autoimmune disease (associated SS). Mean age was 64.3 years, and 92.8% of the patients were women. A total of 87.5% used PHC services, with a mean of 19.8 consultations/year. The general practitioner was the most visited health professional, with a mean of 10.9 consultations/year, followed by the nurse, with a mean of 5.7. Characteristics associated with a greater use of PHC services in SS patients were associated SS, higher adjusted morbidity groups (AMG) risk level and older age. Additional factors included symptoms such as dry mouth, fatigue, dry vagina and joint and muscle pain; comorbidities such as atrial fibrillation, diabetes, hypertension, solid malignant neoplasms, coronary heart disease and chronic obstructive pulmonary disease; and treatments such as sterile saline solution, corticosteroids, opioids and biologic disease-modifying anti-rheumatic drugs. Most SS patients used PHC services during the study period, and the mean number of consultations was remarkably high. Utilisation was mainly associated with AMG risk level, ageing, glandular and extra-glandular symptoms, substantial comorbidities and various treatments. An optimised design of PHC policies will facilitate early diagnosis, improved management and better quality of life for SS patients.

The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda.

This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.

Externally oriented thinking style increases primary health care use in adolescence.

Alexithymia has been related to adult health care use. We investigated the association between alexithymia and the utilization of primary health care services by adolescents and young adults. The participants (n = 751, aged 13-18 years) in this 5-year follow-up study were assessed with the 20-item Toronto Alexithymia Scale (TAS-20) and its three subscales, difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT), and the 21-item Beck Depression Inventory (BDI). Primary health care data were gathered from health care centre registers in 2005-10. Generalized linear models and mediation analyses were used. An increase in the TAS-20 total score correlated with a higher number of primary health care and emergency care visits, but in multivariate general linear models, TAS-20 total scores were no longer significant. Younger age, female gender and an increase in the baseline EOT score are associated with a higher number of both primary health care and emergency room visits. In females, a smaller change in the EOT score from baseline to follow-up was associated with a higher number of primary health care visits. In mediation analyses, EOT had a direct effect on a higher number of primary health care and emergency room visits, whereas the BDI score mediated the incremental effect of DIF and DDF on visit numbers. The results suggest that an EOT style independently increases health care use by adolescents, whereas the effects of difficulties identifying and describing feelings on health care use are mediated by symptoms of depression.

Understanding the impact of the COVID‑19 pandemic on healthcare services for adults during three waves of COVID‑19 infections: A South African private sector experience.

Since the onset of the COVID‑19 pandemic, healthcare resources have been repurposed to focus on COVID‑19. Resource reallocation and restrictions to movement that affected general access to care may have inadvertently resulted in undue disruptions in the continuum of care for patients requiring non-COVID‑19 healthcare services. To describe the change in pattern of health service use in the South African (SA) private sector. We conducted a retrospective study of a nationwide cohort of privately insured individuals. An analysis of claims data was performed for non-COVID‑19 related healthcare services provided from April 2020 to December 2020 (year 1 of COVID‑19) and April 2021 to December 2021 (year 2 of COVID‑19) relative to the same period in 2019 prior to the COVID‑19 pandemic in SA. Over and above plotting the monthly trends, we tested for statistical significance of the changes using a Wilcoxon test given the non-normality of all the outcomes. Between April and December 2020, relative to the same period in 2021, and also relative to the same period in 2019, we found a 31.9% (p<0.01) and a 16.6% (p<0.01) reduction in emergency room visits, respectively; a 35.9% (p<0.01) and 20.5% (p<0.01) reduction in medical hospital admissions; a 27.4% (p=0.01) and 13.0% (p=0.03) reduction in surgical hospital admissions; a 14.5% (p<0.01) and 4.1% (p=0.16) reduction in face-to-face general practitioner consultations for chronic members; a 24.9% (p=0.06) and 5.2% (p=0.54) reduction in mammography for female members; a 23.4% (p=0.03) and 10.8% (p=0.09) reduction in Pap smear screenings for female members; a 16.5% (p=0.08) and 12.1% (p=0.27) reduction in colorectal cancer registrations and an 18.2% (p=0.08) and 8.9% (p=0.07) decrease in all oncology diagnoses. Uptake of telehealth services throughout the healthcare delivery system increased by 5 708% in 2020 compared with 2019, and 36.1% for 2021 compared with 2020. A significant reduction in emergency room visits, hospital admissions and utilisation of primary care services was observedsince the start of the pandemic. Further research is required to understand if there are long-term consequences of delayed care. An increase in the use of digital consultations was observed. Research on their acceptability and effectiveness may open new modalities of care, which may have cost- and time-saving benefits.

Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program’s Impact on Healthcare Utilization

Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 ± 0.6; p &lt; .0001) but significantly decreased utilization of in-clinic primary care visits (−3.2 ± 0.6; p &lt; .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p’s ≥ .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.

Household Survey on Access to Medicines Used for the Treatment of Diarrhoea in Musoma Municipal Council, Tanzania

Background: Access to medicines is part of the human right to health. According to WHO, access to medicine is measured by how easily households obtain medicines for acute and chronic conditions including diarrhoea through household surveys. Diarrhoea is among the top ten leading causes of death. Anti-diarrhoea medicines save lives but, should be available and obtainable to do so. The objectives of this study were to determine anti-diarrhoea medicines used by households, their sources and factors affecting their accessibility in Musoma Municipal. Methods: A cross-section survey was conducted in Musoma Municipal Council, Mara, Tanzania. The lottery method of simple random sampling was used to select three wards and pick three streets from each ward. The study population was 255 household heads from households selected by systematic random sampling from each street. A structured questionnaire was used to obtain information from household heads. Results and Discussion: Males (51.8%) had more diarrhoea illnesses than females (48.2%). Distinctive household heads (52.6%) had primary education. The majority, (79.1%) of all diarrhoea patients were recommended/prescribed anti-diarrhoea medicines. Of those whom anti-diarrhoea medicines were prescribed/recommended, 63.5% adhered to the prescriber’s/dispenser’s instructions and obtained and used anti-diarrhoea medicines. The most frequent source of anti-diarrhoea medicines was ADDO (38%). Widely used anti-diarrhoea medicines were antimicrobials (77.5%) followed by ORS (17.5%). Reasons not to seek or obtain anti-diarrhoea medicines were; Patient started feeling better (56.3%), Alternative treatment (26%), Financial reasons (10%), Decided medicines weren’t needed (3.5%), Distance from source (2.2%), Reactions to medicine (1%). Utilization of primary health care services was only 21.5%. Under-fives were mostly prescribed with antimicrobials (62.5%) than ORS (31.2%) and Zinc (6.3%) in mild to moderate dehydration contrary to Standard treatment guidelines (STG) in Tanzania. Conclusion: Anti-diarrhoea medicines are moderately easily obtainable in Musoma Municipal (50% of all diarrhoea patients obtained medicines). Alternative treatment (26%) and financial reasons (10%) were vivid factors hindering access. Treatment of diarrhoea in under-five years old is not adhered to in Musoma Municipal (use of 62.5% of antimicrobials and only 31.2% of ORS in mild diarrhoea cases).

The use of routine data from primary care practices in Germany to analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus

BackgroundRoutinely collected health data from ambulatory care providers offer a wide range of research opportunities. However, the access is often (e.g., technically) hindered, particularly in Germany. In the following, we describe the development of an infrastructure for the analysis of pseudonymized routine data extracted from primary care practices in Germany. Further, we analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus (DM type 2).MethodsIn this retrospective cohort study, routine data were extracted from nine private primary care practices before and since the outbreak of SARS-CoV-2 in Germany. The sample consisted of patients who were treated between 2016 and 2022 in one of the participating practices. The effects of the outbreak on the frequency of practice visits and the disease course of DM type 2 patients were analyzed by means of bivariate and multivariate analyses.ResultsThe developed infrastructure offers an analysis of routine data from outpatient care within 24 h. In total, routine data of 30,734 patients could be processed for the analyses with 4182 (13.6%) patients having a diagnosed DM type 2 and 59.0% of these patients were enrolled in a disease management program (DMP). In the multivariate analysis, there was a significant negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease. This decrease was less pronounced among DMP patients. The glycated haemoglobin level (HbA1c) has not changed significantly.ConclusionsThe study showed that the analysis of routine data from outpatient care in Germany is possible in a timely manner using a special developed electronic health record system and corresponding software. The significantly negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease was less pronounced among DMP patients. Two years after the start of the Covid pandemic a significantly worsened course of illness cannot be observed. However, it must be taken into account that the observation period for clinically relevant outcomes is still relatively short.

Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage.

In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.

Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis

IntroductionAn increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting...

Changes in healthcare utilization after mass trauma: A register-based study of young survivors’ utilization of primary care and mental health services before and after the Utøya attack in Norway

Abstract Introduction Using register-based data, this study had a unique possibility to investigate how young survivors’ use of primary care and mental health services (MHS) changed after a terrorist attack. Methods We analyzed data on consultations with primary care physicians (PCP) and MHS among 255 survivors (48% female) of the 2011 Utøya youth camp attack in Norway three years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC-2). Results The majority of survivors consulted PCP both before and after the attack, with a marked increase in psychological reasons for encounter after the attack. Few consulted MHS before the attack, while most survivors did after the attack. In total, 93% of female survivors and 88% of male survivors consulted PCP in the three years before the attack, compared to respectively 98% and 96% in the three years after the attack. Moreover, 17% of female survivors and 11% of male survivors consulted MHS in the 3 years before the attack, compared to respectively 80% and 65% in the 3 years after the attack. From the year before to the year after the attack, the mean yearly consultation rates (CR) increased two-fold for PCP and nearly 8-fold for MHS in female survivors, and more than two-fold for PCP and nearly 12-fold for MHS in male survivors. Both before and after the attack, the consultations rates for PCP and MHS were higher for female than male survivors. The levels of posttraumatic stress, depression and anxiety symptoms and somatic symptoms were also higher in female survivors both early and at long-term after the attack. Conclusions Our study demonstrated that both PCP and MHS played important roles in providing healthcare for psychological problems in young survivors of terrorism in Norway. Potential implications for public health preparedness to mass trauma will be discussed in the presentation.

5.O. Workshop: Psychosocial impact and healthcare utilization after terrorist attacks

Abstract Terrorist attacks can be regarded as a major public health issue, confronting not only political leaders with adequate answers to these threats, but also the public healthcare, and especially the public mental healthcare. The impact of terrorist attacks is mostly severe, widespread, affecting those directly exposed and their close ones, but also first responders, healthcare workers, local communities and even the society at large. While the directly involved are often confronted with severe physical and acute, often transient, traumatic stress symptoms, longitudinal studies increasingly show that a much larger group is affected by persistent mental health problems, such as posttraumatic stress disorders, depression, or a general undermining of their mental and physical wellbeing, sometimes seriously impairing their personal and social functioning. These problems may differ by severity of exposure and individual risk factors, but are also related to access to timely, appropriate and effective healthcare and psychosocial support. The mostly unpredictability of these threatening events, the urgency of response, and the often-chaotic circumstances are challenging factors to identify the most vulnerable people that need psychosocial care, and to organize optimal care. It also impedes the assessment of the efficiency of implemented psychosocial care. However, systematic planning and evaluating psychosocial care based on scientific evidence on the best practices is important to efficiently respond to and recover from mass casualty incidents such as terrorist attacks. Until now, scientific knowledge about the current state of utilization of healthcare by the affected population, and about the best practices taking into account specificity of certain vulnerable subgroups is still very scarce. In this workshop four speakers from different countries will present their research findings about the psychosocial impact of terrorist attacks, the way how this is addressed by society and the actual healthcare utilization of the affected people. Recommendations regarding a more adequate response are proposed. Roel Van Overmeire will talk about the long-term psychosocial care response by the Belgium government, from both the level of the policy, as well as from the perspective of victims. Lise Stene will present a register-based study of survivors'utilization of primary care and mental health services before and after the Utoya attack in Norway. Yvon Motreff will inform us about the psychological impact on first responders and their engagement in mental health care after the 2015 terrorist attacks in France. Finally, Ulrich Wesemann will further focus on mental healthcare provided to emergency responders after the Berlin terrorist attack in 2016 in Germany, and will specifically examine the outcome of crisis intervention in relation to gender and occupational characteristics. Key messages • Public mental health impact of terrorist attacks is substantial and needs an adequate and differentiated psychosocial care response. • Research on healthcare utilization after terrorist attacks is needed to strengthen public health preparedness.

Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study

IntroductionPublic health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of...