Utilization Of Primary Care Services Research Articles

Primary Care Service Utilization Among People at High Risk of Fatal Opioid Overdose: A Short Communication on an Autopsy Study.

Objectives: We sought to explore the sociodemographics and primary care service utilization among people who died from opioid overdose and to assess the possibility of using this information to identify those at high risk of opioid overdose using routine linked data. Methods: Data related to decedents of opioid overdose between January 1, 2012 and December 31, 2015 were linked with general practitioner (GP) records over a period of 36 months prior to death. Results: Of n = 312 decedents of opioid overdose, 73% were male (n = 228). Average age at death was 40.72 (SD 11.92) years. A total of 63.8% of the decedents were living in the 2 most deprived quintiles according to the Welsh Index of Multiple Deprivation. Over 80% (n = 258) of the decedents were recorded as having at least 1 GP episode during the 36-month observation period prior to death. The median number of episodes per decedent was 75 [38-118]. Overall, 31.8% (n = 82) of decedents with at least 1 GP episode received a prescription for a proton pump inhibitor and 31% (n = 80) were prescribed a broad-spectrum antibiotic. According to their GP records, less than 10% were referred to or receiving specialist drug treatment (n = 24, 9.3%); or were known to be drug dependent (n = 21, 8.14%), or a drug user (n = 5, 1.94%). In all, 81% were recorded as smokers (n = 209) and 10.5% as ex-smokers (n = 27). Conclusions: The majority of decedents of opioid overdose were in contact with GP services prior to death. GPs are either often unaware of high-risk opioid use, or rarely record details of opioid use in patient notes. It is possible that GP awareness of high-risk opioid use could be increased. For example, awareness of the risks associated with opioid use, and the relationship between the sociodemographic and clinical characteristics of opioid overdose decedents could be raised using educational materials prominently displayed in waiting areas. Clinicians in primary care may be in an excellent position to intervene in problematic opioid use.

A Study on Utilization of Primary Health Care Services among the People Residing in a Semi-Urban Area

Background: Primary healthcare is a vital strategy which remains the backbone of health service delivery. As on March 31 st 2017, there were a total of 25, 650 primary health centres(PHC) functioning in the country. Though the number of PHC’s had increased, the utilization is declining over the years as people seek private health sectors due to various reasons. Objective: To assess the awareness and utilization of primary health care services provided by Thirumazhisai PHC. Methodology: A Community based cross-sectional study was conducted among people residing in Thirumazhisai. The Sample size of 233 was calculated. The study population was selected by simple random sampling technique. A pre-designed, pre-tested semi- structured questionnaire was used to collect data. Data entered in MS excel and analyzed using proportion. Results: Among 233 people, 183 (78.8%) people knew about PHC services. Regarding utilization of services, 165(70.8%) were availing services provided by PHC. The reasons given for non utilization of services were long waiting time (51.4%), dissatisfaction of Doctor-Patient relationship(17.7%), non-availability of essential medicines (14.7%), PHC not clean (8.8%), and PHC does not have all required services (7.4%). Conclusion: In resource-constrained developing countries like India, all efforts should be undertaken to bring about the maximum efficiency of health care delivery. Role of primary healthcare is essential in the progress towards achieving universal health coverage (UHC).

Determinants of frequent use of primary care in the German healthcare system

Abstract Background In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system. Methods The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany’s national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of physician contacts in the preceding 12 months as frequent attenders. Binary logistic regression models with average marginal effects were used to identify determinants for the frequent use of primary care services. Results The sample comprised 7,956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, and factors related to objective need for medical care and subjective health status. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect between subjective health status and number of non-communicable diseases, indicating the association of disease with frequent use was highly moderated by subjective perception of health. Conclusions We observed strong associations between frequent primary care attendance and objective and subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization behaviour and avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services. Key messages The number of NCDs diseases and subjective health had the strongest effect on frequent primary care use. The findings suggest that better coordination of care may be the preferred method to manage health services utilization.

Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013

IntroductionCambodia’s health equity fund (HEF) is the country’s most significant social security scheme, covering the poorest one-fifth of the national population. During the last two decades, the HEF system was...

Epidemiology and utilization of primary health care services in Qatar by asthmatic children 5\u201312\u2009years old: secondary data analysis 2016\u20132017

BackgroundChildhood asthma is a growing clinical problem and a burden on the health care system due to repetitive visits to children’s emergency departments and frequent hospital admissions where it is poorly controlled. Due to lack of reliable baseline information on its prevalence among children in Qatar and the extent of their utilization of primary health care services, we sought to analyse electronic medical records data for children aged 5–12 years.ObjectivesOur primary objective was to establish point prevalence over the period 2016–2017. Furthermore, we wanted to assess the frequency and pattern of use of the primary care services including any demographic and seasonal variations, the types of clinical encounter and treatment received.MethodsA cross sectional study on 54,704 clinical encounters of electronic health records for children aged 5 to 12 years in which a diagnosis of Asthma was tagged during a two years period.ResultsThe prevalence rate of Asthma out of total registered clients in the specified pediatric age group (196,557) is 6.1%. The rate was highest (10.2%) in youngest age group (5–6 years old) and lowest (4.1%) in teenagers (10–12 years old). An obvious peak of clinical encounters of Asthma cases was observed in Oct and Nov. The work load in PHCC clinics for Asthma clinical encounters is increased by more than 50% compared to the average monthly count of 4556.Moreover, the rate was higher in males (7.6%) compared to females (4.6%). The most frequently prescribed medication group was antihistamine (57.8%) followed by adrenergic bronchodilators (33.9%).ConclusionsAsthma constitutes an important part (8.5%) of the total primary care clinic work load among children aged 5–12 years in Qatar. A guideline need to encourage physician to use preventive Asthma strategies including steroid medications to provide continuity of care for Asthma cases.

Patterns of primary health care service use of Indigenous Australians diagnosed with cancer.

The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. A total of 138 patients' records were audited. During 12months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.

Primary care engagement is associated with increased pharmacotherapy prescribing for alcohol use disorder (AUD)

BackgroundPrimary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary care engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is unknown.MethodsWe examined a 5-year (2010–2014) retrospective cohort of patients with AUD, 18 years and older, at an urban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no primary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy prescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association between primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical factors.ResultsOf 21,159 adults (28.9% female) with AUD, 2.1% (n = 449) were prescribed pharmacotherapy. After adjusting for confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care was 1.61% (95% CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56% (95% CI 2.06, 3.06) for patients with limited primary care and 2.89% (95% CI 2.44, 3.34%) for patients engaged with primary care.ConclusionsThe percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care engagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase primary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing; however, strategies to increase prescribing across health care settings are needed.

Utilization of primary health care services among Syrian refugee and Lebanese women targeted by the ICRC program in Lebanon: a cross-sectional study

BackgroundThe Syrian crisis has put tremendous strain on the Lebanese health system, particularly in the historically underserved border region. The ICRC Primary Health Care program has focused on refugee and host communities in these areas. This study objectives were: 1) to determine whether the ICRC program was reaching the most vulnerable populations; 2) to understand the key perceived health needs in the catchment areas of the ICRC supported facilities; and 3) to identify barriers to utilization of health care services.MethodsBetween July and September 2017 we conducted two cross-sectional studies - one randomized household survey and one clinic-based - in the catchment areas of three ICRC-supported facilities, targeting women of reproductive age and caretakers of children under five. Differences between groups were analysed with t-test or chi-squared test.ResultsIn the household survey, similar socio-demographic profiles were observed between Syrian refugee women and vulnerable Lebanese hosts. With regard to the study objectives:The most vulnerable populations were those seen in the ICRC-supported facilities.For both populations, the most common reasons for seeking care were non-communicable diseases (40.6%) and sexual and reproductive health issues (28.6%). Yet the people reaching the ICRC supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey.In the catchment areas, reported gaps included low immunization coverage and low levels of antenatal care and family planning both for Syrian and Lebanese. Dental care also emerged as an issue. Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness.ConclusionsDespite the ICRC reaching the most vulnerable Syrian and Lebanese communities, the population-based survey revealed that important gaps exist in terms of utilization of health care services among women of reproductive age and their children. A stronger outreach component is needed to address lack of awareness. Innovative solutions are also needed to address cost barriers at the levels of both facility and individual user.

\u201cI feel more comfortable speaking to a male\u201d: Aboriginal and Torres Strait Islander men\u2019s discourse on utilizing primary health care services

BackgroundAboriginal and Torres Strait Islander men have the highest morbidity and mortality rates, and lowest rates of health service utilization in Australia. There is a current perception that Aboriginal and Torres Strait Islander men are disinterested in their health. This study aimed to identify the perceived motivators, barriers and enablers of Aboriginal and Torres Strait Islander men’s utilization of primary health care services, explore their experiences and obtain suggestions from them as to how services could be modified to improve utilization.MethodsThis study utilized the principles of Indigenist Research Methods. Semi-structured interviews with Aboriginal and Torres Strait Islander men (N = 19) took place in South Australia and far north Queensland. Participants were asked about their experiences with primary health care services, including what they could remember as a child. A thematic analysis of the qualitative data was completed without the use of computer software.ResultsFeelings of invincibility, shame, being uncomfortable, fearful, along with long waiting times, having a lack of knowledge, and culturally inappropriate staff/services were all found to be barriers to service utilization. Enabling factors included convenience, the perceived quality of the service, feeling culturally safe and/or a sense of belonging, and having a rapport with staff. Motivation for attending primary health care services included going when feeling sick/unwell, attending a particular service (dental or sexual health), visiting for check-ups and preventative health and family encouragement.This study also highlights strategies surrounding logistical factors, promotion of services and improved communications, having culturally appropriate services and providing gender specific services all of which were suggested by the participants to improve service utilization.ConclusionContrary to common misperceptions, this study demonstrated that most of the Aboriginal and Torres Strait Islander men participants were motivated to engage with primary health care services for preventative health care. Even though there were men that fitted the stereo-type who avoid doctors, there were usually underlying reasons and barriers accounting for this reluctance. This study suggests that if primary health care services commit to better understanding the barriers, enablers and motivators their cohort of men face, then utilization could be greatly improved.

Understanding the utilization of primary health care services by Indigenous men: a systematic review

BackgroundAboriginal and Torres Strait Islander men experience worse health outcomes and are the most marginalized and disadvantaged population group in Australia. Primary health care services are critical to providing both clinical and social and emotional support, however, remain underutilized by Aboriginal and Torres Strait Islander men. This review aims to better understand the utilization of primary health care services by Indigenous men and assess the effectiveness of strategies implemented to improve utilization.MethodsA four-step search strategy was employed across four databases to find peer-reviewed publications and grey literature from Australia, New Zealand, Canada and America. The search began in March 2015 and included the following databases PubMed, CINAHL, Informit (Indigenous collection) and Embase. Additional databases and websites were also searched for grey literature, reference lists of included publications were searched for additional studies and relevant experts were consulted.ResultsThe literature search found seven articles that met the inclusion criteria; four describing three research projects, plus three expert opinion pieces. The search was unable to find published research on strategies implemented to improve primary health care utilization by Indigenous men.There is limited published research focused on the utilization of primary health care by Indigenous men. From the identified papers Indigenous men described factors impacting utilization which were categorized into three primary organizing themes; those related to health services, the attitudes of Indigenous men and knowledge. It is evident from the identified papers that improvements in Indigenous health can only occur if future programs are developed in collaboration with health services and Indigenous men to address differing requirements.ConclusionsCurrently, health systems in Australia are limited in their ability to improve the health and wellbeing of Aboriginal and Torres Strait Islander males without such strategies. Future research should focus on evaluating the implementation of men specific utilization strategies. It is through evidence-based research that subsequent policies and programs can be made and implemented to improve Indigenous men’s health.

Utilization of Primary Health Care Services in Rural and Urban Areas in Shiraz

Background: Different factors affect individuals’ behaviors when they encounter a health problem or a disease. This cross-sectional study was conducted to analyze health-seeking behaviors and utilization pattern of primary health care services among the households living in Shiraz, Iran. Methods: This household survey was conducted among 500 households living in urban and rural areas, selected through three-stage sampling during 2016 - 2017. The data were collected via a questionnaire designed by the researcher (Cronbach’s alpha coefficient: 0.747), and the questions were answered by the most informed family members. The data were then analyzed using Chi-square, independent samples t-test, one-way analysis of variance (ANOVA) and Pearson correlation coefficient. Results: We found that 52.4% of the subjects were female, 65.6% were married and 34.4% had academic education. Furthermore, 95% were under the coverage of a health insurance, of which 64.4% had social security insurance. The mean age of the participants was 39.08 years. In terms of socio-economic characteristics of the households, 52.4% had a personal house and 56.6% were in the income group of 10 - 20 million Rials. The average household size was 3.86. Further, 41.8% of the households had elderly member(s), 49.6% had hypertensive patient(s) and 32.8% of the households had diabetic member(s). Only 31.2% of the participants said they needed consultation on high-risk behaviors. According to our findings, the subjects had inappropriate health-seeking behaviors (direct referral to a specialist physician and disregarding the problem) when facing four out of the seven services surveyed (about 60%). The most important reason for disregarding the problem was that it did not seem serious to the individuals. Our results showed when facing simple illnesses, education level (P = 0.003), age (P = 0.001), insurance (P = 0.000), type of insurance (P = 0.000), income level (P = 0.001), residence (P = 0.001) and type of referral system (P = 0.004) had a statistically significant relationship with the possibility seeking service and the level of services utilized. The factors affecting the utilization of primary health care services when requiring nutritional counseling, psychological services, counseling for high-risk behaviors, elderly care, as well as hypertension and diabetic care were different. Conclusions: In half of the studied first-level health services, referral to specialist physicians was more common; this behavior would increase the health costs of the country. Therefore, it seems necessary to improve the quality of primary health care services, promote culture and adopt policies to encourage the referral system usage and carry out patient screening.

Assessment of utilization of primary health care services among settled Fulani agro-pastoralists in Ogun State, Nigeria

Utilization of primary health care services among settled Fulani agro-pastoralists in Ogun State was assessed in this study. Sixty (60) respondents were purposefully selected and interviewed using an interview guide. The data obtained were analyzed using descriptive and inferential statistics. The study revealed that the mean age of the respondents was 35.82, 68.3% of the respondents were females and majority (80.0%) of the respondents have no formal education. The results showed that friends and relatives were the main sources of information on primary health care services. About 90.0% of the respondents had positive attitude towards the use of primary healthcare services. The study also revealed that respondents visits primary health facility for pharmacy/dispensary (95.0%), maternity (98.3%) and vaccination/immunization (86.7%). The result of the study revealed that the most pressing constraint faced by the agro-pastoralists was the distance of health facility from their settlement. Regression analysis showed that income, distance from home to health care center, information, attitude and constraints face influenced the utilization of primary healthcare services among the respondents. The study recommends that government should build health centres close to the agro-pastoralists to reduce the cost of medical services accessed by the pastoralists. Keywords: Fulani, healthcare, Ogun State, pastoralist, utilization

Does quality influence utilization of primary health care? Evidence from Haiti

BackgroundExpanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti.MethodsWe constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery.ResultsFacilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure.ConclusionsPoor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Utilization of primary care among college students with mental health disorders.

Our goal was to assess whether integration of behavioral and medical services in college settings is associated with decreased use of primary care by patients with mental health diagnoses (MHDs). The cohort consisted of 80,219 patients with at least 1 MHD in 21 universities. Two levels of service integration were defined: "standard"-universities with separate electronic health records (EHR) systems and minimal clinical collaboration between services, and "enhanced"-universities with shared EHR and collaborative patient care. Frequency, the total number of primary care visits, and complexity, the total visit length for primary care per unit time, were compared by using multilevel models. Nine schools met the criteria of enhanced clinical integration; a tenth school shifted to enhanced service during the study period. Student and patient demographics and clinical diagnoses were similar between the 2 categories. When controlling for variance in age, sex, and total time in school, patients with MHDs in standard systems had 15.72% (95% confidence interval [CI]: 10.77%-20.44%) more primary care visits and 22.88% (95% CI: 21.42%-24.38%) more time than patients in enhanced systems. Students with MHDs have significantly lower utilization of primary care services in integrated health care systems, but only a minority of institutions nationally have adopted this model of care. Although further research is needed to specifically assess differences in health outcomes and perceived suffering, it is possible that reduced primary care visits in enhanced integrative service settings with robust mental health support indicates overall reduction in perceived suffering for patients/clients. (PsycINFO Database Record

The impact of transitional care programs on health services utilization in community-dwelling older adults: a systematic review.

The objective was to identify and synthesize the best available evidence on the impact of transitional care programs on various forms of health services utilization in community-dwelling older adults. There is growing evidence that transitional care programs can help address important challenges facing health care systems and our increasing older adult population in many countries by reducing unnecessary health service utilization. There is a need for a systematic review of the research evaluating the impact of transitional care programs on hospital and other health service usage. The review included studies on community-dwelling adults age 60 and over with at least one medical diagnosis, and which evaluated the outcomes of transitional care programs on health system utilization of older adults. The outcomes for this review were hospital usage including admissions and readmissions, emergency department usage, primary care/physician usage, nursing home usage, and home health care usage. The review considered experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, and case-control studies. A three-step search was utilized to find published and unpublished studies conducted in any country but reported in English. Six electronic databases were searched from inception of the database to May, 2016. A search for unpublished studies was also conducted. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research synthesis. Quantitative data were extracted from included studies independently by the two reviewers using the standardized Joanna Briggs Institute data extraction tools. Due to the methodological heterogeneity of the included studies, a comprehensive meta-analysis for all outcomes was not possible. Meta-analysis was conducted for rehospitalization at 30, 90 and 180 days. A narrative summary of other quantitative findings was conducted. Twenty-three studies met the inclusion criteria and were included in the review. Nineteen of the studies were randomized controlled trials and four were case control studies, involving 20,997 participants in total with a mean age of 76. Meta-analysis found that transitional care significantly reduced hospital readmission rates at 30 days (odds ratio [OR] 0.75, 95% confidence intervals [CIs] 0.62-0.91, p < 0.01), 90 days (OR 0.77, 95% CIs 0.59-1.02, p = 0.04), and 180 days (OR 0.67, 95% CIs 0.46-0.99, p < 0.01). Narrative synthesis indicated little impact of transitional care on emergency department and nursing home usage, increased use of primary care/physician usage, and decreased home health care usage. Based on a review of 23 studies conducted in the USA, Hong Kong, Canada, Germany, the Netherlands, Sweden and Switzerland, we identified four major conclusions. First, transitional care reduces rehospitalization rates over time, with the largest effects seen at 30 days. Second, transitional care may increase the utilization of primary care services and thus have a favourable impact on preventative care. Third, transitional care may reduce home health usage. Fourth, transitional care interventions of one month or less appear to be as effective as longer interventions in reducing hospital usage.

Post-stroke hypertension control and receipt of health care services among veterans.

Many ischemic stroke patients do not achieve goal blood pressure (BP<140/90mm Hg). To identify barriers to post-stroke hypertension management, we examined healthcare utilization and BP control in the year after index ischemic stroke admission. This retrospective cohort study included patients admitted for acute ischemic stroke to a VA hospital in fiscal year 2011 and who were discharged with a BP≥140/90mm Hg. One-year post-discharge, BP trajectories, utilization of primary care, specialty and ancillary services were studied. Among 265 patients, 246 (92.8%) were seen by primary care (PC) during the 1-year post-discharge; a median time to the first PC visit was 32days (interquartile range: 53). Among N=245 patients with post-discharge BP data, 103 (42.0%) achieved a mean BP<140/90mm Hg in the year post-discharge. Provider follow-ups were: neurology (51.7%), cardiology (14.0%), nephrology (7.2%), endocrinology (3.8%), and geriatrics (2.6%) and ancillary services (BP monitor [30.6%], pharmacy [20.0%], nutrition [8.3%], and telehealth [8%]). Non-adherence to medications was documented in 21.9% of patients and was observed more commonly among patients with uncontrolled compared with controlled BP (28.7% vs 15.5%; P=.02). The recurrent stroke rate did not differ among patients with uncontrolled (4.2%) compared with controlled BP (3.8%; P=.89). Few patients achieved goal BP in the year post-stroke. Visits to primary care were not timely. Underuse of specialty as well as ancillary services and provider perception of medication non-adherence were common. Future intervention studies seeking to improve post-stroke hypertension management should address these observed gaps in care.

Evaluation of results-based financing in the Republic of the Congo: a comparison group pre–post study

Results-based financing (RBF) has been advocated and increasingly scaled up in low- and middle-income countries to increase utilization and quality of key primary care services, thereby reducing maternal and child mortality rates. This pilot RBF study in the Republic of the Congo from 2012 to 2014 used a quasi-experimental research design. The authors conducted pre- and post-household surveys and gathered health facility services data from both intervention and comparison groups. Using a difference-in-differences approach, the study evaluated the impact of RBF on maternal and child health services. The household survey found statistically significant improvements in quality of services regarding the availability of medicines, perceived quality of care, hygiene of health facilities and being respected at the reception desk. The health facility survey showed no adverse effects and significantly favourable impacts on: curative visits, patient referral, children receiving vitamin A, HIV testing of pregnant women and assisted deliveries. These improvements, in relative terms, ranged from 42% (assisted deliveries) to 155% (children receiving vitamin A). However, the household survey found no statistically significant impacts on the five indicators measuring the use of maternal health services, including the percentage of pregnant women using prenatal care, 3+ prenatal care, postnatal care, assisted delivery, and family planning. Surprisingly, RBF was found to be associated with a reduction of coverage of the third diphtheria, pertussis, and tetanus immunization among children in the household survey. From the health facility survey, no association was found between RBF and full immunization among children. Overall, the study shows a favourable impact of an RBF programme on most, but not all, targeted maternal and child health services. Several aspects of programme implementation, such as timely disbursement of incentives, monitoring health facility performance, and transparency of using funds could be further strengthened to maximize RBF's impact.

Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study

ObjectiveThe objective was to analyze possible inequalities by gender in the utilization of health services (general practitioner [GP] and hospital), among people with non-communicable diseases (NCDs) in the Republic of Serbia, with special reference to multimorbidity. In addition, we examined the prevalence patterns of NCDs by sociodemographic characteristics of the population. Study designThis study is a population-based, cross-sectional survey. MethodsA secondary analysis from the 2013 Serbian National Health Survey included 13,765 adults aged ≥20 years. Multivariable logistic and linear regression analyses were performed to assess the association between NCDs and health care utilization. ResultsMultimorbidity was present in 30.2% of the total sample. An increased number of NCDs was associated with a higher utilization of both primary (odds ratio [OR] for having any GP visit is 3.17 in males and 3.14 in females; unstandardized coefficient [B] for number of GP visits is 0.33 for both gender) and secondary health care services (OR for having any hospitalization is 2.45 in males and 1.97 in females; B for number of overnight stays in hospital is 1.62 in males and 0.97 in females) in Serbia. ConclusionsOur study provided strong evidence that an increased number of NCDs was significantly associated with a higher utilization of health care services in Serbia. There is a need for wise, decisive, and integrated care interventions for effective management of NCDs and their risk factors. Further research is necessary with special emphasis on the role of the health system in satisfying needs of such patients.

Utilisation of primary health care services among rural dwellers in Oyo State

Utilisation of primary health care services among rural dwellers in Oyo State

Diabetes Screening among Antipsychotic-Treated Adults with Severe Mental Illness in an Integrated Delivery System: A Retrospective Cohort Study.

Severe mental illness (SMI) is associated with increased risk for type 2 diabetes, partly due to adverse metabolic effects of antipsychotic medications. In public health care settings, annual screening rates are 30%. We measured adherence to national diabetes screening guidelines for patients taking antipsychotic medications. To estimate diabetes screening prevalence among patients with SMI within an integrated health care system, and to assess characteristics associated with lack of screening. Retrospective cohort study. Antipsychotic-treated adults with SMI. We excluded participants with known diabetes. Primary outcome was screening via fasting glucose test or hemoglobin A1c during a 1-year period. In 2014, 16,754 patients with SMI diagnoses were receiving antipsychotics. Seventy-four percent of these patients' providers ordered diabetes screening tests that year, but only 55% (9247/16,754) received screening. When the observation time frame was extended to 2years, 73% (12,250/16,754) were screened. Adjusting for sex and race/ethnicity, young adults (aged 18-29 years) were less likely to receive screening than older age groups [adjusted RR (aRR) 1.23-1.57, p<0.0001]. Compared to whites, screening was more common for Asians (aRR 1.141, 95% CI 1.089-1.195, p<0.0001), less common for blacks (aRR 0.946, 95% CI 0.898-0.997, p<0.0375), and no different for Hispanics (aRR 1.030, 95% CI 0.988-1.074, p=0.165). Smokers were less likely to be screened than non-smokers (aRR 0.93, 95% CI 0.89-0.97, p<0.0008). Utilization of either mental health or primary care services increased the likelihood of screening. While almost three-fourths of adults with SMI taking antipsychotic medications received a lab order for diabetes screening, only 55% received screening within a 12-month period. Young adults and smokers were less likely to be screened, despite their disproportionate metabolic risk. Future studies should assess the barriers and facilitators with regard to diabetes screening in this vulnerable population at the patient, provider, and system levels.