Primary Health Care Utilization Research Articles

Awareness and Utilisation of Primary Healthcare to Reduce Emergency Department Overcrowding in Saudi Arabia

Background Patients seeking emergency department (ED) care for non-acute conditions are a major contributor to ED overcrowding, which results in longer wait times. Method This was a cross-sectional study, conducted using an online survey among the Saudi population to assess their awareness about primary healthcare clinics (PHCCs) and urgent care clinics (UCCs), their role, and their scope of practice. Results A total of 565 participants were included in this study. Most of the respondents (81.1%) reported lengthy waiting times in the ED. Moreover, most (81.6%) stated that they had never visited a family doctor, yet they (92.6%) favoured having one for follow-up care. Close to half of the participants (50.3%) reported attending PHCCs without an appointment, and the majority of them (69.2%) said that PHCCs were overcrowded. Finally, most participants (92.4%) had not heard aboutUCCs. Conclusion ED overcrowding and prolonged waiting times remain a public concern. PHCCs and UCCs are underutilised, and this is attributed to the lack of awareness about their scope and their services.

Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort study

Objectives To (1) describe primary health care utilization and (2) estimate the effect of primary care early follow-up, continuity, regularity, frequency, and long consultations on asthma hospital readmission, including secondary outcomes of emergency (ED) presentations, asthma preventer adherence, and use of rescue oral corticosteroids within 12 months. Methods An Australian multi-site cohort study of 767 children aged 3–18 years admitted with asthma between 2017 and 2018, followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets. We estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status and self-reported GP characteristics. Results The median number of general practitioner (GP) consultations, unique GPs and clinics visited was 9, 5, and 4, respectively. GP care was irregular and lacked continuity, only 152 (19.8%) children visited their usual GP on more than 60% of occasions. After adjusting for confounders, there was overall weak indication of effects due to any of the exposures. Increased frequency of GP visits was associated with reduced readmissions (4–14 visits associated with risk ratio of 0.71, 95% CI 0.50–1.00, p = 0.05) and ED presentations (>14 visits associated risk ratio 0.62, 95% CI 0.42–0.91, p = 0.02). Conclusions Our study demonstrates that primary care use by children with asthma is often irregular and lacking in continuity. This highlights the importance of improving accessibility, consistency in care, and streamlining discharge communication from acute health services.

Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

China launched the primary health care (PHC) system oriented National Essential Public Health Service Package (NEPHSP) in 2009, to combat health challenges including the increasing burden from hypertension and type-2 diabetes (T2DM). In this study, the PHC system was assessed to understand factors influencing the uptake of the NEPHSP for hypertension and T2DM management. A mixed-methods study was conducted in seven counties/districts from five provinces across the mainland of China. Data included a PHC facility level survey and interviews with policy makers, health administrators, PHC providers, and individuals with hypertension and/or T2DM. The facility survey used the World Health Organisation (WHO) service availability and readiness assessment questionnaire. Interviews were thematically analysed using the WHO health systems building blocks. A total of 518 facility surveys were collected with over 90% in rural settings (n=474). Forty-eight in-depth individual interviews and 19 focus-group discussions were conducted across all sites. Triangulating the quantitative and qualitative data found that China's continuous political commitment to strengthening the PHC system led to improvements in workforce and infrastructure. Despite this, many barriers were identified, including insufficient and under-qualified PHC personnel, remaining gaps in medicines and equipment, fragmented health information systems, residents' low trust and utilization of PHC, challenges in coordinated and continuous care, and lack of cross-sectorial collaborations. The study findings provided recommendation for future PHC system strengthening, including improving the quality of NEPHSP delivery, facilitating resource-sharing across health facilities, establishing integrated care systems, and exploring mechanisms for better cross-sectorial engagement in health governance. The study is supported by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Disease funding (APP1169757).

Impact of community-based health insurance on healthcare utilisation and out-of-pocket expenditures for the poor in Senegal

ObjectivesThis study aims to assess the impact of the subsidised community health insurance scheme in Senegal particularly on the poor.Design and settingThe study used data from a household survey conducted...

Impact of Covid-19 Pandemic on Primary Health Care Utilization in Alberta

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Cutaneous melanoma, prostate-specific antigen testing and the subsequent risk of prostate cancer diagnosis: a prospective analysis of the 45 and Up Study

BackgroundThe association between cutaneous melanoma and subsequent risk of prostate cancer (PC) was examined in a large population-based cohort study.MethodsMale participants in the Sax Institute’s 45 and Up Study (Australia) were recruited between 2006 and 2009. Questionnaire data and linked administrative health data from the Centre for Health Record Linkage and Services Australia identified melanomas diagnosed between 1/1/1994 and 12 months before Study recruitment (i.e., between 2005 and 2008), incident PCs, primary healthcare utilisation and prostate-specific antigen (PSA) tests. Men were excluded from the current analyses if they had a recorded PC or other cancer diagnosis other than melanoma and non-melanoma skin cancer prior to recruitment. Multivariable Cox regression was used to estimate hazard ratios (HRs) adjusting for PSA-testing frequency before PC diagnosis.ResultsOf 96,548 eligible men, 1899 were diagnosed with melanoma during the melanoma diagnosis period and 3677 incident PC diagnosed during follow-up (latest date 31/12/2013). Men with melanoma diagnosis had increased risk of a subsequent PC diagnoses (vs. no melanoma; fully adjusted HR = 1.32; 95% CI: 1.09–1.60). There was weak evidence of higher risks of a subsequent PC diagnosis for men diagnosed with more than one melanoma compared to men diagnosed with only one melanoma (p = 0.077), and if first melanoma diagnosis was 10 to 15 years before Study recruitment (fully adjusted HR = 2.05; 95% CI [1.35, 3.12]).ConclusionMelanoma diagnosis was associated with increased risk of subsequent PC diagnosis, after adjusting for PSA testing and primary healthcare utilisation. While our ability to adjust for PC screening reduced risk of detection bias, we acknowledge that residual confounding from increased medical surveillance after melanoma diagnoses cannot be entirely ruled out.

Effectiveness of community-based multidisciplinary integrated care for older people: a protocol for a systematic review

IntroductionThe increasing number of older adults with multiple complex care needs has placed increased pressure on healthcare systems internationally to reorientate healthcare delivery. For many older adults, their first point...

Behavioral Risk Factor and Primary Healthcare Utilization in South Africa.

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

Impacts of Internet Use on Chinese Patients' Trust-Related Primary Healthcare Utilization.

Background: The internet has greatly improved the availability of medical knowledge and may be an important avenue to improve patients’ trust in physicians and promote primary healthcare seeking by reducing information asymmetry. However, very few studies have addressed the interactive impacts of both patients’ internet use and trust on primary healthcare-seeking decisions. Objective: To explore the impact of internet use on the relationship between patients’ trust in physicians and primary healthcare seeking among Chinese adults 18 years of age and older to understand the varieties of effects in different cities. Methods: Generalized linear mixed models were applied to investigate the interactive impacts of internet use and patients’ trust in physicians on primary healthcare seeking using pooled data from the China Family Panel Study of 2014 to 2018. We also compared these effects based on different levels of urbanization, ages, and PHC services. Results: Overall, a higher degree of patients’ trust (p < 0.001) was able to directly predict better primary healthcare seeking, and internet use significantly increased the positive effect of patients’ trust on primary healthcare seeking (p < 0.001). However, the marginal effect analysis showed that this effect was related to the level of patients’ trust and that internet use could reduce the positive effect of patients’ trust on primary healthcare seeking when the individual had a low level of trust (≤ 3 units). Further, the heterogeneity analysis indicated that the benefits from internet use were higher in cities with high urbanization, high aging, and high PHC service levels compared to cities with low levels of these factors. Conclusions: The internet use may enhance patients’ trust-related PHC utilization. However, this impact is effective only if patients’ benchmark trust remains at a relatively high level. Comparatively, the role of internet use is more effective in areas with high urbanization, high aging and high PHC level. Thus, with increasing accessibility to the internet, the internet should be regulated to disseminate correct healthcare information. Moreover, in-depth integration of the internet and PHC should be promoted to provide excellent opportunities for patient participation, and different strategies should be set according to each city’s characteristics.

Impact of COVID-19 on pregnancy-related healthcare utilisation: a prospective nationwide registry study

ObjectiveTo assess the impact of COVID-19 on pregnancy-related healthcare utilisation and differences across social groups.DesignNationwide longitudinal prospective registry-based study.SettingNorway.ParticipantsFemale residents aged 15–50 years (n=1 244 560).Main outcome measuresPregnancy-related inpatient, outpatient...

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018.

Health development in the Papua region often lags behind other areas of Indonesia. The study aims to analyze the role of government-run insurance in primary health care utilization in the Papua region, Indonesia. The study examined 17,879 Papuan. The study used primary health care utilization as an outcome variable and health insurance ownership as an exposure variable. The study also employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and travel time to primary health care. The research employed data using binary logistic regression in the final analysis. The results show that Papuans with government-run insurance were three times more likely to utilize primary health care than uninsured Papuans (AOR 3.081; 95% CI 3.026-3.137). Meanwhile, Papuan with private-run insurance were 0.133 times less likely to utilize primary health care than uninsured Papuans (AOR 0.133; 95% CI 0.109-0.164). Moreover, Papuans who have two types of health insurances (government-run and private-run) were 1.5 times more likely to utilize the primary health care than uninsured Papuan (AOR 1.513; 95% CI 1.393-1.644). The study concluded that government-run insurance increases the chance of primary health care utilization in the Papua region, Indonesia. Government-run insurance has the most prominent role compared to other health insurance categories.

Use of primary health care services among older patients with and without diabetes

BackgroundThe aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes.MethodsElectronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person with diagnosis of diabetes. A health questionnaire was sent by mail to 527 people with diabetes and 890 controls. Of the persons who answered the questionnaire, 518 persons were randomly selected to participate in a health examination. The study group in this analysis consisted of 187 persons with diabetes and 176 persons without diabetes who attended the health examination. The data on primary health care utilization were extracted from electronic patient records one year before and one after the health examination.ResultsBefore the onset of the study, the patients with diabetes had more doctor’s appointments (p < 0.001), nurse’s appointments (< 0.001) and laboratory tests taken (p < 0.001) than those without diabetes After 1-year follow-up period the patients with diabetes had more doctor’s appointments (p = 0.002), nurse’s appointments (p = 0.006), laboratory tests taken (p = 0.006) and inpatient care at the community hospital (p = 0.004) than patients without a diagnosis of type 2 diabetes. The use of the community hospital increased significantly among patients with diabetes (ratio 2.50; 95% Cl 1.16–5.36) but not by patients without diabetes (ratio 0.91; 95% Cl 0.40.2.06). The number of nurse’s appointments increased for patients without diabetes (ratio 1.31; 95% Cl 1.07–1.60) but not for those with diabetes (ratio 1.04; 95% Cl 0.88–1.24).ConclusionsPatients with diabetes visit more often physicians and nurses compared with those without diabetes. During a 1-year follow-up, the use of community hospital care increased significantly among patients with diabetes. In addition to focusing on prevention and care of diabetes, these results suggest the importance of diabetes in planning community-based health care services.

Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states

BackgroundApproximately every fourth person in Germany has a migration background. Health research on the use of primary and specialist health care in this group is still scarce. Few studies have suggested a difference in the use of primary and specialist health care among people with a migration background. Potential resources and barriers to health care access should be investigated as they are critical to health equity. This study investigates associated sociodemographic, migration-sensitive, and health-related factors of primary and specialist health care utilization among people with a migration background as defined by nationality.MethodsAnalyses are based on data from a feasibility study of the project “Improving Health Monitoring in Migrant Populations” (IMIRA), conducted by the Robert Koch Institute. The sample (n = 1055) included persons with Croatian, Polish, Romanian, Syrian, and Turkish nationalities living in the federal states of Berlin and Brandenburg, Germany. Descriptive and bivariate analyses as well as multiple binary logistic regression analyses were carried out to assess sociodemographic (sex, age, socioeconomic position), health-related (self-rated health), and migration-sensitive factors (duration of residence in Germany, residence status, German language proficiency) associated with the use of primary and specialist health care services in the past 12 months.ResultsOf the total study population, 79.62% visited a general practitioner and 59.53% a specialized physician in the past 12 months. Participants who were female sex, aged 65 and older, and with moderate/poor/very poor self-rated health had higher odds of visiting a general practitioner and a specialized physician, with the strongest impact from self-rated health. After controlling for sociodemographic and health-related factors, duration of residence in Germany and residence status were associated with primary but not with specialist health care utilization.ConclusionsOur results suggest that migration-sensitive characteristics, such as duration of residence, should be considered in a differentiated manner in health services research to gain detailed insights into health care utilization and its potential barriers among the heterogenous group of people with a migration background. Further research needs to be done to evaluate how to get people into contact with a general practitioner.

Utilisation of village clinics in Southwest China: evidence from Yunnan Province.

Primary healthcare in rural China is underutilised, especially in village clinics in Southwest China. The aim of this study was to explore any relationships among the ethnicity of the healthcare provider, the clinical competence of the healthcare provider, and the utilisation of village clinics in Southwest China. This cross-sectional survey study involved 330 village healthcare providers from three prefectures in Yunnan Province in 2017. Multiple logistic regressions were adopted to investigate the utilisation of primary healthcare among different ethnic healthcare providers. Primary healthcare utilisation was higher in village clinics where healthcare providers were Han Chinese than those where healthcare providers were ethnic minority (151 vs 101, P=0.008). The logistic regression analysis showed that clinical competence was positively associated with the utilisation of primary healthcare (odds ratio [OR]=1.49, 95% confidence interval [CI]=1.12-2.00; P=0.007) and that inadequate clinical competence of ethnic minority health workers may lead to a lag in the utilisation of primary healthcare (OR=0.45, 95% CI=0.23-0.89; P=0.022). Our results confirm differences in the utilisation of primary healthcare in rural Yunnan Province among healthcare providers of different ethnicities. Appropriate enhancements of clinical competence could be conducive to improving the utilisation of primary healthcare, especially among ethnic minority healthcare providers.

Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare

BackgroundOpioid substitution treatment (OST) populations are aging and have increased mortality and somatic morbidity compared to general populations internationally. While OST patients have poor self-rated physical health and unmet healthcare needs, documented healthcare utilization has been sparsely investigated. The aim of this study was to assess registered healthcare utilization for somatic conditions in a sample of Swedish OST patients, and compare healthcare utilization among OST patients with and without use of on-site primary healthcare (PHC).MethodsPatients in OST in Malmö, Sweden, were recruited for a survey study conducted in 2017–2018. Survey data were compared with comprehensive patient records from specialized and primary care during one year prior to study inclusion (total n = 190). All patient records were examined for healthcare utilization, source of healthcare (PHC, emergency care and secondary care), and documented diagnoses and symptoms. Factors associated with healthcare utilization were analyzed by using logistic regression analysis. Patients with and without on-site PHC were compared by using descriptive statistics and Chi-2 test.ResultsA total of 88% of the sample had been in direct or indirect contact with somatic healthcare during one year (PHC 66%; emergency care 28%; secondary care 67%). The most prevalent somatic diagnoses were infectious diseases (39%) and symptom diagnoses (37%). Respiratory, dermatological and musculoskeletal diagnoses, and trauma/intoxication were documented in 21–26% of the sample, respectively. PHC utilization was associated with older age and being born in Sweden. Among patients with on-site PHC (n = 25), the number utilizing secondary care was 84%, and certain diagnostic codes were more frequent in this group.ConclusionOST patients are seemingly underserved as regards their physical health. Since increased OST access decreases opioid overdose fatalities, the life expectancy among OST patients is likely to increase and thereby also increases the risk of age-related conditions. Thus, easily accessible physical healthcare is of great importance in this group. On-site PHC might be a way to establish healthcare contact with OST patients, especially for non-acute conditions, although further research is needed.

Research on Disparities in Primary Health Care in Rural versus Urban Areas: Select Perspectives

Much of the differences in health care outcomes can be attributed to the differential rates of primary health care utilization and resource allocation across population subgroups [...].

Effects of long-term care benefits on healthcare utilization in Catalonia

This paper estimates effects of long-term care (LTC) benefits on utilization of primary and secondary healthcare in Catalonia (Spain). Identification comes from plausibly exogenous variation in the leniency of LTC needs assessment. We estimate that receiving LTC benefits worth 365 euros per month, on average, reduces the probability of avoidable hospital admissions by 66%, and has no significant effect on planned hospitalisations nor on hospitalisation for any reason. Receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. These findings have important policy implications suggesting that allocating resources to LTC may not only increase the welfare of LTC beneficiaries but also reduce avoidable and unscheduled utilisation of healthcare.

Nurse visit utilization and blood pressure control: A multi-cohort study in New Zealand.

This study aimed to retrospectively examine the contribution of nurses to population health outcomes with reference to nurse visits and blood pressure measurement in primary health settings. A retrospective study was conducted using New Zealand Health Survey (NZHS) from 2012 to 2017. Adult population who are 18 years old and over living in New Zealand. Age, gender, and ethnicity, the service utilization of primary health care nurse visit and blood pressure measurement were extracted from the NZHS (2012-2017) to compare with the service utilization of primary health care nurses by different demographic groups. Females who have treated hypertension shows higher utilization of nurse visit than males. From 2015 to 2017, the participants in this cohort have visited a primary health care nurse at least more than once within a year. With blood pressure control, the overall pooled results show the impact of visiting primary health nurses on systolic and diastolic blood pressure control. Our study at a national scale, demonstrated the impact of nurse's contribution to population health outcomes among people living with hypertension in New Zealand. Nurses are key to improving population health outcomes and to achieve universal health coverage.

Health and related indicators 2021

This chapter aims to provide a repository of data, focusing on the national and provincial levels, that describes the broad status of the South African health system (socio-demographic indicators and determinants and health status indicators, as well as health service indicators). Data were sourced primarily from national routine data sources, but also captured major surveys and global reports. The impact of the COVID-19 pandemic was viewed through multiple lenses. COVID-19 hastened the development of new or improved health information systems or modules to track both the disease and health system inputs and responses. Real-time reporting of incident cases, hospitalisations and mortality was enabled, including weekly estimates of the number of excess deaths associated with the pandemic. Ensuring that these innovations are retained after the pandemic will be important. COVID-19 has also emphasised the need to ensure that all data systems use a common unique identifier. COVID-19 has resulted in many collateral impacts on other aspects of health service delivery and outcomes, and selected examples were reported on, using routine data to illustrate the difference between expected and observed measures. Marked impacts were shown on the Primary Health Care utilisation rate and antenatal care, and on specific disease programmes, such as tuberculosis screening, testing and treatment initiation, HIV testing, antiretroviral therapy initiation and continuity of care. Less dramatic impacts on childhood immunisation coverage were evident from routine data. Community Health Workers have been a vital cadre in the response to COVID-19 and in mitigating disruptions to health service delivery as a result of the pandemic, yet their role in the health system is poorly documented and managed, since they are not included in the mainstream information systems. As South Africa transitions from a pandemic response to the means of managing COVID-19 as an endemic disease, a key task will be to retain what is most useful in health information systems and other innovations, and to ensure that these continue to contribute to the unfinished agenda of universal health coverage.

The impact of non-response weighting in health surveys for estimates on primary health care utilization.

BackgroundLow response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years.MethodsRegistry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents.ResultsAcross all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%.ConclusionsApplying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.