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Having a family doctor was associated with lower utilization of hospital-based health services.

ABSTRACT: Primary care in the United States and most countries in Asia are provided by a variety of doctors. However, effectiveness of such diversified primary care in gate-keeping secondary medical services is unknown. This study aimed to evaluate health services utilization rates of hospital emergency and admission services among people who used different primary care doctors in Hong Kong.This study was a population-based cross-sectional telephone survey using structured questionnaire on health services utilization rates and pattern in Hong Kong in 2007 to 2008. Information on the choice of primary care doctors, utilization rates and patterns of primary care service were collected. Poisson and logistic regression analyses were used to explore any differences in service utilization rates and patterns among people using different types of primary care doctors.Out of 3148 subjects who completed the survey, 1896 (60.2%) had regular primary care doctors, of whom 1150 (60.7%) regarded their regular doctors as their family doctors (RFD). 1157 (36.8%) of them did not use any regular doctors (NRD). Only 4.3% of the RFD group (vs 7.8% of other regular doctors (ORD) and 9.6% of NRD) visited emergency service and only 1.7% (vs 3.6% of ORD and 4.0% of NRD) were admitted to hospital for their last episode of illness. Regression analyses controlling for sociodemographics and health status confirmed that respondents having RFD were less likely to use emergency service than people who had NRD (OR 0.479) or ORD (OR 0.624) or being admitted to hospital (OR 0.458 vs NRD and 0.514 vs ORD) for their last episode of illness.Primary care is the most effective in gate-keeping secondary care among people with regular family doctors. People without any regular primary care doctor were more likely to use emergency service as primary care. The findings supported a family doctor-led primary care model.ClinicalTrials.gov ID: NCT01422031.

SUBMITTER: Fung CS

PROVIDER: S-EPMC4312460 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Having a family doctor was associated with lower utilization of hospital-based health services.

Fung Colman S C CS Wong Carlos K H CK Fong Daniel Y T DY Lee Albert A Lam Cindy L K CL

BMC health services research 20150128

<h4>Background</h4>Primary care in the United States and most countries in Asia are provided by a variety of doctors. However, effectiveness of such diversified primary care in gate-keeping secondary medical services is unknown. This study aimed to evaluate health services utilization rates of hospital emergency and admission services among people who used different primary care doctors in Hong Kong.<h4>Method</h4>This study was a population-based cross-sectional telephone survey using structure ...[more]

PMID: 25627936

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Project description:BACKGROUND: Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference. METHODS: We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient's concerns. RESULTS: One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient's concerns. CONCLUSION: People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations.

Project description:BackgroundEthiopia is one of the developing countries with the poorest health status and the health services utilization is generally low with different patterns in different regions of the country. Therefore, the aim of this study was to assess utilization of modern health services and associated factors in Dessie, Ethiopia.MethodsA cross sectional study design was employed from January to March, 2015 in Dessie City. The total sample was 420 adults. Adults were selected by stratified random sampling. The strata were made using residence as urban and rural residents. The data was collected using pre-tested, interviewer administered questionnaire. The data was entered into Epi infoTM7 software and exported to Statistical Package for Social Sciences (SPSS) version 20 Software for analysis. Binary logistic regression was used to evaluate independent effect of each variable on modern health service utilization by controlling the effect of others. The strength of association between dependent variable and independent variables was expressed by odds ratio with 95% confidence interval.ResultsThe overall modern health services utilization rate was 41.8%. Being Female sex, annual income greater than poverty line, poor perception of health status, high perceived severity of illness, two or more than two number of illnesses in the last 12 months prior to the survey and presence of chronic health problem were found to have a significant association with utilization of modern health services.ConclusionModern health services utilization was found to be low. Being female sex, annual income above poverty line, having poor perceived health status, having two or more than two illnesses, severe perceived severity of illness and having chronic health problem were found to have a statistically significant association with utilization. Therefore, efforts have to be made to increase utilization of modern health services through establishing systems like health extension workers and health development army.

Project description:ObjectiveFamily doctors fulfill the role of gatekeepers in protecting residents' health with contracted services. Providing these valuable services involves multiple causes, relationships, and indirectly observable variables. This study used structural equation modeling to construct a dynamic model of the work of family doctors to provide a basis for incentives.MethodsThis study used 2-year follow-up data from a survey of 294 family doctors in Changning District, Shanghai. Data were analyzed using confirmatory factor analysis and structural equation modeling. The measurement model and structural model were defined, identified, verified, integrated, and revised to identify the factors motivating family doctors to provide contracted services. A dynamic path for the family doctor contracted services model was established and eventually modified with six endogenous latent variables: cognition, environmental satisfaction, income satisfaction, support satisfaction, stability, and contracting performance, underpinned by 27 measurement variables.ResultThe standardized regression coefficient of the effect of cognition on environmental satisfaction was 0.37 (P < 0.05) and the degree of variation interpretation was 0.14. The effect of cognition on income satisfaction was 0.54 (P < 0.05) and the degree of variation interpretation was 0.29. The effect of cognition on stability was 0.40 (P < 0.01), the effect of environmental satisfaction on stability was 0.12 (P < 0.05), and the effect of income satisfaction on stability was 0.22 (P < 0.05), all with a degree of variation interpretation of 0.369. Finally, the effect of stability on contracting performance was 0.51 (P < 0.05) with a degree of variation interpretation of 0.343.ConclusionsThe degree of family doctors' understanding (cognition) of their own work largely determines their behavioral orientation and service effectiveness. These results raise the possibility of enhancing family doctors' work stability and improving the performance of contracted services by increasing the income of family doctors.

Project description:BackgroundReducing the 30-day hospital readmission rate is a national priority and patient activation has emerged as a modifiable target to reduce hospital readmissions.ObjectivePrior studies demonstrate that low patient activation and low health literacy are each associated with higher rates of hospital utilization. The aim of this study was to use path analysis methods to assess if patient activation mediates the relationship between health literacy and hospital utilization in the 30 days after discharge.Design and participantsWe performed a secondary analysis of data from a randomized controlled trial of patients receiving care at an urban safety net hospital. Path analyses were used to assess patient activation as a mediator of the relationship of education and health literacy with 30-day hospital utilization. The final model was stratified by race and ethnicity.Measure30 day Hospital Utilization.ResultsIn the overall study sample, a one standard deviation (SD) higher patient activation measure (PAM) score was associated with 18% reduced odds of hospital utilization (odds ratio (OR) 0.82, 95% confidence interval (CI): 0.73, 0.91, p=<0.001). PAM mediated the relationship between education level and health literacy and hospital utilization. When stratified by race, the mediating effect of PAM was evident among Whites, but not among non-Whites. Specifically, a one SD higher PAM score was significantly associated with a 33% reduced odds of utilization among Whites (OR 0.67, 95% CI: 0.57, 0.79, p<0.001). With the inclusion of PAM in the model, there was no direct relationship between either health literacy or education and 30-day hospital utilization.ConclusionPatient activation is only associated with hospital utilization among Whites. Further research is needed to assess if this selective protection is seen in other cohorts. Potential interventions to reduce hospital readmissions may need to consider other modifiable factors in racially and ethnically diverse populations.

Project description:The Integrated Child Development Services (ICDS) program launched in India in 1975 is one of the world's largest flagship programs that aims to improve early childhood care and development via a range of healthcare, nutrition and early education services. The key to success of ICDS is in finding solutions to the historical challenges of geographic and socioeconomic inequalities in access to various services under this umbrella scheme. Using birth history data from the National Family Health Survey (Demographic and Health Survey), 2015-2016, this study presents (a) socioeconomic patterning in service uptake across rural and urban India, and (b) continuum in service utilization at three points (i.e., by mothers during pregnancy, by mothers while breastfeeding and by children aged 0-72 months) in India. We used an intersectional approach and ran a series multilevel logistic regression (random effects) models to understand patterning in utilization among mothers across socioeconomic groups. We also computed the area under the receiver operating characteristic curve (ROC-AUC) based on a logistic regression model to examine concordance between service utilization across three different points. The service utilization (any service) by mothers during pregnancy was about 20 percentage points higher for rural areas (60.5 percent; 95% CI: 60.3; 30.7) than urban areas (38.8 percent; 95% CI: 38.4; 39.1). We also found a lower uptake of services related to health and nutrition education during pregnancy (41.9 percent in rural) and early childcare (preschool) (42.4 percent). One in every two mother-child pairs did not avail any benefits from ICDS in urban areas. Estimates from random effects model revealed higher odds of utilization among schedule caste mothers from middle-class households in rural households. AUC estimates suggested a high concordance between service utilization by mothers and their children (AUC: 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuum if service utilization commences at pregnancy.

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Having a family doctor was associated with lower utilization of hospital-based health services.

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Having a family doctor was associated with lower utilization of hospital-based health services.

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