scholarly journals A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

2020 ◽  
Author(s):  
Mia Messi ◽  
Yolanda Mueller ◽  
Dagmar M. Haller ◽  
Andreas Zeller ◽  
Stefan Neuner-Jehle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Healthcare Use ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Andersen Model ◽  
Multimorbid Patients ◽  
Services Use

Abstract Background: Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. Method: In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient's demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient's quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients' healthcare use.Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28–98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62–0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28–0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59–3.90). The number of contacts with a GP (median 11 (IQR 7-16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83–0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02–1.10).Conclusion: Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.

scholarly journals A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

2020 ◽  
Author(s):  
Mia Messi ◽  
Yolanda Mueller ◽  
Dagmar M. Haller ◽  
Andreas Zeller ◽  
Stefan Neuner-Jehle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Healthcare Use ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Andersen Model ◽  
Multimorbid Patients ◽  
Services Use

Abstract Background: Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. Method: In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient's demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient's quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients' healthcare use.Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28–98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62–0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28–0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59–3.90). The number of contacts with a GP (median 11 (IQR 7-16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83–0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02–1.10).Conclusion: Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.

scholarly journals A cross-sectional study of ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

2020 ◽  
Author(s):  
Mia Messi ◽  
Yolanda Mueller ◽  
Dagmar M. Haller ◽  
Andreas Zeller ◽  
Stefan Neuner-Jehle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Healthcare Use ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Andersen Model ◽  
Multimorbid Patients ◽  
Services Use

Abstract Background: Multimorbidity is frequently encountered in primary care and is associated with an increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients’ use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen’s model to explore factors associated with this use. Method: In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model’s three categories : predisposing factors ( patient’s age, sex, marital status, educational level), enabling factors (health literacy (HLS EU 6), deprivation (DipCare)), and need factors (patient’s quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions and number of medications). Logistic regressions (for dichotomous variables) and negative binomial regressions (for count variables) were calculated to identify predictors of multimorbid patients’ healthcare use. Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0); 48.3% men; 15.1% (127/843) used homecare; 34.9% (294/843) used other health services; median patient–GP contacts (previous year), 11 (IQR 7–16); mean number of specialist’s involved 1.9 (SD 1.4). In the complete Andersen model, not having an informal caregiver (OR 0.50, 95%CI 0.28–0.88), using more medications (OR 1.13, 95%CI 1.05–1.21), and being less independent (OR 2.47, 95%CI 1.36–4.51) were all factors positively associated with homecare services use. Social deprivation was related with a decrease in homecare services use (OR 0.75, 95%CI 0.62–0.89).” Conclusion: Multimorbid patients in primary care reported a high use of ambulatory healthcare services variably associated with the Andersen model’s factors: Healthcare use was associated with objective medical needs, but also on contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patients’ profile

scholarly journals Exploring University Students’ Attitudes towards Primary Care: Evidence from a Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Gianluca Voglino ◽  
Giuseppina Lo Moro ◽  
Maria Rosaria Gualano ◽  
Fabrizio Bert ◽  
Roberta Siliquini
Keyword(s):  
Primary Care ◽  
Health Services ◽  
University Students ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Health Services Use ◽  
Cross Sectional ◽  
Significance Level ◽  
Students Attitudes ◽  
The University

The general practitioner (GP) has a significant role in primary care, being more than a gatekeeper to health services access. In Italy, if a citizen moves for studies for at least 3 months, he/she can choose temporarily another GP in the new city (the so-called “Healthcare Domicile” (HD)). The aims were to estimate the university students’ knowledge about the HD, evaluate the frequency of the transition to another GP, and assess the university students’ attitudes towards the primary care services. In 2018, a cross-sectional pilot study was performed in study rooms among students attending the University of Turin Participation was voluntary, anonymous, and without compensation. A 25-item questionnaire collected information about the sociodemographic characteristics, health services use, health conditions and medications, HD knowledge, and HD use. The outcomes were having the GP far away, knowing HD, and not moving the GP even if aware of HD. Chi-square test, Mann–Whitney U-test, and logistic regression analyses were performed. The significance level was p≤0.05. Participants were 388 and those who knew HD were 45.36%. Among those who moved to Turin (44.85%), 77.67% knew HD but did not move the GP anyway. The 72.68% used medications without prescription (the most taken: nonsteroidal anti-inflammatory drugs and antibiotics). Age, nationality, and degree course type could be predictors for outcomes considered. HD knowledge was associated with a different use of healthcare resources. The data of the present paper suggest that further studies are required to better understand the framework connected with the university students’ access to primary healthcare. Our results highlighted the need to implement campaigns targeted to university students to spread information about the HD and a more appropriate use of the healthcare services and medications.

scholarly journals Exploring university students’ attitudes towards Primary Care: evidence from a cross-sectional study

2019 ◽  
Author(s):  
Gianluca Voglino ◽  
Giuseppina Lo Moro ◽  
Maria Rosaria Gualano ◽  
Fabrizio Bert ◽  
Roberta Siliquini
Keyword(s):  
Primary Care ◽  
Health Services ◽  
University Students ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Health Services Use ◽  
Cross Sectional ◽  
Significance Level ◽  
Students Attitudes ◽  
The University

Abstract Background The general practitioner (GP) has a significant role in primary care, being more than a gatekeeper to health services access. In Italy, if a citizen moves for studies for at least 3 months, he/she can choose temporarily another GP in the new city (the so-called “Healthcare Domicile”, HD). The aims were to estimate the university students’ knowledge about the HD, evaluate the frequency of the transition to another GP and assess the university students’ attitudes towards the primary care services. Methods In 2018, a cross-sectional pilot study was performed in study rooms amongst students attending Turin’s University. Participation was voluntary, anonymous, without compensation. A 25-item questionnaire collected information about: socio-demographic characteristics, health services use, health conditions and medications, HD knowledge, HD use. The outcomes were having the GP far away, knowing HD, not moving the GP even if aware about HD. Chi-square, Mann-Whitney U, logistic regression analyses were performed. The significance level was p≤0.05. Results Participants were 388 and those who knew HD were 45.36%. Among those that moved to Turin (44.85%), 77.67% knew HD but did not move the GP anyway. The 72.68% used medications without prescription (the most taken: non-steroidal anti-inflammatory drugs, antibiotics). Age, nationality and degree course type could be predictors for outcomes considered. HD knowledge resulted associated with a different use of healthcare resources. Conclusions The data of the present paper suggest that further studies are required to better understand the framework connected with the university students’ access to primary health care. Our results highlighted the need to implement campaigns targeted to university students to spread information about the HD and a more appropriate use of the healthcare services and medications.

scholarly journals Evaluation of e-health (Seha) application: a cross-sectional study in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abeer Alharbi ◽  
Joharah Alzuwaed ◽  
Hind Qasem
Keyword(s):  
Saudi Arabia ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Advanced Technology ◽  
Sectional Study ◽  
Cross Sectional ◽  
Technical Problems ◽  
Significant Difference ◽  
Ease Of Access

Abstract Background The Ministry of Health in Saudi Arabia is expanding the country’s telemedicine services by using advanced technology in health services. In doing so, an e-health application (app), Seha, was introduced in 2018 that allows individuals to have face-to-face visual medical consultations with their doctors on their smartphones. Objective This study evaluated the effectiveness of the app in improving healthcare delivery by ensuring patient satisfaction with the care given, increasing access to care, and improving efficiency in the healthcare system. Methods A cross-sectional study design was used to assess the perceptions of users of the Seha app and non-users who continued with traditional health services. The data were collected using an online survey via Google Forms between June 2020 and September 2020. Independent t tests and chi-square (χ2) tests were conducted to answer the research questions. Results There was a significant difference between users and non-users in terms of ease of access to health services (t =  − 9.38, p < 0.05), with app users having a higher mean score (4.19 ± 0.91) than non-users (3.41 ± 1.00); satisfaction with health services (t =  − 6.33, p < 0.05), with users having a higher mean score (3.96 ± 0.91) than non-users (3.45 ± 0.94); and efficiency (only one visit needed for treatment) (t =  − 3.20, p < 0.05), with users having a higher mean score (3.71 ± 0.93) than non-users (3.45 ± 0.93). There were significant associations between the use of the Seha app and age (χ2 = 8.79, p < 0.05), gender (χ2 = 22.19, p < 0.05), region (χ2 = 19.74, p < 0.05), and occupation (χ2 = 22.05, p < 0.05). There were significant relationships between the three items (on access, satisfaction, and efficiency) and experiencing technical issues (t = 4.47, t = 8.11, and t = 3.24, respectively, p < 0.05), with users who faced technical problems having significantly lower mean scores for all three items. Conclusion This study provided evidence that the Seha app improved the delivery of healthcare in Saudi Arabia. Users of the app had a better health experience in terms of their perceived ease of access to healthcare services; their satisfaction with healthcare services; and the efficiency of the system, measured by the number of required doctor visits. Other factors that appeared to influence the use of the app included age, gender, usual source of care, and technical difficulties.

scholarly journals Barriers to the use of health services among deaf and hard of hearing adults in Greece: a Cross-Sectional Study

2018 ◽  
Vol 6 (4) ◽  
pp. 638 ◽  
Author(s):  
Dialechti Tsimpida ◽  
Daphne Kaitelidou ◽  
Petros Galanis
Keyword(s):  
Health Services ◽  
Sign Language ◽  
Hard Of Hearing ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Minority Population ◽  
Health Providers ◽  
Cross Sectional ◽  
Use Of Health Services

Rationale, Aims and Objectives: To explore the issues related to the use of health services by deaf and hard of hearing adults in Greece.Method: The study population consisted of 140 adults with hearing loss (86 deaf and 54 hard of hearing). We gathered information about sociodemographic characteristics, use of health services characteristics, satisfaction from health providers and complaints during the use of health services.Results: A considerable percentage of the participants did not make appropriate use of healthcare services, as they made avoidable visits to emergency departments even for minor, short-term conditions (p=0.002) or used to just wait for the symptoms to pass in an illness occurrence (p=0.06). They also experienced major difficulties as part of the health visit (p=0.01) and the quality of communication with health providers (p=0.002). The absence of assistive technology, along with the lack of low availability of Sign Language interpreters, were important barriers for those that communicate in Sign Language. Regarding the engagement with healthcare providers, there were high rates of dissatisfaction from doctors, nurses and receptionists related to issues during the use of health services.Conclusions: Our results underscore the fact that deaf and hard of hearing persons constitute a minority population that experience major barriers during the use of health services and considerable difficulties in the healthcare provider-patient relationship. In light of these findings, a special effort must be made to ensure that deaf and hard of hearing individuals receive appropriate, ethical and person-centered healthcare.

scholarly journals Impact of COVID-19 and Mitigation Plans on Essential Health Services: Institutional Experience of St. Paul’s Hospital Millennium Medical College

2021 ◽  
Author(s):  
Firaol Dandena ◽  
Berhanetsehay Teklewold ◽  
Dagmawi Anteneh
Keyword(s):  
Health Services ◽  
Health Care Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Vital Role ◽  
Cross Sectional ◽  
Poor Countries ◽  
Medical College ◽  
Treatment Centre ◽  
The Impact

Abstract BackgroundHealth systems around the world are being challenged by on-going COVID-19 pandemic .The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself ,especially in resource-poor countries such Ethiopia. This study aimed to explore the impact of the pandemic on these service and measures taken to combat the effect.MethodsThe study was conducted at St. Paul’s hospital millennium medical college (SPHMMC). The study was conducted from December 15, 2020 to January 15, 2021 using comparative cross- sectional study design. We collected data on the number of clients getting different essential healthcare services from May to October 2019 (Pre COVID) and same period in 2020 (during COVID-19 pandemic) from patient registry book. The analysis was done with SPSS version 24 software.ResultOverall, the essential services of SPHMMC were affected by COVID-19 pandemic. The most affected service is inpatient admission that showed 73 % (2044 to 682) reduction from pre- COVID period and the least affected is maternal service, which only decrease by 13% (3671 to 3177). During the 6 months after COVID-19 pandemic, there is a progressive increment in number of clients getting essential health services.ConclusionThe establishment of a triple setup for fighting against COVID-19, which encompass; non COVID service, isolation centre and COVID-19 treatment centre played a vital role in preserving essential health services.

scholarly journals Healthcare services utilization among international students in Ankara, Turkey: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abednego Nzyuko Masai ◽  
Bahar Güçiz-Doğan ◽  
Polet Njeri Ouma ◽  
Israel Nyaburi Nyadera ◽  
Victor Kipkoech Ruto
Keyword(s):  
International Students ◽  
Health Services ◽  
Healthcare Access ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Health Providers ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Exact Test ◽  
Services Utilization

Abstract Background While international students form an increasing population of higher education students in Turkey, there is limited empirical evidence about their health services utilization. The study aim was to investigate healthcare access among a group of international students studying in Ankara city and identify potential barriers that affect full healthcare utilization. Method A total of 535 international students from 83 countries completed an online-based questionnaire. The survey was conducted from September until October 2020. Variables between groups within the study sample were compared using ANOVA and Chi-square tests (with Fisher’s exact test). Logistic regression analysis was used to evaluate the relationships between variables related to access to health services. Results Of the study population, 80.6% accessed the general practitioner (GP), 40% accessed the student health centres, and 11.4% were admitted to the hospital at least once. About 80% of international students reported changing their views to access healthcare more because of the COVID-19 pandemic. Conclusion Lack of awareness of healthcare support systems, perceived stigma associated with mental health services, and language barriers were the main barriers affecting healthcare access by international students. Implications Study findings indicate the need for education of international students on available healthcare, targeted health promotion, and training of health providers on effective communication.

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