scholarly journals Chronic care services and variation between Danish general practices: A nationwide cohort study

2021 ◽  
pp. BJGP.2021.0419
Author(s):  
Anders Prior ◽  
Claus Vestergaard ◽  
Anette Riisgaard Ribe ◽  
Annelli Sandbæk ◽  
Flemming Bro ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cohort Study ◽  
Low Socioeconomic Status ◽  
Service Provision ◽  
Chronic Care ◽  
Long Term Conditions ◽  
Low Socioeconomic ◽  
Care Services ◽  
Specific Factors ◽  
Random Variation

Background: Little is known about variations in the provision of chronic care services in primary care. Aim: To describe the frequency of chronic care services provided by GPs and analyse the extent of non-random variation in service provision. Design and setting: Nationwide cohort study in Denmark in 2016. Method: Information on chronic care services was obtained from national health registers, including annual chronic care consultations, chronic care procedures, outreach home visits, and talk therapy. The associations between provided services, patient morbidity, and socioeconomic factors were estimated. Service variations were analysed, and excess variation related to practice-specific factors was estimated while accounting for random variation. Results: Chronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status. Variation across practices ranged from 1.4 to 128 times more than expected after adjusting for differences in patient population and random variation. Variation related to practice-specific factors was present for all investigated chronic care services. Older patients with lower socioeconomic status and multimorbidity were clustered in practices with low propensity to provide certain chronic care services. Conclusion: Chronic care was provided to patients typically in need of healthcare, i.e. the old, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices. GPs provided slightly fewer chronic care services than expected in practices where many patients with multimorbidity and low socioeconomic status were clustered, suggesting inverse care law mechanisms.

scholarly journals Does socio-economic status influence the effect of multimorbidity on the frequent use of ambulatory care services in a universal healthcare system? A population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cynthia MBUYA-BIENGE ◽  
Marc SIMARD ◽  
Myles GAULIN ◽  
Bernard CANDAS ◽  
Caroline SIROIS
Keyword(s):  
Socioeconomic Status ◽  
Cohort Study ◽  
Ambulatory Care ◽  
Low Socioeconomic Status ◽  
Population Based ◽  
Low Socioeconomic ◽  
Universal Healthcare ◽  
Care Services ◽  
Frequent Use ◽  
Universal Healthcare System

Abstract Background Frequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire population covered by a universal health system. Methods Using a linkage of administrative databases, we conducted a population-based cohort study of all adults in Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in the total population during the 2014–15 fiscal year. We used ajusted logistic regressions to model the association between frequent use of health services and multimorbidity, depending on socioeconomic status. Results Frequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency departments and general practitioners. Socioeconomic status modified the association between multimorbidity and frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general practitioner. Conclusion Even in a universal healthcare system, the gap between socioeconomic groups widens as a function of multimorbidity with regard to visits to the specialist physicians. Further studies are needed to better understand the differential use of specialized care by the most deprived individuals.

scholarly journals Associations of Depressive Symptoms with All-Cause and Cause-Specific Mortality by Race in A Low-Socioeconomic Population: A Report from the Southern Community Cohort Study

2020 ◽  
Author(s):  
Yong Cui ◽  
Wei Zheng ◽  
Mark Steinwandel ◽  
Hui Cai ◽  
Maureen Sanderson ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cohort Study ◽  
Depressive Symptoms ◽  
Low Socioeconomic Status ◽  
Cox Regression ◽  
Depression Scale ◽  
The United States ◽  
Epidemiological Studies ◽  
Low Socioeconomic ◽  
Specific Mortality

Abstract Depression is a leading cause of disability in the United States, but its impact on mortality among racially diverse, low-socioeconomic populations is largely unknown. Using data from the Southern Community Cohort Study, 2002-2015, we prospectively evaluated the associations of depressive symptoms with all-cause and cause-specific mortality in 67,781 black (72.3%) and white (27.7%) adults, predominantly with a low-socioeconomic status. Baseline depressive symptoms were assessed using the ten-item Center for Epidemiological Studies Depression Scale. The median follow-up time was 10.0 years. Multivariate Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality in association with depressive symptoms. Mild/moderate/severe depressive symptoms were associated with increased all-cause (HR=1.12, 95%CI: 1.03-1.22; HR=1.17, 95%CI: 1.06-1.29; HR=1.15, 95%CI: 1.03-1.28, respectively) and cardiovascular disease mortality (HR=1.23, 95%CI: 1.05-1.44; HR=1.18, 95%CI: 0.98-1.42; HR=1.43, 95%CI: 1.17-1.75, respectively) in whites but not in blacks (Pinteraction< 0.001, for both). Mild/moderate/severe depressive symptoms were associated with increased external cause mortality in both races (HR=1.24, 95%CI: 1.05-1.46; HR=1.31, 95%CI: 1.06-1.61; HR=1.42, 95%CI: 1.11-1.81, respectively; for all subjects, Pinteraction=0.48). No association was observed for cancer mortality. Our study showed that depression-mortality associations differed by race and cause of death in individuals with a low-socioeconomic status.

scholarly journals Socio-demographic determinants of malnutrition among school going children in an urban slum area of central India with special reference to nutritional anaemia

2018 ◽  
Vol 5 (9) ◽  
pp. 4009
Author(s):  
Tarachand Tukaram Meshram ◽  
Ashish Wasudeo Khobragade
Keyword(s):  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Health Care Services ◽  
Central India ◽  
Urban Slum ◽  
Slum Area ◽  
Quality Health Care ◽  
Low Socioeconomic ◽  
Care Services ◽  
Quality Health

Background: Children residing in urban slum area are the most vulnerable. Poverty, illiteracy, neglect of health, low socioeconomic status and non-affordability of quality health care services make them more vulnerable to malnutrition.Methods: 361 school going children residing in urban slum area were included in study. Socio-demographic details of the children taken from their parents. Health check-up was done.Results: Prevalence of malnutrition was 40.17%. 17.17% children were underweight and 22.99% were stunted.Conclusions: Family size and socioeconomic status are the important determinants of malnutrition.

Sign in / Sign up

Export Citation Format

Share Document