Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care

Objectives: Considering the rapid growth of Iran’s elderly population with consequent increase in the costs of health services, it is necessary to be aware of the pattern of outpatient health service utilization, in the elderly for resource allocation and health planning. This study aims to determine the pattern of outpatient service utilization for the elderly in Iran and explore determinant factors. Methods & Materials: This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services. Results: Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services. Conclusion: Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.

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Study on the Demand and Utilization of Health Services for the Poor Elderly in China

10.21203/rs.3.rs-46192/v1 ◽

2020 ◽

Author(s):

Yanbing Zeng ◽

Weiqian Xu ◽

Bei Luo ◽

Ya Fang

Keyword(s):

Health Status ◽

Health Service ◽

Health Services ◽

Service Utilization ◽

Health Behaviour ◽

Health Service Utilization ◽

Utilization Of Health Services ◽

The Poor ◽

Inpatient Services ◽

Part Model

Abstract Background Despite historic achievements in fighting poverty over recent decades, the unmet health needs of the poor elderly are still a severe problem in China. This paper investigates the demand and utilization status of health services among the poor elderly and examines the factors that affect healthcare service utilization. Methods According to the international poverty line of each year, we selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 to create nationally representative estimates. The main outcome measures include utilization indicators for the probability and costs of outpatient/inpatient services. Based on a modified Andersen behaviour model, a two-part model is designed to investigate and analyse how predisposing factors, enabling factors, and need and health behaviour variables affect the health service utilization of the poor elderly. The prediction of marginal effect of the unconditional healthcare expenditure are estimated by jointing the model of probability and expenditure of health service utilization. Results The morbidity and chronic disease rates of the poor elderly were 16.93% and 79.43%, respectively. The visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalization rate increased from9.87–16.89%. In terms of medical expenditures, the median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10,000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3% respectively. Overall, 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The two-part model showed that the poor elderly who are higher educated, have children, live in central regions, and have social security and a poor health status and who do not smoke or drink are more likely to use health services. Males who live in the eastern regions with poor self-reported health, physical disabilities and chronic diseases have more medical expenses. Margin effect analysis finds that the need factor is more important than other factors in determining health service utilization. Conclusion The poor elderly in China, as the most vulnerable group, tends to have a worse health status and a heavier medical burden. Due to a variety of constraints, the poor elderly had a lower utilization of health services. Predisposing, enabling, need and health behaviour variables should be considered when making policy and taking measures to eliminate health inequalities to improve the health service utilization and the health of the poor elderly.

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Health Service Utilization and associated factors Among Older Adults in Ambo Town, West Shoa Zone, Oromia, Ethiopia

Community Medicine and Health Education Research ◽

10.33702/cmher.201901.1.2 ◽

2019 ◽

Vol 1 (1) ◽

pp. 8-19

Author(s):

Abiru Neme Negewo ◽

Wadu Wolancho Debocha ◽

Gadisa Bekele Bedada

Keyword(s):

Older Adults ◽

Health Service ◽

Health Services ◽

Medical History ◽

Service Utilization ◽

Chronic Condition ◽

Health Service Utilization ◽

Associated Factors ◽

The Elderly ◽

History Of

In any country use of health services by elderly could vary according to the cultural, social, economic and demographic situation of the person who may need care. In certain contexts, it particularly varies with age and sex of the potential service user. However; there is paucity of information on the level and associated factors on health service utilization among elderly population in Ethiopia in general and in the study site in particular. To assess Factors Health Service Utilization and associated factors Among Older Adults in Ambo Town, West Shoa Zone, Oromia, Ethiopia. A community based cross sectional study carried out on 284 elderly populations residing in Ambo town from February- March 2018. The collected data was cleaned, coded and entered into computer and analyzed using SPSS windows version 20.0. Descriptive statistics were done to summarize data. Binary and multiple logistic regression was undertaken to determine the independent predictor of health service utilization. The following factors were identified as determinants of health service utilization among the elderly in Ambo: a medical history of at least one chronic condition (OR = 1.737; [0.425-2.562]; p < 0.000), who had reported enough money to meet their need were 75% utilize health services when compared to participants who did not have enough money to meet their need 47.3% (OR = 1.587; 95% CI = [1.236 – 2.037], p = 0.004). Age, Income, education, medical history of at least one chronic condition and poor perceived health status were the most pervasive determinants of health service utilization. These factors could help health policy makers and health service providers identify and understand the situation of the elderly and consequently create conducive environment for providing appropriate health services.

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Study on the Health Status and Health Service Utilization for the Rural Elderly in the Metropolitan Suburb During the Urbanization Process: A Case for Mingxing Village, Guangzhou

Sustainability ◽

10.3390/su12093560 ◽

2020 ◽

Vol 12 (9) ◽

pp. 3560

Author(s):

Zhiping Zhong ◽

Lin Lin ◽

Ying Yang

Keyword(s):

Health Status ◽

Health Service ◽

Service Utilization ◽

Health Service Utilization ◽

The Elderly ◽

Rural Elderly ◽

Living Environment ◽

National Average ◽

Depression Symptoms ◽

Rapid Urbanization

Rapid urbanization development significantly accelerates residents’ income in China, but there still exists a series of problems in rural areas, especially the health status of the rural elderly in the metropolitan suburb, a crucial matter worthy of attention. Regarding the rural elderly in a suburb of Guangzhou as a research object, this paper focuses on comparison of the health status and health service utilization differences between the national and local rural area, and qualitatively analyze and explain it by the cumulative disadvantage theory during the life course. By random sampling in the study group, 122 seniors from Mingxing village in Guangzhou are selected for structured face-to-face interviews. Data analysis of questionnaires (collected by trained investigators) shows that, except for self-care ability, the elderly in the village exhibit more serious hearing, vision, movement disorder, daily activity, and pain problems than the national average. Regarding mental health, the proportion of anxiety and depression symptoms in Mingxing village is 21%, both over the national countryside average. The two-week prevalence, chronic disease prevalence, and inpatient out of hospital are 78%, 85%, and 53%, respectively, which are still higher than the 2013 national rural average. Research demonstrates that the elderly mainly choose village clinics for outpatient treatment, county hospitals for inpatient treatment. The two-week visiting rate is 33%, lower than that in 2013, and the hospitalization rate is 15%, close to 2013 level. In conclusion, the health status and health service utilization of the elderly in Mingxing village in Guangzhou is generally lower than the national average level. Daily living habits, traditional notions and willingness for medical treatment are indispensable factors in affecting the elderly health. Economic status, living environment and education level continue to be the main factors in influencing the health service utilization for the elderly in Mingxing village.

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Analysis of diverse factors influencing the health status as well as medical and health service utilization in the floating elderly of China

BMC Health Services Research ◽

10.1186/s12913-021-06410-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuwei Fu ◽

Weiwei Lin ◽

Yuan Yang ◽

Ranran Du ◽

Dongping Gao

Keyword(s):

Health Status ◽

Health Service ◽

Health Services ◽

Service Utilization ◽

Health Service Utilization ◽

Well Being ◽

Good Health ◽

Utilization Rate ◽

Public Health Services ◽

Special Investigation

Abstract Background Based on the “China Migrants Dynamic Survey-Special investigation on Floating Elderly in 8 megacities in 2015”, the health status and the utilization of medical and health services in floating elderly were described and analyzed. Objective Scientific basis and critical suggestions are provided for improving the utilization level of medical and health services in the floating elderly and designing targeted health policies to improve their well-being. Methods The rank-sum test and Pearson χ2 test were used to compare the health status of floating elderly with different characteristics. Thereafter based on Andersen model, floating characteristics were added and binary logistic regression was used to explore the influencing factors of medical and health service utilization in the floating elderly. Results About 94.7% of the floating elderly were self-assessed as healthy/basically healthy. About 24.2% had hypertension or diabetes as diagnosed by the qualified doctors. About 7% suffered from diseases that required hospitalization. Only 28.6% of the floating elderly with hypertension or diabetes had visited a doctor for follow-up. In the case of minor ailments, only 48.7% decided to visit the clinics. Approximately 70.7% of the floating elderly had used in-patient services when they suffered from diseases requiring hospitalization. Conclusion The floating elderly were observed to be generally in good health but a high prevalence of hypertension or diabetes was observed among them. The cultivation of health awareness was found to be of great significance contributing to the improvement of the overall health level among the floating elderly. The basic medical insurance coverage was low, and the medical and health services were found to be severely underutilized. Adequate social support can promote the health of the floating elderly and improve their utilization of medical and health services. The floating reasons, scope and years of the elderly significantly affected their health status and the utilization rate of the basic public health services.

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Effects of health literacy on health status and health service utilization amongst the elderly

Social Science & Medicine ◽

10.1016/j.socscimed.2008.01.003 ◽

2008 ◽

Vol 66 (8) ◽

pp. 1809-1816 ◽

Cited By ~ 202

Author(s):

Young Ik Cho ◽

Shoou-Yih D. Lee ◽

Ahsan M. Arozullah ◽

Kathleen S. Crittenden

Keyword(s):

Health Status ◽

Health Literacy ◽

Health Service ◽

Service Utilization ◽

Health Service Utilization ◽

The Elderly

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Modern Health Service Utilization and Associated Factors among Adults in Southern Ethiopia

Journal of Environmental and Public Health ◽

10.1155/2021/8835780 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Shimelash Bitew Workie ◽

Niguse Mekonen ◽

Mulugeta W. Michael ◽

Getahun Molla ◽

Solomon Abrha ◽

...

Keyword(s):

Health Status ◽

Health Service ◽

Health Services ◽

Marital Status ◽

Service Utilization ◽

Health Service Utilization ◽

Associated Factors ◽

Southern Ethiopia ◽

Wealth Status ◽

Wolaita Sodo

Background. The Ethiopian government is striving to improve the health status of its population through the expansion and strengthening of primary health care services in both rural and urban settings of the country. The study aimed to measure modern health service utilization and associated factors in Wolaita Sodo town, Ethiopia. Method. A cross-sectional study design was implemented from May to June 2019 in Wolaita Sodo town, Ethiopia. All 786 study participants were selected by multistage systematic random sampling. Data were collected by face-to-face interviews using a pretested structured questionnaire. Data were collected by an open data kit. Stata window version 15.0 was also employed for statistical analysis. Multiple logistic regression was conducted, and a 95% confidence interval was considered for interpretation. Result. Health service utilization was 77.2% with (95% CI of 74.1%, 80.0%). In terms of health facilities in which they visit, first 50.6% were at the public health center and 25.5% of them were at Teaching and Referral Hospital. Respondents with marital status married and widowed have higher odds of utilizing health services compared to single marital status (AOR: 2.96; 95% CI: 1.7–5.2 and 9.0; 95% CI: 1.69–48.0), respectively. Respondents with middle and highest wealth status have higher odds of health service utilization than poor wealth status with AOR (1.75 95% CI 1.03–2.97 and 1.58 95% CI; 1.01, 2.77). Similarly, respondents who had chronic disease and perceived poor health status have higher odds of health service utilization. Conclusion. Modern health services utilization was found to be unsatisfactory. Being married, wealth status being middle and high, having chronic health conditions, and having poor perceived health status were found to have a statistically significant association with health service utilization.

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Health literacy and health outcomes in China’s floating population: mediating effects of health service

BMC Public Health ◽

10.1186/s12889-021-10662-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hai-YanYu ◽

Wei-Ling Wu ◽

Lin-Wei Yu ◽

Lei Wu

Keyword(s):

Health Literacy ◽

Health Service ◽

Health Services ◽

Health Outcomes ◽

Service Utilization ◽

Health Service Utilization ◽

Mediating Effect ◽

Floating Population ◽

Equation Modeling ◽

Mediating Effects

Abstract Background The floating population in China consists primarily of internal immigrants and represents a typical health vulnerable group. Poor health literacy has recently become an obstacle in the accessibility and utilization of health services for the vulnerable population, leading to adverse health outcomes. This study aimed to examine whether health literacy affected health outcomes in China’s floating population and whether health service utilization had a mediating effect between health literacy and health outcomes. Method The current study utilized a cross-sectional stratified, multistage, proportional to scale (PPS) study in Zhejiang Province, China, in November and December 2019. In total, 657 valid self-reported questionnaires were recovered and used for data collection. Questionnaires included questions regarding sociodemographic characteristics, health literacy, health outcomes, and health service utilization. Confirmatory factor analysis was used to test questionnaire validity; descriptive statistics were used to understand the demographic characteristics of the floating population; and structural equation modeling was used to determine whether health service utilization mediated health literacy and health outcomes. Results We report positive correlations between health literacy, health service utilization, and health outcomes. Mediation analysis demonstrated that health service utilization had partial mediating effects between health literacy and health outcomes. In the relationship between health literacy and health outcomes, the indirect effects of health service utilization accounted for 6.6–8.7% of the total effects. Conclusion Complete health literacy, through health care literacy and health promotion literacy, affects the mobile population’s initiative to use health services, which, in turn, affects health outcomes. Thus, improving the health literacy of the floating population will help to improve health outcomes. Furthermore, health service providers should enhance the diversity of health service supply to ensure that the floating population has the external resources to improve personal health literacy.

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Youth Reproductive Health Service Utilization and Associated Factors among Amhara Region Female Night Students, Ethiopia

BioMed Research International ◽

10.1155/2021/6640219 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Tewachew Muche Liyeh ◽

Yitayal Ayalew Goshu ◽

Habtamu Gebrehana Belay ◽

Habtamu Abie Tasew ◽

Gedefaye Nibret Mihiretie ◽

...

Keyword(s):

Reproductive Health ◽

Health Service ◽

Health Services ◽

Service Utilization ◽

Health Service Utilization ◽

Sexual And Reproductive Health ◽

Reproductive Health Service ◽

Health Issues ◽

Reproductive Health Services ◽

Amhara Region

Introduction. Youth is a decisive age to shape the direction of their life and that of their family. However, due to the host of biological, social, and economic factors, adolescent females can be at high risk of adverse sexual and reproductive health outcomes. Therefore, assessing youth reproductive service utilization and associated factors among female night students is very crucial for timely intervention to their gaps. Method. An institutional-based cross-sectional study design was conducted in Amhara region among 2,050 female night students from September 15 to November 15, 2018. A self-administered pretested questionnaire was used to collect the data. Bivariate and multivariable logistic regression models were used. Odds ratio with 95% confidence interval was computed to determine the strength of association between predictor and outcome variables. P value less than or equal to 0.05 is considered as the level of significance. Results. Out of the total respondents, about 54.6%(CI: 52.5%-56.8%) of them utilized reproductive health services. Respondents who were attending secondary education ( AOR = 2.55 , 95 % CI = 1.97 ‐ 5.62 ), attitude towards youth reproductive health services ( AOR = 2.74 , 95 % CI = 2.07 ‐ 5.30 ), those who had a habit of communicating on sexual and reproductive health issues with their family ( AOR = 3.66 , 95 % CI = 3.59 ‐ 7.41 ), discussion on sexual and reproductive health issue with peers/friends ( AOR = 1.43 , 95 % CI = 1.01 ‐ 2.02 ), respondents with good knowledge on youth reproductive health services ( AOR = 2.03 , 95 % CI = 1.49 ‐ 2.75 ), and those who had faced reproductive health problems ( AOR = 2.03 , 95 % CI = 1.49 ‐ 2.75 ) were significantly associated with youth reproductive health service utilization. Conclusion. Youth reproductive health service utilization among female night students was not satisfactory. Therefore, special focus should be given to female night students by providing accessible, acceptable, confidential, flexible, and friendly reproductive health service utilization. Finally, community health promotion and education are mandatory to promote the practice of discussing youth reproductive health issues with their children.

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