Comparison of Health Status in Primary Care Underserved Area Residents and the General Population in Korea

Abstract

Background: This study compared chronic diseases and health-related quality of life (HRQoL) in between primary care underserved areas residents and the general population. Methods: Underserved areas were identified according to accessibility and the time relevance index for primary care. Overall, 279 participants aged ≥60 years from four counties enrolled voluntarily. A total of 1,873 individuals were assigned in the control group using the Korea National Health and Nutrition Examination Survey database. We assessed the differences in prevalence, awareness, and control of hypertension and diabetes and HRQoL using both subjective health status and the Korean version of the EuroQol-5D (EQ-5D) questionnaire using multivariate logistic regression analysis between the two groups. Results: For hypertension, prevalence did not differ significantly between the two groups, whereas awareness and control were lower in the underserved areas than that in the general population; the adjusted odds ratios (95% confidence interval) were 0.40 (0.25-0.64) and 0.27 (0.18-0.41), respectively. For diabetes, differences in prevalence, awareness, and control were statistically insignificant. The proportion reporting poor subjective health status and problems in four EQ-5D indexes (ability to exercise, daily activities, pain/discomfort, anxiety/depression) was higher in the underserved areas, which also had a lower EQ-5D index, than that in the general population. Conclusion: Primary care underserved area residents were underdiagnosed and under-controlled for hypertension and reported poorer subjective health and HRQoL compared to the general population. Primary care is the attributable factor to awareness and control of chronic diseases and subjective health and QoL in communities.

The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients

“…Kim et al used TRI to identify medically underserved areas and found that hypertension in residents of such areas was undiagnosed and under-controlled. 19 Specifically, the actual prevalence did not differ significantly between the two groups, whereas awareness (OR, 0.40; 95% CI, 0.25–0.64, P < 0.001) and disease control (OR, 0.27; 95% CI, 0.18–0.41, P < 0.001) were lower in the underserved areas than that in the general population. 19 Another study of patients, aged over 70 years, with chronic diseases also used TRI to evaluate access to medical services.…”

“… 19 Specifically, the actual prevalence did not differ significantly between the two groups, whereas awareness (OR, 0.40; 95% CI, 0.25–0.64, P < 0.001) and disease control (OR, 0.27; 95% CI, 0.18–0.41, P < 0.001) were lower in the underserved areas than that in the general population. 19 Another study of patients, aged over 70 years, with chronic diseases also used TRI to evaluate access to medical services. 37 They studied the relationship between medical experience, including medical accessibility, and unmet medical health care perception in areas with a TRI of less than 30%.…”

“…18 MUAs are defined using the time relevance Index (TRI), a proven index of accessibility, to identify places with low accessibility and poor quality of care. 19 Previously, several studies have investigated risk factors for COPD re-admission, 5,6,[20][21][22][23] but no studies on MUAs and COPD re-admission. Therefore, we investigated the factors associated with the risk of COPD re-admission in Korea and used TRIs to compare COPD re-admission in general populations with areas defined as MUAs.…”

Functional Status and Health-Related Quality of Life in Patients with Peripheral Artery Disease: A Cross-Sectional Study

“…This result is higher than the estimated EQ-5D utility scores of 0.64 for those diagnosed with PAD within one year [23,28], 0.73 for symptomatic patients with PAD [29], and 0.79 for chronic obstructive pulmonary disease in patients living with PAD [30]. However, this is lower than the estimated EQ-5D utility scores of 0.87 for the general population over 60 years in Korea [31]. This result suggests that PAD is a risk factor in lowering HRQOL and that HRQOL could be further reduced depending on comorbid diseases or symptoms.…”

Measuring the Burden of Disease in Korea Using Disability-Adjusted Life Years (2008–2020)

“… 50 51 In Korea, medical facilities are predominantly concentrated in metropolitan areas and large cities 52 and the concentration of population in large cities further exacerbates the concentration of healthcare resources in these areas, resulting in disparities in medical utilization. Because insufficient primary care can contribute to poor control of chronic diseases and quality of life, 53 we suggest that a national approach to ensure an even distribution of medical institutions capable of providing primary care and early screening is needed. Considering these possibilities, future studies could explore the relationship between regional characteristics and YLLs and YLDs measurements from this study to identify geographical health risks.…”