Distance to hospital and socioeconomic status influence secondary health care use

Zieliński, Andrzej; Borgqúist, Lars; Halling, Anders

doi:10.3109/02813432.2012.759712

Cited by 26 publications

(21 citation statements)

References 23 publications

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“…Other studies also found associations between patient characteristics and health care use. Like in our study, young children [ 8 ], foreigners [ 9 , 10 ], and patients living close to the service [ 12 , 14 ] were found to contact acute care services more often. Our findings regarding characteristics of the general practices related to out-of-hours care use are partly consistent with studies in the ED setting [ 9 , 16 - 23 ].…”

Section: Discussionsupporting

confidence: 72%

“…For instance, having many chronically ill patients in the practice implies higher use of healthcare. Likewise, it is known that parents of young children [ 8 ], foreigners [ 9 , 10 ], patients with low socioeconomic status [ 11 - 13 ] and patients living close to the service [ 12 , 14 ] relatively often contact acute care services, such as the ED and GP cooperative. However, the differential use of out-of-hours care could also be caused by variation in accessibility and availability of general practices [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between general practice characteristics and use of out-of-hours GP cooperatives

Smits¹,

Peters²,

Broers³

et al. 2015

BMC Fam Pract

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BackgroundThe use of out-of-hours healthcare services for non-urgent health problems is believed to be related to the organisation of daytime primary care but insight into underlying mechanisms is limited. Our objective was to examine the association between daytime general practice characteristics and the use of out-of-hours care GP cooperatives.MethodsA cross-sectional observational study in 100 general practices in the Netherlands, connected to five GP cooperatives. In each GP cooperative, we took a purposeful sample of the 10 general practices with the highest use of out-of-hours care and the 10 practices with the lowest use.Practice and population characteristics were obtained by questionnaires, interviews, data extraction from patient registration systems and telephone accessibility measurements. To examine which aspects of practice organisation were associated with patients’ use of out-of-hours care, we performed logistic regression analyses (low versus high out-of-hours care use), correcting for population characteristics.ResultsThe mean out-of-hours care use in the high use group of general practices was 1.8 times higher than in the low use group. Day time primary care practices with more young children and foreigners in their patient populations and with a shorter distance to the GP cooperative had higher out-of-hours primary care use. In addition, longer telephone waiting times and lower personal availability for palliative patients in daily practice were associated with higher use of out-of-hours care. Moreover, out-of-hours care use was higher when practices performed more diagnostic tests and therapeutic procedures and had more assistant employment hours per 1000 patients.Several other aspects of practice management showed some non-significant trends: high utilising general practices tended to have longer waiting times for non-urgent appointments, lower availability of a telephone consulting hour, lower availability for consultations after 5 p.m., and less frequent holiday openings.ConclusionsBesides patient population characteristics, organisational characteristics of general practices are associated with lower use of out-of-hours care. Improving accessibility and availability of day time primary day care might be a potential effective way to improve the efficient use of out-of-hours care services.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Association between general practice characteristics and use of out-of-hours GP cooperatives

Smits¹,

Peters²,

Broers³

et al. 2015

BMC Fam Pract

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“…This is likely to reflect the improvement of population health on the one hand, and the advances in health care technology and changes in treatment practices shifting focus from hospital inpatient care to ambulatory care on the other hand. The use of hospital care was inversely related to socioeconomic position among both genders throughout the study period: the lower the income, the higher the hospitalisation rate, which is concordant with earlier evidence from Finland and elsewhere [ 4 , 5 ]. Our study adds to the literature by examining long-term trends in somatic specialised hospital care.…”

Section: Discussionsupporting

confidence: 87%

“…However, increasing differences were found in the content of care: lower income group patients underwent fewer common surgical operations than higher income group patients. Similar differences in specialist hospital care have been reported earlier in other countries [ 5 ] and in the use of some elective surgical operations both in Finland [ 6 ] and internationally [ 7 , 8 ] and in the care of specific diseases like coronary heart disease both in Finland and elsewhere [ 9 – 11 ]. Additionally, studies have reported socioeconomic differences in mortality amenable to health care interventions and the differences have been reported to be especially large in mortality amenable to specialist health care interventions [ 12 ].…”

Section: Introductionsupporting

confidence: 77%

Has socioeconomic equity increased in somatic specialist care: a register-based cohort study from Finland in 1995–2010

Manderbacka

Arffman

Keskimäki

2014

BMC Health Serv Res

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BackgroundEqual access to health care according to need is an important goal for health policy in Finland. Earlier research in Finland and elsewhere has mainly been cross-sectional, but the results have implied that the goal has not been fully realised in somatic specialist hospital care. This study examines trends in socioeconomic equity in use of somatic specialist hospital care.MethodsWe used register data on somatic specialist hospital admissions among 25–84 year-old persons in Finland in 1995–2010 with individually linked register-based socio-demographic information. We calculated age-standardised admission rates per 100,000 person years by income, examined risk ratios using Poisson regression models and computed concentration indices separately for men and women. Linear trends in the socioeconomic distribution of admissions and surgical procedures were estimated with linear regression models for annual concentration indices.ResultsOverall, use of somatic specialist hospital care decreased steadily throughout the study period. A stepwise inverse income pattern was found in hospitalisation risk and in non-surgical admissions: the lower the income group, the higher the risk. The relative admission risk was approximately two times higher in the lowest income group compared to the highest among both genders. Few differences were found in surgical admissions. Income group differences remained stable in hospitalisations and surgical admissions, but increased in non-surgical admissions during the study period. An inverse pattern of increasing operation rates with decreasing income was found in primary hip and knee replacement operations, and in lower limb amputations. A similar pattern emerged during the study period in coronary revascularisations. There were no differences were found in lumbar fusion or lumbar disc operations, prostatectomies or appendectomies. Income group differences in hysterectomies disappeared during the study period.ConclusionsWhile the results of the current study suggest that use of somatic specialist care declined in line with improving population health in 1995–2010, the increase of socioeconomic health differentials was only partly reflected in the distribution of somatic specialist hospital care. Further research is needed to evaluate the need to improve use and content of specialised hospital care among the low-income groups in order to improve equity in health care.

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“…But when a hospital closes, some patients who would have visited that hospital's ED for care may decide not to access emergency care because of distance or other factors, or may instead go to a nearby urgent care center or other alternative to emergency care. 36 This drop-off in demand for emergency services that occurs after a hospital closure has not been previously explored to the study team's knowledge. 37 Because all volume from closed EDs may not redistribute to nearby hospitals, this study offers one way of estimating this drop-off in demand.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

Lee

Carr

Smith

et al. 2015

Population Health Management

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Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

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Distance to hospital and socioeconomic status influence secondary health care use

Cited by 26 publications

References 23 publications

Association between general practice characteristics and use of out-of-hours GP cooperatives

Association between general practice characteristics and use of out-of-hours GP cooperatives

Has socioeconomic equity increased in somatic specialist care: a register-based cohort study from Finland in 1995–2010

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

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