The Tromsø study: factors affecting patient‐initiated and provider‐initiated use of health care services

Abstract

Knut Fylkesnes, Roar Johnsen and Olav Helge F0rde The Troms0 study: factors affecting patientinitiated and provider-initiated use of health care services Abstract The aim of this study was to examine factors influencing decisions involved in i) patient-intiated visits to general practitioners and ii) provider-initiated use of referral services.The analyses were performed with regression models on a set of data from a comprehensive population study of 7369 men aged 20-61 and 6832 women aged 20-56. Marked gender differences appeared in both patient-initiated and physician-initiated health care use. Various health status dimensions were found to be important determinants of patient-initiated use, in particular self-rated health, physical distress and transitory morbidities. Further, having a primary provider was found to increase patient-initated use strongly. Among the health status measures only self-rated health and chronic disease appeared as important determinants of provider-initiated use. Age and years of education were negatively associated with GP visits and positively associated with the use of referral services. The higher rate of referral of patients with higher educational achievement indicates a social status bias among general practitioners, creating considerably inequitable access to referral services. Further, the analyses indicate that positive lifestyles are associated with increased health care consumption among men.

Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia

“…Self-rated health has been found to be among the most sensitive indicators of the way individuals perceive various threats related to health or life stresses, and a large number of studies in high-income countries have consistently shown self-rated health to be the strongest independent determinant of health care use [27-30]. The results obtained from our data were consistent with these previous studies.…”

“…Excellent/good were combined and coded as 0, and very poor/poor/fair were coded as 1 [25-27]. This measure has been found to be a very sensitive marker of changes in the various dimensions of health status, to be among the strongest predictors of health care use, and to operate as a strong independent predictor of survival [28-30]. We evaluated the mental distress by using a self-reporting questionnaire (SRQ-10), which included 10 questions that had to be answered as ‘yes’, ‘no’, and ‘don’t know’.…”

Socio-economic inequalities in health care utilisation in Norway: a population based cross-sectional survey

“…GP referrals might thus be biased according to SES and gender. This interpretation is in accordance with former findings of higher GP referral rates for the better or more educated [22,31], and later referral of women [32]. On the other hand, disadvantaged groups may miss out on attending additional somatic care.…”

Socioeconomic differences in outpatient healthcare utilisation are mainly seen for musculoskeletal problems in groups with poor self-rated health

“…This is in line with previous reports [4,6,9,10], where people with good resources tend to be referred to specialised services to a higher extent. Some studies has also described this phenomenon as a ''social status bias'' where higher educated groups may be able to present health problems using a language that more often match professional conceptions, which in turn may affect the chances of being referred [24]. Thus, these two findings highlights the need in studies on healthcare utilisation to understand if an outcome may be driven by actual need of health service or can be more explained by cultural context [17].…”