Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups

Abstract

Background Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors. Methods Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed. Results The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017–0.052 and 0.008–0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198–1.726 and 2.722–4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457–14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022–6241 and 1.949–3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068–1.51 and 0.103–0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659–4.319 and 3.629–4.989). Conclusions The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.

Situation of the Elderly Living Alone: Morbidity and Services Provided from the Field of Primary Health Care of Gran Canaria

“…This may indicate that the AMG colors associated with each patient in Drago-EHRPC discriminate very well in relation to the number of consultations that patients tend to use, since a higher AMG indicates greater morbidity, greater complexity, and greater demand for social and health services. These data coincide with the results of Barrio-Cortes et al [ 22 ], where contact with the physician was higher compared to nursing, and with higher utilization based on female sex, age, and clinical need (high risk of morbidity). Cassell et al [ 23 ] showed in their study a strong association between MM and the configured annual rate of GP consultations, where patients with MM had 2.56 times more consultations than patients without MM; in addition, the latter was associated with female sex, increased age, and lower economic resources, a parameter not valued in our study.…”

“…Differences in the use of medical and nursing consultations were discovered, with women attending more medical consultations and men attending more nursing/social-work consultations, data that coincide with the results of Barrio-Cortes et al [ 22 ]. When we consulted the European Health Survey in Spain (2020) [ 20 ], it coincided with these data; however, when we narrowed it down by age group to between 75–84 years and 85 years, percentages of over 40% for both sexes attended the family doctor’s office in the previous four weeks [ 26 ].…”

Utilization and out-of-pocket expenses of primary care among the multimorbid elderly in China: A two-part model with nationally representative data

“…Similar to the results of previous studies ( 62 , 71 ), women have significantly higher OOPE than men. Compared with men, women have a higher probability to delay hospitalization for family or financial reasons, increasing the severity of diseases and causing more complications, which result in an escalation of expenditures.…”

Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease

“…There are many unresolved problems in CVD patients [1][2][3]. Most patients with chronic diseases (including cardiovascular diseases) have an increased need for medical care [5]. Promoting the enhancement of protective factors (disease surveillance and support through social health programs) and the adoption of healthy behaviors are important strategies to reduce the burden of noncommunicable diseases [6].…”