Fonte usual de cuidado e o acesso de adolescentes brasileiros a serviços de Atenção Primária à Saúde (APS) / Usual source of care and Brazilian adolescent access to Primary Health Care (PHC) services

Resumo Objetivou-se analisar a associação entre o reconhecimento de uma fonte usual do cuidado de Atenção Primária à Saúde (APS) e o acesso aos serviços de APS, entre adolescentes brasileiros. Estudo transversal, a partir da Pesquisa Nacional de Saúde do Escolar realizada com 68.968 adolescentes brasileiros, através de amostragem por conglomerados. Foram realizadas análises descritivas através do χ2 de Pearson e a razão de prevalência (RP) através dos modelos de regressão logística entre acesso aos serviços de APS e o reconhecimento da FUC APS. Dos adolescentes que procuraram os serviços de APS, 74,6% referiram acesso, sendo a maior do sexo feminino (79,3%). Na análise multivariada, observa-se associação positiva (RP: 1,25; IC95%: 1,24-1,26), e na estratificado por sexo, observou-se associações positivas para ambos os sexos, (RP: 1,30; IC95%: 1,28-1,31) masculino e (RP: 1,21; IC95%: 1,20-1,23) feminino. Verifica-se que a maioria dos adolescentes brasileiros que têm a APS como sua FUC conseguiram acessar os serviços de APS, apesar de que, a falta de acesso foram mais frequentes entre os mais vulneráveis economicamente e devido a comportamentos de risco, indicando iniquidades potencialmente evitáveis por meio de uma APS mais efetiva e longitudinal.

Abstract We analyzed the association between the recognition of a usual source of care (USC) of Primary Health Care (PHC) and access to services among Brazilian adolescents. This is a cross-sectional study using data from the National Adolescent School-based Health Survey with 68,968 Brazilian adolescents and cluster sampling. Descriptive analyses were carried out with Pearson's χ2 and prevalence ratios (PR) using logistic regression models between access and recognition of USC. It was observed that 74.6% reported access, and this was higher among females (79.3%). In the multivariate analysis, there was a positive association (PR: 1.25; 95%CI: 1.24-1.26); and, when stratified by sex, positive associations for both sexes, (PR: 1.30; 95%CI: 1.28-1.31) male and (PR: 1.21; 95%CI: 1.20-1.23) female. The majority of Brazilian adolescents demonstrated PHC as a USC and were able to access services, but lack of access was more frequent among the most economically vulnerable and those with risk behaviors, indicating potentially avoidable inequities with more equitable and longitudinal PHC services.

Association between Types of Usual Source of Care and User Perception of Overall Health Care Service Quality in Korea / 가정의학회지

BACKGROUND: Patients' perceptions of care tend to correlate with the quality of care provided. Different health care systems and service environments may show different associations between types of usual source of care (USC) and overall service quality assessment. We attempted to analyze this association as a benefit of having a USC. METHODS: This study used the 2012 Korea Health Panel data version 1.1 as representative national household survey data. The total number of subjects aged 18 years or more was 12,708. The number of subjects in the final analysis was 10,665. Multiple logistic regression analysis was used to assess the association between types of USC and overall health care service quality. The main outcome variable was users' ratings of the quality of health care service. RESULTS: People having a usual doctor (n=1,796) were more likely to positively assess the quality of health care they received than those not having a USC (n=7,920; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.20–1.60) or with those having only a place as a USC without a usual doctor (n=949; OR, 1.29; 95% CI, 1.05–1.58) after adjustment for demographic characteristics and health-related variables. CONCLUSION: People having a usual doctor rated overall health care service quality as high, which might be due to benefits of primary care attributes related to usual doctors. Further studies are needed to elucidate the causal relationship. This finding implies that health policies encouraging people to have a usual doctor are needed in Korea.

Effect of Having a Usual Source of Care on Medical Expenses – Using the Korea Health Panel Data

BACKGROUND: There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. METHODS: The participants included those aged 20 years and older who responded to the questionnaire about “having a usual source of care” from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with “I do not get sick easily” or “I rarely visit medical institutions” as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. RESULTS: The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. CONCLUSION: This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization.

The Effect of Having Usual Source of Care on the Choice among Different Types of Medical Facilities / 보건행정학회지

BACKGROUND: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. METHODS: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. RESULTS: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. CONCLUSION: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.

The Association between having a Usual Source of Care and Adherence to Medicines in Patients with Chronic Diseases

OBJECTIVE: This study was to explore the association between having a usual source of care and adherence to medicines in patient with chronic diseases. METHODS: The 2012 Korea Health Panel was used as a data source. We analyzed 4,418 respondents that were diagnosed with chronic diseases and utilized health care services. Non-adherence to medication, a dependent variable, was defined as "not taking the medicines that were prescribed for treating chronic disease" or "not following the direction for medication". Whether having a usual source of care or not was used as a key independent variable, which was defined as having a regular site or a regular doctor for medical test, treatment, and consultation. Sex, age, education level, marital status, income, the type of health insurance, the number of chronic disease and CCI (Charlson Comorbidity Index) were included as covariates in the analysis. We conducted a multivariate logistic regression. RESULTS: Totally, 30 percent of respondents reported to experience nonadherence to medication. Having a usual source of care was significantly associated with lower non-adherence to medication regardless its type, which is a regular doctor (OR=0.61, 95% CI=0.53-0.70) or a regular site (OR=0.67, 95% CI=0.58-0.78). Furthermore, having a usual source of care was associated with both of medication persistence (OR=0.66, 95% CI=0.54-0.81) and compliance (OR=0.65, 95% CI=0.56-0.76). CONCLUSION: Our results showed the possibility that usual source of care is able to conduct a positive role in improving adherence to medication with better management of chronic disease.

Effects of Having Usual Source of Care on Preventive Services and Chronic Disease Control: A Systematic Review / 가정의학회지

BACKGROUND: Having usual source of care has been associated with improved receipt of preventive services and control of chronic diseases (such as hypertension, diabetes, and hypercholesterolemia). The objective of this study was to examine whether having usual source of care is associated with improved receipt of preventive services and control of chronic diseases. METHODS: We searched MEDLINE, EMBASE, Cochrane, CINAHL, KMbase, KoreaMed, RiSS4U, National Assembly Library, and KISS for studies released through May 31st 2011. Two authors independently extracted the data. We manually searched the references and twenty recent related articles on PubMed. To assess the risk of bias RoBANS tool was used. RESULTS: We identified 10 studies. Most having usual source of care were associated with improved receipt of preventive services (cervical cancer screening, clinical breast exam, mammogram, prostate cancer screening, and flu shot) compared with no usual source of care. However, gastric cancer and colon cancer screening were difficult to conclude and blood pressure checkup showed mixed results. Overall there was no association between having usual source of care and smoking behaviors and the effect on chronic disease control was difficult to conclude. CONCLUSION: Having usual source of care was associated with improved receipt of preventive services and overall the results were consistent. So, the results suggested that having usual source of care may help to receive preventive services. Hereafter, cohort studies are needed to evaluate casual relationships and more studies are needed in various countries and systems.

Association between Primary Care Quality and Health Behaviors in Patients with Essential Hypertension Who Visit a Family Physician as a Usual Source of Care / 가정의학회지

BACKGROUND: Management of hypertension has been performed mainly in primary care institutions, but hypertension control in population is still unsatisfactory. This study was aimed at finding a strategy to improve health promotion activities in patients with hypertension by exploring the association between health behaviors and quality of primary care. METHODS: April to June in 2007, a questionnaire survey of the patients who has a family physician as a usual source of care was conducted for the development of the Korean Primary Care Assessment Tool (KPCAT). In this study, a usual source of care was defined as a physician of the persons who had visited their primary care clinic on six or more occasions over a period of more than 6 months. Of the data collected from 9 private clinics (3 in Seoul and 6 at small cities), cases of the patients who marked on having hypertension were selected. The associations between levels of quality of primary care and socio-demographic characteristics or health behaviors were analysed by Student t-test and chi-square test. Controlling socio-demographic variables, the association between quality of primary care and health behaviors was examined by multiple logistic regression analysis. RESULTS: Among the patients (n = 602) of 9 private clinics who has a family physician as a usual source of care, those who marked on having hypertension were 134. Among 5 domains of the KPCAT, the highest domain in score was personalized care (71.7/100), and the lowest domain in score was coordination function (49.7/100). In patients who gave total average (69.2/100) or more in total primary care score, after adjustment with age, sex, income, education, and duration, odds ratio to have a normal BMI (<25 kg/m2) was 2.53 (P = 0.02), and odds ratio to have a habit drinking an adequate amount of alcohol was 4.32 (P = 0.02). CONCLUSION: The fact that high-quality primary care was associated with good health behaviors in this study suggests that improving quality of primary care by health care reform can make health behaviors more desirable in patients with essential hypertension.

Patient Assessment of Primary Care of Health Cooperative Clinics in South Korea / 가정의학회지

BACKGROUND: In South Korea, major health care problems have been occurred under the structural background that medical services are mainly provided by private medical institutions. Primary health care, which is very crucial in public health, has been overlooked, and is disorganized and fragmented. In the mean time, health cooperative movement was initiated by local residents and medical doctors to overcome health care problems in 1987. We conducted this study to evaluate the role of health cooperative clinics and obtain lessons for the future primary care policy. METHODS: During April to June in 2007, survey was performed by a trained interviewer at the waiting rooms of 3 health cooperative clinics, in the process of development of the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of 5 domains (21 items): first contact (5), coordination function (3), comprehensiveness (4), family/community orientation (4), and personalized care (5). Subjects were patients (or guardians) who had visited their health cooperative clinics on six or more occasions over a period of more than 6 months. We compared primary care scores of each domain between members and non-members of health cooperative clinics by student t-test. Effect of having a membership on each primary care domains was examined by multiple regression analysis. RESULTS: Among the participants (N = 100), members of health cooperatives were 48, and non-members 52. Total average scores of 5 primary care domains of the KPCAT were 78.0 +/- 13.5 on 100 point scale. (82.0 +/- 13.1 in members, and 74.3 +/- 13.0 in nonmembers; P = 0.004) Among primary care domains, personalized care was the highest (91.4 +/- 11.0), and coordination function the lowest (61.0 +/- 33.1) in score. Significant differences between members and nonmembers were noted in coordination function (68.9 vs. 53.7, P = 0.021) and comprehensiveness (78.4 vs. 67.2, P = 0.008). These differences were continued after adjusting by multiple regression analysis for socio-demographic variables including age, sex, income, education, number of disease, and duration since the first visit. CONCLUSION: In the health cooperative clinics whose primary care performance has been considered exemplary in the context of health care in South Korea, primary care scores assessed by members were higher than those by non-members. The significant differences of scores in coordination function and comprehensiveness between members and nonmembers suggest that the future primary care policy should be focused to strengthen these two domains of primary care.