Factors associated with the utilization of primary care emergency centers in a Spanish region with high population dispersion: a mixed-methods study

BMC Health Services Research

Miguel San Sebastián³  Teresa Blasco-Hernández¹  Laura Otero-García²  Belén Sanz-Barbero² 

[1] National Centre of Tropical Medicine, Health Institute Carlos III, Madrid, Spain;CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain;Department of Public Health and Clinical Medicine Umeå University, Umeå International School of Public Health, Umeå, Sweden

关键词: Mixed-methods approach, Spain;    Health services utilization;    Primary care emergency center;   

Others  :  1126551
DOI  :  10.1186/1472-6963-14-368

 received in 2013-03-01, accepted in 2014-08-21,  发布年份 2014

【 摘 要 】

Background

Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers’ perceptions regarding PCEC utilization.

Methods

A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase:14 in-depth- interviews of rural-based PCEC providers.

Results

Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p < 0.001). Healthcare providers perceived that distance to hospital increased PCEC utilization, and distance to PCEC decrease its use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours.

Conclusions

The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.

【 授权许可】

   
2014 Sanz-Barbero et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Monden CW, van Lenthe FJ, Mackenbach JP: A simultaneous analysis of neighbourhood and childhood socio-economic environment with self-assessed health and health-related behaviours. Health Place 2006, 12:394-403.
• [2]van Lenthe FJ, Mackenbach JP: Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors. J Epidemiol Community Health 2006, 60:699-705.
• [3]Exworthy M, Bindman A, Davies H, Washington AE: Evidence into policy and practice? Measuring the progress of U.S. and U.K. policies to tackle disparities and inequalities in U.S. and U.K. health and health care. Milbank Q 2006, 84:75-109.
• [4]Arcury TA, Gesler WM, Preisser JS, Sherman J, Spencer J, Perin J: The effects of geography and spatial behaviour on health care utilization among the residents of a rural region. Health Serv Res 2005, 40:135-155.
• [5]Hiscock R, Pearce J, Blakely T, Witten K: Is neighborhood access to health care provision associated with individual-level utilization and satisfaction? Health Serv Res 2008, 43:2183-2200.
• [6]Beattie TF, Gorman DR, Walker JJ: The association between deprivation levels, attendance rate and triage category of children attending a children’s accident and emergency department. Emerg Med J 2001, 18:110-111.
• [7]Li G, Grabowski JG, McCarthy ML, Kelen GD: Neighborhood characteristics and emergency department utilization. Acad Emerg Med 2003, 10:853-859.
• [8]Lee JE, Sung JH, Ward WB, Fos PJ, Lee WJ, Kim JC: Utilization of the emergency room: impact of geographic distance. Geospat Health 2007, 2:243-253.
• [9]Sanz-Barbero B, Otero García L, Blasco Hernández T: The effect of distance on the use of emergency hospital services in a Spanish region with high population dispersion: a multilevel analysis. Med Care 2012, 50:27-34.
• [10]Oterino De La Fuente D, Baños Pino JF, Fernández Blanco V, Rodríguez Alvarez A, Peiró S: Hospital and primary care emergency services in Asturias [Spain]: variations among health areas and trends between 1994–2001. Gac Sanit 2007, 21:316-320.
• [11]García MF, Fernández Quintana AI, Díaz Prats A: Emergency care in the autonomous regions of Spain. Improvement in pre-hospital emergency care and welfare coordination. Gac Sanit 2012, 26(Suppl 1):134-141.
• [12]Nicholl J, Munro J: Systems for emergency care. Integrating the components is the challenge. Br Med J 2000, 320:955-956.
• [13]López-Casasnovas G, Costa-Font J, Planas I: Diversity and regional inequalities in the Spanish 'system of health care services. Health Econ 2005, 14:S221-S235.
• [14]Martín JJ, González MP: [The sustainability of the Spanish National Health System]. Cien Saude Colet 2011, 16:2773-2782.
• [15]Wisdom JP, Cavaleri MA, Onwuegbuzie AJ, Green C: Methodological reporting in qualitative, quantitative, and mixed methods health services research articles. Health Serv Res 2012, 47:721-745.
• [16]Instituto Nacional de Estadística (INE): Padrón Municipal de Habitantes. 2009. http://www.ine.es/inebmenu/indice.htm#6 webcite
• [17]Instituto Nacional de Estadística: Padrón Municipal de Habitantes 2006. 2006. http://www.ine.es/inebmenu/indice.htm#6 webcite
• [18]León J d C y, de Sanidad C: Guía de Ordenación Sanitaria 2007. 2007. http://www.salud.jcyl.es/sanidad/cm/institucion/tkContent?pgseed?=?1233532149842&idContent?=?312478&locale?=?es_ES&textOnly?=?false webcite
• [19]León J d C y, de Sanidad C: III Plan de Salud Castilla y León (2008–2012). 2008. http://www.saludcastillayleon.es/institucion/es/organizacion/ordenacion-sistema-sanitario/guia-ordenacion-sanitaria-castilla-leon-2007 webcite
• [20]Instituto Nacional de Estadística: Encuesta Nacional de Salud 2003. Metodología detallada. 2003. http://www.ine.es/metodologia/t15/t1530419.pdf webcite
• [21]Instituto Nacional de Estadística: Censo de Población y Vivienda 2001. 2001. http://www.ine.es/jaxi/menu.do?type?=?pcaxis&path?=%2Ft20%2Fe242&file?=?inebase&L?=?0 webcite
• [22]Snijders TAB, Bosker RJ: Multilevel analysis: an introduction to basic and advanced multilevel modelling. Thousand Oaks, CA: Sage Publications; 1999.
• [23]Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, Råstam L, Larsen K: Brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health 2006, 60:290-297.
• [24]Rabe-Hesketh S, Skrondal A, Gjessing HK: Biometrical Modeling of Twin and Family Data Using Standard Mixed Model Software. Biometrics 2008, 64:280-288.
• [25]Stata Statistical Software [computer program]: Version Release 11. StataCorp. College Station, TX: StataCorp LP; 2009.
• [26]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24:105-112.
• [27]Strauss AL, Corbin J: Basics of qualitative research: Techniques and procedures for developing grounded theory. 2a edition. Thousand Oaks, CA: Sage Publications; 1998.
• [28]O'Reilly D, Stevenson M, McCay C, Jamison J: General practice out-of-hours service, variations in use and equality in access to a doctor: a cross-sectional study. Br J Gen Pract 2001, 51:625-629.
• [29]Leibowitz R, Day S, Dunt D: A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction. Fam Pract 2003, 20:311-317.
• [30]Turnbull J, Martin D, Lattimer V, Pope C, Culliford D: Does distance matter? Geographical variation in GP out-of-hours service use: an observational study. Br J Gen Pract 2008, 58:471-477.
• [31]Turnbull J, Pope C, Martin D, Lattimer V: Management of out-of-hours calls by a general practice cooperative: a geographical analysis of telephone access and consultation. Fam Pract 2011, 28:677-682.
• [32]Salisbury C: The demand for out-of-hours care from GPs: a review. Fam Pract 2000, 17:340-347.
• [33]Giesen P, Franssen E, Mokkink H, van den Bosch W, van Vugt A, Grol R: Patients either contacting a general practice cooperative or accident and emergency department out of hours: a comparison. Emerg Med J 2006, 23:731-734.
• [34]Huibers LA, Moth G, Bondevik GT, Kersnik J, Huber CA, Christensen MB, Leutgeb R, Casado AM, Remmen R, Wensing M: Diagnostic scope in out-of-hours primary care services in eight European countries: an observational study. BMC Fam Pract 2011, 12:30. BioMed Central Full Text
• [35]Instituto Nacional de Estadística: Encuesta de Población Activa 2003. 2003. http://www.ine.es/censos2011_datos/cen11_datos_inicio.htm webcite
• [36]Torné Vilagrasa E, Guarga Rojasa A, Torras Boatella MG, Pozuelo García A, Pasarin Rua M, Borrell Thió C: Análisis de la demanda en los servicios de urgencies. Aten Prim 2003, 32:423-429.
• [37]Farmer J, Iversen L, Campbell NC, Guest C, Chesson R, Deans G, MacDonald J: Rural/urban differences in accounts of patients’ initial decisions to consult primary care. Health Place 2006, 12:210-221.
• [38]Borda A, Fernánzdez P, Otero L, Sanz-Barbero B: Rurality and Avoidable Hospitalization in a Spanish region with high population dispersion. Eur J Publ Health 2012. Nov 26. [Epub ahead of print]