Analysis of social determinants of health on the use of consultations in primary health care
DOI:
https://doi.org/10.32385/rpmgf.v39i4.13651Keywords:
Social determinants of health, Healthcare utilization determinants, Primary healthcareAbstract
Introduction: The social determinants of health (SDH) are the circumstances in which people are born, grow, live, work, and age, which influence their health status. There are several studies on social determinants and their influence on health; however, little has been investigated about these determinants and their action in the search for primary health care.
Objectives: This study aims to determine the influence of SDH (sex, age, distance from home to health center, nationality, education, professional situation, income, social dysfunction, and lifestyles) on the use of consultations in primary health care and to reflect on how these can be organized more efficiently and equitably.
Methods: An observational and retrospective analysis was carried out in a health center; whose target population is patients aged 28 years or older (n=8.781). It uses a multivariate analysis (multiple linear regression) to determine whether the independent variables (SDH) influence the dependent variable (number of consultations in the last 10 years), analyzing year by year and performing a comparison between the period pre and post-COVID-19 pandemic.
Results: Through this investigation, we concluded that the SDH has an influence on the use of consultations in primary health care, such as sex, age, nationality, body mass index (BMI), income, education, professional status, family dysfunction, distance from home to the health center, the fact of being a non-smoker and drug use. As for the analysis of the period pre and post-COVID-19 pandemic, it was found that this had an impact on changing some patterns of behavior on the part of patients.
Conclusion: Thus, it is believed that by acting at the level of these determinants, it is possible to improve equity in access to health care and equity in health status.
Downloads
References
World Health Organization. Social determinants of health [homepage]. Geneva: WHO; [cited 2022 Mar 14]. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
NEJM Catalyst. Social determinants of health (SDOH) [homepage]. NEJM Catalyst. 2017 Dec 17 [cited 2022 Mar 26]. Available from: https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0312?targetBtn=articleToolSaveBtn
Sousa P. Desigualdades socioeconómicas e doenças cardiovasculares [Equity, socioeconomic inequalities and cardiovascular disease]. Rev Port Cardiol. 2013;32(11):855-6. Portuguese
Eikemo TA, Huijs T, Bambra C, McNamara C, Stornes P, Balaj M, et al. Desigualdades sociais na saúde e seus determinantes: resultados em destaque da 7ª edição do Inquérito Social Europeu (ESS). Londres: European Social Survey; [cited 2022 Apr 25]. Available from: http://www.europeansocialsurvey.org/docs/findings/TL6_Health-Portuguese.pdf
Organisation for Economic Co-operation and Development. Health at a glance 2021: OECD indicators [homepage]. Paris: OECD; 2021. Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2021_ae3016b9-en
Serviço Nacional de Saúde. Utentes inscritos em cuidados de saúde primários [homepage]. Lisboa: SNS; 2022 [cited 2022 Sep 4]. Available from: https://transparencia.sns.gov.pt/explore/dataset/utentes-inscritos-em-cuidados-de-saude-primarios/table/?flg=pt&disjunctive.ars&disjunctive.aces&sort=periodo&refine.periodo=2022
World Health Organization. Primary health care: report of the International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 [homepage]. Geneva: WHO; 1978. Available from: https://apps.who.int/iris/handle/10665/39228
Allen J, Gay B, Crebolder H, Heyrman J, Svab I, Ram P, et al. A definição Europeia de medicina geral e familiar: clínica geral/medicina familiar [Internet]. World Organization of Family Doctors; 2002 [cited 2022 Mar 14]. Available from: https://www.woncaeurope.org/file/b662cccc-6ad6-4d34-a9a2-fd02d29fae5b/European%20Definition%20in%20Portuguese.pdf
Organisation for Economic Co-operation and Development. Health for everyone? Social inequalities in health and health systems [homepage]. Paris: OECD; 2019. Available from: https://www.oecd.org/health/health-for-everyone-3c8385d0-en.htm
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-81.
Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ. 2015;16(1):21-33.
Geitona M, Zavras D, Kyriopoulos J. Determinants of healthcare utilization in Greece: Implications for decision-making. Eur J Gen Pract. 2007;13(3):144-50.
Luppa M, Giersdorf J, Riedel-Heller S, Prütz F, Rommel A. Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS). BMC Fam Pract. 2020;21(1):10.
Fjær EL, Balaj M, Stornes P, Todd A, McNamara CL, Eikemo TA. Exploring the differences in general practitioner and health care specialist utilization according to education, occupation, income and social networks across Europe: findings from the European social survey (2014) special module on the social determinants of health. Eur J Public Health. 2017;27(Suppl 1):73-81.
Jusot F, Or Z, Sirven N. Variations in preventive care utilisation in Europe. Eur J Ageing. 2011;9(1):15-25.
Or Z, Jusot F, Yilmaz E. Impact of health care system on socioeconomic inequalities in doctor use [Internet]. Paris: Institut de Recherche et Documentation en Économie de la Santé; 2008. Available from: https://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/DT17ImpactHealthCareSystSocioeconomicInequalities.pdf
Robles R, Gili M, Gelabert J, Llull M, Bestard F, Vicens C, et al. Sociodemographic and psychopathological features of frequent attenders in primary care. Actas Esp Psiquiatr. 2009;37(6):320-5.
Gili M, Luciano JV, Serrano MJ, Jiménez R, Bauza N, Roca M. Mental disorders among frequent attenders in primary care: a comparison with routine attenders. J Nerv Ment Dis. 2011;199(10):744-9.
Luciano JV, Fernández A, Pinto-Meza A, Luján L, Bellón JA, García-Campayo J, et al. Frequent attendance in primary care: comparison and implications of different definitions. Br J Gen Pract. 2010;60(571):49-55.
Field KS, Briggs DJ. Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health Soc Care Community. 2001;9(5):294-308.
Scaife B, Gill P, Heywood P, Neal R. Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data. Fam Pract. 2000;17(4):298-304.
Vedsted P, Christensen MB. Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health. 2005;119(2):118-37.
Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Schene AH, van Weert HC, et al. Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study. J Psychosom Res. 2014;77(6):492-503.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
