Primary care and healthcare utilization among older Brazilians (ELSI-Brazil)

Macinko, James; Andrade, Fabíola Bof de; Souza Junior, Paulo Roberto Borges de; Lima-Costa, Maria Fernanda

doi:10.11606/S1518-8787.2018052000595

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Sumário

Supplement ELSI-Brazil, Original Article • Rev. Saúde Pública 52 (Suppl 2) • 2018 • https://doi.org/10.11606/S1518-8787.2018052000595 copy

Primary care and healthcare utilization among older Brazilians (ELSI-Brazil)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To characterize healthcare access and utilization among older Brazilians.

METHODS

Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants.

RESULTS

Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization.

CONCLUSIONS

By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.

Aged; Health Services for the Aged; Health Services Needs and Demand; Primary Health Care

Variable	Traditional health posts (n= 1,837)	Family Health Strategy (n = 5,356)	Private health plans (n = 2,210)	Total (n = 9,410)
Female	51.82 (47.62–56.01)	53.68 (50.53–56.79)	56.29 (51.80–60.68)	53.96 (51.00–56.90)
Age (mean)	62.78 (61.88–63.68)	62.49 (61.64–63.35)	64.26 (63.06–65.46)	62.99 (62.16–63.82)
Any functional limitation	26.16 (22.78–29.86)	27.65 (25.33–30.10)	20.73 (17.79–24.02)	25.62^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (23.57–27.78)
1 or more chronic conditions	72.69 (69.24–75.89)	74.22 (72.06–76.27)	73.95 (70.95–76.74)	73.86 (72.09–75.55)
Wealth quintiles (lowest 2)	38.51 (33.05–44.28)	43.54 (36.86–50.47)	15.82 (12.19–20.27)	35.75^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (30.63–41.21)
Doctor visit, past year	75.87 (72.61–78.86)	82.62 (80.64–84.43)	90.35 (88.40–92.01)	83.22^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (81.73–84.61)
Mean doctor visits^b	3.85 (3.59– 4.12)	4.32 (4.10–4–54)	5.06 (4.78–5.34)	4.44^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (4.27–4.60)
1 or more GP visit, past year	66.88 (62.9–70.64)	79 (76.5–81.31)	46.85 (43.1–50.64)	68.27^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (65.79–70.65)
Mean GP visits^b	2.96 (2.73–3.19)	3.51 (3.28–3.74)	3.31 (3.05–3.58)	3.38 (3.21–3.55)
1+ specialist visits, past year	63.52 (59.42–67.43)	55.73 (52.66–58.77)	87.84 (85.75–89.66)	65.71^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (63.4–67.94)
Mean specialist visits^b	2.94 (2.61–3.26)	2.71 (2.51–2.90)	3.99 (3.71–4.27)	3.20^a a Fundação Oswaldo Cruz. Brazilian Longitudinal Study of Aging. Rio de Janeiro; c2015 [cited 2017 Nov 28]. Available from: http:// elsi.cpqrr.fiocruz.br (3.05–3.35)

Variable	Traditional public health posts (n = 1,837)	Family Health Strategy (n = 5,356)	Private health plans (n = 2,210)	Total (n = 9,410)
Access
Difficult to make an appointment	0.5283 (0.4741–0.5818)	0.4031 (0.3736–0.4333)	0.2642 (0.2343–0.2965)	0.3926 (0.365–0.4209)
Cannot see doctor within 24 hours	0.6116 (0.5694–0.6522)	0.492 (0.4487–0.5354)	0.4486 (0.4058–0.4922)	0.5043 (0.4715–0.537)
Difficult to get information by phone	0.732 (0.6881–0.7718)	0.6359 (0.5967–0.6735)	0.4361 (0.4076–0.4652)	0.6043 (0.5742–0.6336)
Continuity of care
Rarely/never see the same doctor	0.4416 (0.4123–0.4712)	0.3738 (0.3435–0.4051)	0.2612 (0.2338–0.2906)	0.3588 (0.3362–0.3821)
Doctor doesn’t know the patient’s medications	0.2589 (0.2292–0.291)	0.1801 (0.1609–0.2011)	0.1116 (0.0925–0.1341)	0.1777 (0.1633–0.1932)
Doctor doesn’t know the patient’s health problems	0.3002 (0.2718–0.3301)	0.1798 (0.1559–0.2064)	0.1208 (0.1002–0.145)	0.188 (0.1677–0.2102)
Provider communication
Doctor does not listen well	0.2542 (0.2217–0.2896)	0.173 7(0.1551–0.1941)	0.1099 (0.0909–0.1322)	0.1732 (0.158–0.1896)
Doctor does not explain things well	0.2732 (0.2439–0.3046)	0.2056 (0.1842–0.2287)	0.1296 (0.1061–0.1574)	0.1996 (0.1838–0.2165)
Appointment does not last enough time	0.3333 (0.3076–0.3601)	0.2763 (0.2473–0.3073)	0.1796 (0.1569–0.2049)	0.2632 (0.2433–0.2841)
Coordination and care resolution
Doctor does not discuss a specialist visit	0.573 (0.5356–0.6096)	0.473 (0.4519–0.4942)	0.4566 (0.4296–0.4838)	0.4881 (0.4691–0.5073)
Little/no help making a specialist appointment	0.0517 (0.0377–0.0704)	0.0326 (0.0237–0.0447)	0.1742 (0.1402–0.2143)	0.0718 (0.0598–0.086)
Doctor unable to resolve the patient’s health problems	0.337 (0.3049–0.3706)	0.2545 (0.2344–0.2758)	0.1456 (0.1233–0.1712)	0.2433 (0.2262–0.2613)
Mean primary care problems (of 12)	4.46 (4.18–4.73)	3.52 (3.30–3.74)	2.73 (2.54–2.92)	3.51 (3.33–3.69)

Variable	Any GP visit	Number of GP visits	Any specialist visit	Number of specialist visits
Family Health Strategy (versus traditional health post)	1.62^c (1.35–1.96)	1.13^b (1.03–1.25)	0.81^b (0.67–0.98)	1.01 (0.88–1.15)
Private health plan	0.52^c (0.41–0.66)	1.1 (0.93–1.29)	3.06^c (2.32–4.04)	1.51^c (1.30–1.75)
3–4 primary care problems (versus < 3)	1.09 (0.92–1.28)	0.98 (0.87–1.10)	0.85 (0.71–1.03)	0.94 (0.81–1.08)
≥ 5 primary care problems	1.36^c (1.18–1.56)	0.8^c (0.71–0.90)	0.73^c (0.63–0.84)	0.9^c (0.79–1.02)
Female	1.22^b (1.02–1.47)	1.13 (1.00–1.27)	0.98 (0.83–1.16)	1.09 (0.97–1.22)
Any functional limitation	1.02 (0.83–1.26)	1.37^c (1.20–1.56)	1.52^c (1.32–1.76)	1.33^c (1.18–1.50)
1 or more chronic conditions	1.21^b (1.03–1.43)	1.59^c (1.41–1.80)	1.24^c (1.04–1.48)	1.37^c (1.21–1.55)
Lowest 2 household wealth quintiles	1.27^b (1.06–1.53)	1.02 (0.90–1.15)	0.63^c (0.53–0.74)	0.93 (0.79–1.10)

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[1] Correspondence: James Macinko. 650 Charles E. Young Dr. South Room 31-235B 90095-1772 Los Angeles, CA, USA Email: jmacinko@ucla.edu