Use of health services by Brazilian older adults with and without functional limitation

Silva, Alexandre Moreira de Melo; Mambrini, Juliana Vaz de Melo; Peixoto, Sérgio Viana; Malta, Deborah Carvalho; Lima-Costa, Maria Fernanda

doi:10.1590/S1518-8787.2017051000243

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Sumário

Original Articles • Rev. Saúde Pública 51 (suppl 1) • 2017 • https://doi.org/10.1590/S1518-8787.2017051000243 copy

Use of health services by Brazilian older adults with and without functional limitation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the use of health services and the quality of medical care received by Brazilian older adults with and without functional limitation.

METHODS

The main analyses were based on a national sample representing 23,815 participants of the National Survey on Health (PNS) aged 60 years or older. Functional limitation was defined by the difficulty to perform at least one out of ten basic or instrumental activities of daily living. Potential confounding variables included predisposing and enabling factors of the use of health services.

RESULTS

The prevalence of functional limitation was 30.1% (95%CI 29.2–31.4). The number of doctor visits and hospitalizations in the past 12 months showed statistically significant associations with functional limitation, both for users of the public system (OR = 2.48 [95%CI 2.13–2.88] for three or more doctor visits and OR = 2.58 [95%CI 2.15–3.09] for one or more hospitalizations) and of the private system (OR = 2.56 [95%CI 1.50–4.36] and OR = 2.22 [95%CI 1.64–3.00], respectively). The propensity to use basic health units was higher among users of the private system with functional limitations (OR = 2.01 [95%CI 1.12–3.59]). Only two out of seven indicators of the quality of medical care received were associated with functional limitation, in the perception of users of public and private systems. The public system users with functional limitations did worse evaluation of the freedom for choosing the doctor and waiting time for an appointment, when compared with users of the same system without these limitations (OR = 0.81 [95%CI 0.67–0.99] and OR = 0.76 [95%CI 0.62–0.93], respectively).

CONCLUSIONS

Older adults with functional limitations use more health services in comparison with those without such limitations. The magnitude of the association between functional limitation and number of doctor visits and hospitalizations was similar in the public and private health systems.

Aged; Frail Elderly; Disabled Persons; Activities of Daily Living; Health Services for the Aged; Quality of Health Care

Characteristic	Total		Source of health care				p^b

	Mean or percentage^a	(95%CI)	Private		Public

			Mean or percentage^a	(95%CI)	Mean or percentage^a	(95%CI)
Age, mean	69.9	69.7–70.1	70.2	69.8–70.6	69.8	69.5–70.0	< 0.001
Female sex, %	56.4	42.8–44.4	59.9	58.5–61.3	54.9	54.0–55.9	< 0.001
Living with spouse/partner, %	57.0	55.9–58.2	59.8	57.5–62.0	55.9	54.6–57.2	< 0.003
Education level, %
Has never studied	31.8	30.5–33.0	12.8	11.3–14.6	39.6	38.1–41.0	< 0.001
Some elementary or middle school	39.3	38.1–40.5	35.2	32.8–37.7	41.0	39.6–42.4
Elementary or middle school/some high school	8.3	7.7–9.0	10.1	8.9–11.4	7.6	6.9–8.3
High school or more	20.6	19.5–21.9	41.9	39.3–44.6	11.9	11.0–12.8	< 0.001
Functional limitation^c, %	30.1	29.2–31.4	25.1	23.4–26.9	32.2	31.1–33.4	< 0.001

Indicator	Public				Private

	With limitation		Without limitation		With limitation		Without limitation

	%^b	95%CI^b	%^b	95%CI^b	%^b	95%CI^b	%^b	95%CI^b
Use of health services (n = 23,815)
Number of doctor visits in the past 12 months
None	12.6	11.4–13.9	23.2	22.0–24.4^c	4.8	3.0–7.4	9.9	8.4–11.6^c
1–2	24.0	22.3–25.8	31.5	30.1–32.9	20.9	17.6–24.8	33.9	31.3–36.6
≥ 3	63.4	61.4–65.4	45.4	43.8–47.0	74.3	70.2–78.1	56.2	53.4–59.0
One or more hospitalizations in the past 12 months	16.2	14.6–18.0	6.4	5.7–7.1^c	20.3	16.9–24.1	9.2	7.7–11.0^c
Medical care by general practitioner in the last doctor visit^d	65.7	63.9–70.9	68.3	65.7–70.7	38.5	31.8–45.6	28.9	25.3–32.8^c
Has health service or doctor of reference	79.1	77.2–80.9	76.9	75.3–78.4	85.3	81.5–88.0	82.9	80.5–85.1
Location usually sought (among those who have health service or doctor of reference)
Basic health unit	59.0	56.1–61.9	62.4	60.3–64.5^c	18.2	14.2–23.1	9.8	8.0–11.9^c
Doctor’s office or private clinic	7.8	6.6–9.2	8.9	7.7–10.2	54.3	49.0–59.5	59.4	55.6–63.2
Emergency room service	13.5	11.7–15.6	10.7	9.5–12.2	19.9	15.9–24.6	20.9	17.8–24.4
Other	19.7	17.6–21.9	18.0	16.4–19.6	7.6	5.7–10.1	9.9	7.9–12.3
Quality of medical care on the last doctor visit (very good/good versus regular/bad/very bad) (n = 9,290)
Physician’s ability to treat them	88.6	86.4–90.5	88.5	86.6–90.2	94.5	92.3–96.1	95.2	92.9–96.8
Physician’s respect in the way of serving them	90.1	87.8–92.0	90.8	89.0–92.4	95.6	92.8–97.3	96.1	94.1–97.4
Clarity in the physician’s explanations	83.2	80.1–86.0	85.9	83.7–87.8	92.5	89.4–94.8	93.3	90.9–95.1
Availability of time for asking questions about the problem	78.7	75.5–81.5	79.7	77.2–82.0	89.2	85.5–92.0	91.3	88.7–93.4
Possibility to talk in privacy with the doctor	83.8	81.0–86.3	84.6	82.4–86.6	91.9	88.8–94.2	92.9	90.3–94.8
Freedom to choose the doctor	56.0	52.3–59.6	58.2	55.2–61.1	77.7	71.1–83.2	83.6	79.8–86.7
Waiting time for the appointment	59.0	55.4–62.5	62.0	59.3–64.7	73.9	67.8–79.2	72.2	67.7–76.3

Indicators	Public^b		Private^b

	OR	95%CI	OR	95%CI
Use of health services (n = 23,815)
Number of doctor visits in the past 12 months (versus none)
1–2	1.39	1.18–1.63^c	1.20	0.69–2.09
≥ 3	2.48	2.13–2.88^c	2.56	1.50–4.36^c
One or more hospitalizations in the past 12 months	2.58	2.15–3.09^c	2.22	1.64–3.00^c
Medical care by general practitioner in the last doctor visit^d	0.99	0.82–1.29	0.93	0.62–1.38
Has health service or doctor of reference	1.15	1.00–1.32	1.11	0.82–1.52
Location usually sought (among those with health service or doctor of reference) (versus others)
Basic health unit	0.88	0.74–1.05	2.01	1.12–3.59^c
Doctor’s office or private clinic	0.86	0.64–1.14	1.28	0.83–1.97
Emergency room service	1.18	0.93–1.51	1.36	0.79–2.32
Quality of medical care in the last doctor visit (very good/good versus regular/bad/very bad) (n = 9,290)
Physician’s ability to treat them	0.95	0.73–1.23	0.74	0.38–1.42
Physician’s respect in the way of serving them	0.87	0.65–1.15	0.84	0.41–1.74
Clarity in the physician’s explanations	0.76	0.57–1.00	0.80	0.47–1.37
Availability of time for asking questions about the problem	0.86	0.67–1.11	0.78	0.48–1.28
Possibility to talk in privacy with the doctor	0.87	0.66–1.14	0.73	0.41–1.31
Freedom to choose the doctor	0.81	0.67–0.99^c	0.64	0.38–1.09
Waiting time for the appointment	0.76	0.62–0.93^c	0.95	0.63–1.43

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[1] Correspondence: Maria Fernanda Lima-Costa. Centro de Pesquisas René Rachou da Fundação Oswaldo Cruz Av. Augusto de Lima, 1715 30190-002 Belo Horizonte, MG, Brasil. E-mail: lima-costa@cpqrr.fiocruz.br