First choice for use of health services by the adult population of the Federal District, Brazil, 2015: a cross-sectional study

Poças, Kátia Crestine; Perillo, Rosângela Durso; Bernal, Regina Tomie Ivata; Malta, Deborah Carvalho; Duarte, Elisabeth Carmen

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 28 (2) • 2019 • https://doi.org/10.5123/S1679-49742019000200017 copy

First choice for use of health services by the adult population of the Federal District, Brazil, 2015: a cross-sectional study^* * This article originated from part of the doctoral thesis by Kátia Crestine Poças entitled “Evaluation of Primary Health Care services in Brazil’s Federal District”, defended at the Postgraduate Program in Public Health, Faculty of Health Sciences, Universidade de Brasília (FS/UnB) in August 2017. This study was funded by the Health Surveillance Secretariat, Brazilian Ministry of Health (SVS/MS), through the 2015 edition of the VIGITEL System (Telephone Surveillance of Chronic Disease Risk and Protective Factors) survey (VIGITEL/2015: Report No. 25.000.066485/2015-10).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to describe the first choice for use of health services and to analyze sociodemographic factors associated with seeking Primary Health Care (PHC) by the adult population of Brazil’s Federal District in 2015.

Methods:

this was a population-based study, with 2,007 individuals, using a sample from the 2015 VIGITEL survey conducted by landline telephone, including questions on use of health services; we used logistic regression to identify factors associated with seeking PHC services.

Results:

participants’ first choice was predominantly for private health services (57.6%), respondents reported seeking public health services less (39.5%), particularly PHC services (primary health centers: 24.6%); multivariate analysis showed that educational level (postgraduate [OR=0.15 - 95% CI 0.04;0.59] and high school [OR=0.37 - 95%CI 0.18;0.75]), and not having private health insurance (OR=27.77 - 95%CI 10.61;72.70) were variables associated with seeking PHC services.

Conclusion:

individuals with low educational level and without private health insurance are those who mostly seek PHC services as their first choice in Brazil’s Federal District.

Keywords:
Primary Health Care; Health Services; Epidemiology, Descriptive; Health Evaluation; Cross-Sectional Studies.

Characteristics (n=2,007)	%	95%CI^b
Sex
Female	53.3	49.1	57.6
Male	46.7	42.4	50.9
Age group (in years)
18-29	27.7	23.7	31.6
30-39	25.5	21.4	29.7
40-59	33.2	29.4	37.0
≥60	13.6	11.8	15.3
Education level
No formal education	1.9	1.3	2.5
Elementary school	28.3	23.7	33.0
High school	34.6	30.8	38.5
Higher education	26.8	23.7	29.8
Post-graduation	7.0	5.8	8.1
Not known/not informed	1.4	0.6	2.2
Health Insurance
Yes	60.0	55.6	64.3
No	40.0	35.7	44.4
Most used health service (n=2,003)^c
Public
PHU^d	24.6	20.3	28.8
Specialty, polyclinic or EC^e	0.7	0.1	1.3
Emergency Care Center	2.3	0.5	4.1
Other type of 24 hours emergency care	0.1	-	0.2
Hospital emergency care unit	2.5	1.3	3.8
Hospital	9.2	6.4	11.9
Home visit by an FHS^f professional	-	-	-
Private
Consulting room or clinic	37.8	34.1	41.6
Octpatient clinic or consulting room company/trade union	0.7	0.2	1.1
Hospital emergency care unit	14.7	12.1	17.6
Home visits by a doctor	0.3	0.1	0.6
Pharmacy	1.5	0.3	2.7
Other service	5.5	3.7	7.2

Variables	Nature of first choice health service
	Private			Public			Other^b
	Proportion (%)	95% CI^c		Proportion (%)	95% CI^c		Proportion (%)		95% CI^c
Sex
Male	57.1	49.8	64.4	39.9	32.4	47.3	3.0	1.2	4.9
Female	58.1	52.9	63.2	39.2	34.1	44.4	2.7	1.4	4.0
Age group (in years)
18-29	63.6	54.3	72.9	33.2	23.8	42.6	3.2	0.4	6.1
30-39	47.6	37.8	57.4	49.8	39.9	59.8	2.6	0.5	4.7
40-59	54.0	47.2	60.8	43.4	36.5	50.2	2.6	2.0	4.2
≥60	73.1	67.0	79.3	23.7	17.5	30.0	3.1	1.7	4.6
Education level
No formal education	22.1	-	64.2	76.3	33.8	100.0	1.6	-	5.8
Elementary school	31.4	21.2	41.1	68.1	58.4	77.7	0.5	-	1.1
High school	53.3	46.7	59.9	41.5	34.8	48.1	5.2	2.5	8.0
Higher education	83.1	78.6	87.6	14.2	10.0	18.5	2.7	0.9	4.5
Post-graduation	92.7	89.0	96.4	5.4	2.3	8.5	1.9	-	4.1
Not known/not informed	80.1	55.8	100.0	18.6	-	42.9	1.3	-	4.1
Private Health Insurance
Yes	88.1	84.3	92.0	8.7	5.1	12.3	3.2	1.6	4.8
No	11.9	8.3	15.4	85.8	82.0	89.7	2.3	0.9	3.8
Total	57.6	53.2	62.0	39.5	35.1	44.0	2.9	1.7	4.0

Variables	First choice health care level^b
	Primary care			Secondary care			Tertiary care			Other^c
	Proportion (%)	95%CI^d		Proportion (%)	95%CI^d		Proportion (%)	95%CI^d		Proportion (%)		95%CI^d
Sex
Male	25.6	18.2	32.8	41.3	34.7	47.9	25.3	19.5	31.7	7.6	4.0	11.3
Female	24.1	19.4	28.9	41.6	37.0	46.3	27.2	22.7	31.8	7.0	4.7	9.4
Age group (in years)
18-29	18.2	10.1	26.2	49.6	40.8	58.4	26.6	19.2	34.0	5.6	2.1	9.1
30-39	35.5	25.0	46.0	29.4	22.2	36.6	28.1	19.0	37.1	7.0	2.2	11.9
40-59	25.3	19.0	31.5	38.1	32.0	44.2	27.7	21.7	33.8	8.9	4.7	13.2
≥60	16.7	10.6	22.9	55.8	49.9	61.7	20.0	15.7	24.3	7.5	5.2	9.8
Education level
No formal education	73.5	30.2	100.0	22.1	-	64.2	2.8	-	9.8	1.6	-	5.8
Elementary school	45.7	34.9	56.5	21.0	13.2	28.8	24.8	15.2	34.4	8.5	2.7	14.3
High school	21.4	15.8	27.1	41.9	35.5	48.3	29.4	23.4	35.4	7.3	4.1	10.5
Higher education	10.2	6.2	14.3	58.7	53.1	64.3	24.8	20.0	29.5	6.3	3.8	8.9
Post-graduation	2.2	-	4.5	65.4	58.6	72.1	28.6	22.3	34.9	3.8	1.2	6.4
Not known/not informed	7.6	-	22.3	22.4	5.8	38.9	40.9	9.8	72.0	29.1	3.6	54.6
Health Insurance
Yes	3.4	0.8	6.1	59.6	54.7	64.5	27.2	22.7	31.6	9.8	6.5	13.0
No	56.7	49.2	64.2	14.2	9.3	19.1	25.4	18.9	31.9	3.7	1.8	5.5
Total	24.8	20.5	29.0	41.5	37.5	45.4	26.5	22.7	30.2	7.3	5.2	9.5

Variables	Use of Primary Health Care service as first choice^b
	None			Once or twice			3 or more times			Cannot remember
	Proportion (%)	95% CI^c		Proportion (%)	95% CI^c		Proportion (%)	95% CI^c		Proportion (%)		95% CI^c
Sex
Male	64.3	57.5	71.2	23.2	17.3	29.1	10.5	5.5	15.5	1.9	0.4	3.5
Female	53.9	48.9	58.9	22.6	18.4	26.9	19.6	15.0	24.1	3.9	2.0	5.8
Age (in years)
18-29 years old	64.4	56.2	72.7	18.7	12.4	25.0	14.4	7.9	20.8	2.5	0.5	5.0
30-39 years old	60.1	50.1	70.0	24.7	16.3	33.1	14.9	6.6	23.3	0.3	-	0.9
40-59 years old	53.0	46.3	59.8	24.2	17.9	30.6	18.3	12.5	24.1	4.4	1.5	7.3
≥60	58.7	52.7	64.7	25.0	19.1	30.8	10.9	7.1	14.7	5.4	2.6	8.3
Education level
No formal education	82.3	57.4	100.0	9.8	-	28.3	5.2	-	15.2	2.7	-	8.0
Elementary school	36.3	25.6	47.0	33.1	23.4	42.8	27.3	17.6	37.0	3.3	0.5	6.0
High school	61.1	54.6	67.6	22.9	17.2	28.7	11.6	7.3	16.0	4.3	1.6	7.0
Higher education	71.4	66.3	76.2	16.0	12.3	19.7	11.1	7.1	15.2	1.5	0.4	2.5
Post-graduation	80.5	74.8	86.2	13.7	8.8	18.7	5.0	1.9	8.0	0.8	-	1.6
Not known/not informed	73.6	48.5	98.8	11.9	-	33.0	10.3	-	25.5	4.1	-	12.5
Health Insurance
Yes	70.9	66.5	75.4	17.3	13.5	21.0	8.4	5.6	11.2	3.4	1.7	5.1
No	40.5	32.9	48.1	31.4	24.5	38.3	25.8	18.7	32.8	2.3	0.5	4.2
Primary Health Care service^d
Yes^e	-			61.5	53.8	69.2	34.5	26.7	42.2	4.1	2.0	6.1
No^e	n.a.^f			33.3	18.2	48.4	53.5	36.4	70.5	13.2	0.9	25.6
Unable to answer^d	n.a.^f			33.8	-	82.6	10.1	-	23.6	56.1	11.7	100.0
Total	58.8	54.5	63.0	22.9	19.3	26.5	15.4	11.9	18.8	3.0	1.7	4.2

Variables	Crude model			Adjusted model
Variables	OR^a	95%CI^b	P-value	OR^a	95%CI^b	P-value
Sex^c
Male	1.00
Female	0.93	0.59; 1.48	0.761	-	-	-
Age group (in years)^d
18-29	1.00			1.00
30-39	2.48	1.22; 5.01	0.012	1.54	0.61; 3.90	0.360
40-59	1.52	0.81; 2.86	0.194	0.99	0.43; 2.29	0.974
≥60	0.90	0.45; 1.81	0.774	1.02	0.41; 2.55	0.965
Education level
No formal education; or elementary school	1.00			1.00
High school	0.30	0.18; 0.52	<0.001	0.37	0.18; 0.75	0.006
Higher education	0.13	0.07; 0.23	<0.001	0.45	0.19; 1.05	0.065
Post-graduation	0.02	0.01; 0.08	<00.01	0.15	0.04; 0.59	0.007
Health Insurance
Yes	1.00			1.00
No	36.93	15.70; 86.84	<0.001	27.77	10.61; 72.70	<0.001

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Kátia Crestine Poças - Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, Campus Universitário Darcy Ribeiro, S/N, Asa Norte, Brasília, DF, Brazil. Postcode: 70904-970 E-mail: katiacretine@gmail.com