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Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia.
Butler, Danielle C; Larkins, Sarah; Jorm, Louisa; Korda, Rosemary J.
Afiliación
  • Butler DC; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia Danielle.Butler@anu.edu.au.
  • Larkins S; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
  • Jorm L; Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Korda RJ; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
BMJ Open ; 14(1): e074624, 2024 01 06.
Article en En | MEDLINE | ID: mdl-38184309
ABSTRACT

OBJECTIVE:

Timely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual's socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in general practitioner (GP) and specialist use in New South Wales (NSW), accounting for area-level variation in use.

DESIGN:

Outcomes were GP use and quality-of-care and specialist use. Multilevel logistic regression was used to estimate (1) median ORs (MORs) to quantify small area variation in outcomes, which gives the median increased risk of moving to an area of higher risk of an outcome, and (2) ORs to quantify associations between outcomes and individual education level, our main exposure variable. Analyses were adjusted for individual sociodemographic and health characteristics and performed separately by remoteness categories.

SETTING:

Baseline data (2006-2009) from the 45 and Up Study, NSW, Australia, linked to Medicare Benefits Schedule and death data (to December 2012).

PARTICIPANTS:

267 153 adults aged 45 years and older.

RESULTS:

GP (MOR=1.32-1.35) and specialist use (1.16-1.18) varied between areas, accounting for individual characteristics. For a given level of need and accounting for area variation, low education-level individuals were more likely to be frequent users of GP services (no school certificate vs university, OR=1.63-1.91, depending on remoteness category) and have continuity of care (OR=1.14-1.24), but were less likely to see a specialist (OR=0.85-0.95).

CONCLUSION:

GP and specialist use varied across small areas in NSW, independent of individual characteristics. Use of GP care was equitable, but specialist care was not. Failure to address inequitable specialist use may undermine equity gains within the primary care system. Policies should also focus on local variation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Médicos Generales / Web Semántica Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Adult / Aged / Humans País/Región como asunto: Oceania Idioma: En Revista: BMJ Open Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Médicos Generales / Web Semántica Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Adult / Aged / Humans País/Región como asunto: Oceania Idioma: En Revista: BMJ Open Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido