Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India
Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India
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DOI：
10.1186/s12939-020-01170-y
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发表时间：
2020-04-29
影响因子：
4.8
通讯作者：
van den Akker, Marjan
中科院分区：
文献类型：
--
作者：
Pati, Sanghamitra;Swain, Subhashisa;van den Akker, Marjan
背景初级保健中的多模态不仅对发展中国家而且对低收入和中等收入国家（LMIC）都是一个挑战。低收入国家的保健服务由公共和私营保健提供者提供。然而，一个关键的知识差距存在于理解的真实程度，在这两种类型的初级保健设置多morphine。方法：我们进行了一项研究，以确定印度奥里萨邦的公共和私人初级保健参与者之间的多发病率和医疗保健利用。共有1649名患者参加40个初级保健设施进行了采访，使用结构化的多变量评估问卷收集信息的22种慢性疾病，药物使用，住院人数和门诊就诊人数。结果总的多发性硬化患病率为28.3%，公共医疗机构和私人医疗机构分别有近1/3和1/4的患者患有多发性硬化。前往公共设施就诊的患者中的主要疾病包括酸性消化系统疾病、关节炎和慢性背痛。各机构间高血压和糖尿病的报告无显著差异。除年龄外，在公共设施就诊的患者中，多死亡的预测因素是女性[AOR：1.6; 95%CI 1.1-1.3]和非原住民群体[AOR：1.6; 95%CI 1.1-2.3]，而在私人女性[AOR：1.6; 95%CI 1.1-2.4]中，较好的社会经济条件[AOR：1.4;受教育程度[完成小学教育[AOR 2.6; 95%CI 1.6-4.2]和中学及以上教育[AOR 2.0; 95%CI 1.1-3.6]以及未受教育被认为是多重死亡的决定因素。受教育程度较低的患者到公共机构就诊的次数增加较多[IRR：1.57; 95%CI 1.13-2.18]，而在私立医院就诊的患者中，受教育程度较高的患者平均到医院就诊的次数增加1.70倍[IRR：1.70; 95%CI 1.01-3.69]。在私立医院就诊的病人每天平均服药次数较多。结论我们的研究结果表明，多发性硬化症是更多的报告，在公共初级保健机构。两种类型的环境中的模式和卫生保健利用是不同的。必须为私人护理提供者设计一种全面的护理方法。
Background Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. Methods We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. Result The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1-1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1-2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1-2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0-2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6-4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1-3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13-2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01-3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals. Conclusion Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.