Use of health services by Brazilian older adults with and without functional limitation
Use of health services by Brazilian older adults with and without functional limitation
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DOI：
10.1590/s1518-8787.2017051000243
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
Lima-Costa, Maria Fernanda
中科院分区：
文献类型：
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作者：
Silva, Alexandre Moreira de Melo;Mambrini, Juliana Vaz de Melo;Lima-Costa, Maria Fernanda
目的：分析有功能障碍和无功能障碍的巴西老年人对医疗服务的利用和接受医疗服务的质量。方法：主要分析基于来自全国60岁及以上健康调查(PNS)23815名参与者的全国样本。功能限制的定义是执行日常生活中至少十分之一的基本或工具性活动的困难。结果：功能受限的患病率为30.1%(95%可信区间为29.2~31.4)。过去12个月的就诊次数和住院次数与功能限制有统计学意义的相关性，公共系统的用户(3次或更多就诊的OR=2.48[95%CI 2.13-2.88]，一次或多次住院的OR=2.58[95%CI 2.15-3.09])和私人系统的用户(OR=2.56[95%CI 1.50-4.36]和OR=2.22[95%CI 1.64-3.00])均有统计学意义。有功能限制的私人系统使用者使用基本卫生单位的倾向较高(OR=2.01[95%CI 1.12~3.59])。在公共和私营系统的使用者看来，在所接受的医疗质量的七个指标中，只有两个与功能限制有关。有功能限制的公共系统用户对选择医生的自由和预约等待时间的评价低于没有功能限制的同一系统的用户(OR=0.81[95%CI 0.67~0.99]和OR=0.76[95%CI 0.62~0.93])。结论：有功能限制的老年人比没有功能限制的老年人使用更多的医疗服务。在公共和私营卫生系统中，功能限制与就诊和住院次数之间的关联程度相似。
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.