دورية أكاديمية
أعرض في EDS

Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia.

التفاصيل البيبلوغرافية
العنوان: Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia.
المؤلفون: 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.
المصدر: BMJ open [BMJ Open] 2024 Jan 06; Vol. 14 (1), pp. e074624. Date of Electronic Publication: 2024 Jan 06.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
مواضيع طبية MeSH: Semantic Web* , General Practitioners*, Adult ; Aged ; Humans ; Multilevel Analysis ; National Health Programs ; Australia ; Educational Status
مستخلص: 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.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
References: Int J Epidemiol. 2008 Oct;37(5):941-7. (PMID: 17881411)
Health Policy. 2011 Nov;103(1):16-23. (PMID: 20888058)
BMC Fam Pract. 2010 Oct 27;11:81. (PMID: 20979612)
Med J Aust. 2011 Aug 15;195(4):198-202. (PMID: 21843123)
PLoS One. 2017 Apr 27;12(4):e0176563. (PMID: 28448555)
Int J Equity Health. 2020 Sep 25;19(1):167. (PMID: 32977813)
Med Care Res Rev. 2006 Apr;63(2):158-88. (PMID: 16595410)
Br J Gen Pract. 2006 Nov;56(532):876-82. (PMID: 17132356)
Aust Health Rev. 2022 Dec;46(6):652-659. (PMID: 36175167)
BMC Fam Pract. 2013 May 31;14:72. (PMID: 23725212)
Med Care. 2003 Apr;41(4):500-11. (PMID: 12665714)
BMC Public Health. 2014 Jul 22;14:741. (PMID: 25048295)
Public Health. 2005 Feb;119(2):97-104. (PMID: 15694956)
J Epidemiol Community Health. 2006 Apr;60(4):290-7. (PMID: 16537344)
Am J Public Health. 2012 May;102(5):945-52. (PMID: 22420809)
Br J Gen Pract. 2011 Jul;61(588):e404-10. (PMID: 21722448)
Aust N Z J Public Health. 2009 Oct;33(5):458-65. (PMID: 19811484)
BMC Health Serv Res. 2015 Oct 09;15:465. (PMID: 26453459)
BMC Fam Pract. 2008 Apr 15;9:21. (PMID: 18412954)
Med Care. 2015 May;53(5):436-45. (PMID: 25793270)
Soc Sci Med. 2020 Jun;255:113004. (PMID: 32371271)
BMC Med Res Methodol. 2010 Apr 01;10:26. (PMID: 20356408)
J Health Soc Behav. 1995 Mar;36(1):1-10. (PMID: 7738325)
N Z Med J. 2011 Feb 11;124(1329):16-25. (PMID: 21475356)
Milbank Q. 2017 Dec;95(4):836-883. (PMID: 29226448)
BJGP Open. 2021 Apr 26;5(2):. (PMID: 33563701)
BMC Health Serv Res. 2020 Apr 19;20(1):325. (PMID: 32306952)
Soc Sci Med. 2018 Jul;208:50-54. (PMID: 29763786)
Int J Equity Health. 2021 Feb 10;20(1):58. (PMID: 33568126)
Med J Aust. 2005 Jul 18;183(2):68-71. (PMID: 16022609)
Lancet Public Health. 2020 Jan;5(1):e42-e50. (PMID: 31837974)
Br J Gen Pract. 2002 Dec;52(485):1012-20. (PMID: 12528590)
Ann Fam Med. 2007 Jul-Aug;5(4):361-7. (PMID: 17664503)
Health Policy. 2009 Oct;92(2-3):180-6. (PMID: 19394106)
فهرسة مساهمة: Keywords: epidemiologic studies; health equity; health policy; primary health care
تواريخ الأحداث: Date Created: 20240106 Date Completed: 20240108 Latest Revision: 20240130
رمز التحديث: 20240130
مُعرف محوري في PubMed: PMC10773367
DOI: 10.1136/bmjopen-2023-074624
PMID: 38184309
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-6055
DOI:10.1136/bmjopen-2023-074624