title: Low education, high GP consultation rates: the effect of psychosocial factors.
abstract: The purpose of this study was to estimate the contribution of psychosocial factors to the increased use of a general practitioner (GP) among those with a lower level of education. The use of GP services was elicited from survey data from 2867 respondents from the Dutch Longitudinal Study on Socio-Economic Differences in the Utilization of Health Services (LS-SEDUHS) using a simple "Yes/ No" format. Psychosocial variables included long-term stressful conditions, social support, external locus of control, coping styles, and tendency to consult (a measure of people's propensity to go to a doctor with health problems). People with primary education used the GP services more than people with higher vocational training or a university degree (OR 1.87, p<0.05), adjusted for health status and health insurance. Only tendency to consult partially explained this difference (OR: 1.74, p>0.05). Most psychosocial factors do not seem very important in explaining high GP utilization rates among those with a low socioeconomic status. Alternative explanations are discussed.
authors.affiliation: Department of Public Health, Erasmus University Rotterdam, The Netherlands. vandermeer@mgz.fgg.eur.nl
authors.forename: J B
authors.initials: JB
authors.lastname: van der Meer
authors.forename: J P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007389:Internal-External Control; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009426:Netherlands; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012923:Social Class; D012944:Social Support