title: Factors associated with health care utilization by the elderly in a public health care system.
abstract: OBJECTIVE
  The objective was to determine the factors associated with the use of health care services by the elderly residing in the community.
  
  
  METHODS
  A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status.
  
  
  RESULTS
  The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41).
  
  
  CONCLUSIONS
  Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.
authors.affiliation: Centro de Salud Universitario Zona IV, Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain. cfolano@pulso.com
authors.forename: C
authors.initials: C
authors.lastname: Fernández-Olano
authors.forename: J D López-Torres
authors.initials: JD
authors.lastname: Hidalgo
authors.forename: R
authors.initials: R
authors.lastname: Cerdá-Díaz
authors.forename: M
authors.initials: M
authors.lastname: Requena-Gallego
authors.forename: C
authors.initials: C
authors.lastname: Sánchez-Castaño
authors.forename: L
authors.initials: L
authors.lastname: Urbistondo-Cascales
authors.forename: A
authors.initials: A
authors.lastname: Otero-Puime
mesh_terms: D000368:Aged; D002755:Choice Behavior; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009313:National Health Programs; D011634:Public Health; D013030:Spain