title: Factors related to frequent usage of the primary healthcare services in old age: findings from The Swedish National Study on Aging and Care.
abstract: People aged 60 or more are the most frequent users of healthcare services. In this age range, however, both frequent and infrequent users can be found. Frequent users have high rates of illnesses. Previous research has found that the frequency may be influenced also by psychological and social factors. The aim of this study was to investigate to what degree such factors add to the explanation of differences in number of visits to a physician. A cross-sectional study was conducted with a random sample consisting of 1017 individuals, aged 60 to 78 years, from the Blekinge part of the Swedish National Study on Aging and Care database. The data were collected during 2001 to 2003. Hierarchical logistic regression analyses were used with frequent (three visits or more during a year) and infrequent use as a dichotomous dependent variable. The final statistical analyses included 643 individuals (63% of the sample). Independent variables were sense of coherence (SOC), internal locus of control, education level and social anchorage. Control variables were age, gender, functional ability and comorbidity. The results showed that comorbidity was most strongly related to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI) 5.54–12.04]. In addition, SOC and internal locus of control had small, but significant effects on the odds of being a frequent user (adjusted OR = 1.03, 95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, respectively). The lower the SOC and the internal locus of control were, the higher were the odds of frequent use. Education level and social anchorage were unrelated to frequency of use. The results indicate that frequent healthcare services users are more ill than infrequent users. Psychological factors influence the use only marginally, and social factors as well as age and gender are not by themselves reason for frequent healthcare services use.
authors.affiliation: Växjö University, School of Social Sciences, Växjö. mikael.rennemark@vxu.se
authors.forename: Mikael
authors.initials: M
authors.lastname: Rennemark
authors.forename: Göran
authors.initials: G
authors.lastname: Holst
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fagerstrom
authors.forename: Anders
authors.initials: A
authors.lastname: Halling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011639:Public Opinion; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology