title: A reappraisal in São Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule".
abstract: OBJECTIVE
  Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources.
  
  
  METHODS
  This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview.
  
  
  RESULTS
  The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital.
  
  
  CONCLUSIONS
  The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations.
authors.affiliation: School of Medicine, University of São Paulo, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Roncoletta
authors.forename: Gustavo D
authors.initials: GD
authors.lastname: Gusso
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires