title: Attributes and circumstances that induce inappropriate health services demand: a study of the health sector in Brazil.
abstract: BACKGROUND
  The current economic and social context has required health systems to provide top quality services and to be efficient in controlling costs. An obstacle to achieve these goals is the inappropriate health services demand. This study aims to present these inappropriate health service demand determinants from data on telephone calls made to a medical advice call centre.
  
  
  METHODS
  This study used a Brazilian medical advice call centre data sample in the period of November and December 2012 (n = 19690), which supplied data on the user's initial request, the physician's recommendation, information on the patient and circumstances (the day and time of the day of the telephone call). The convergence between user intent and medical recommendation consists in adequate demand; otherwise the divergence consists in an inadequate one. In this way, using a logistic regression model, the critical factors that determine inappropriate health services request could be estimated.
  
  
  RESULTS
  In general, the user's initial intent is the most critical for the inappropriate health system demand occurrence: the greater the complexity of the patient's initial intent, the greater the chance the intent is wrong: (OR: 1.160; 95% CI: 1.113-1.210). With regard to the social characteristics, men are more likely to make inappropriate requests (OR: 1.102; 95% CI: 1038-1169); as well as youngsters are more likely to use the system incorrectly (OR = .993; 95% CI: .992 - .994). Regarding the circumstances (day and time of the call), requests in the final hours of the day and on days close to the weekend are more likely to be the inappropriate ones (OR: 1.082 for each six hour increase; 95% CI: 1.049-1.116) and weekday (OR: 1.017 for each day increase; 95% CI: 1.002-1.032).
  
  
  CONCLUSIONS
  The critical profile for the inappropriate use occurrence consists of males and youngsters, who use the health service in the final hours of the day and at weekends, and mainly want to use more complex services. A practical implication of this research is to provide health systems managers, supporting information to the most critical users in order to assist them in making a decision when asking for health care.
authors.affiliation: Production Engineering Department, Federal University of Pernambuco, Recife, Brazil. dsgjunior@gmail.com.|Logistics Departament, University of Pernambuco, Nazaré da Mata, Brasil. dsgjunior@gmail.com.
authors.forename: Djalma S
authors.initials: DS
authors.lastname: Guimarães
authors.affiliation: Production Engineering Department, Federal University of Pernambuco, Recife, Brazil. eduardo.epa@gmail.com.|Production Engineering Department, University of the State of Mato Grosso, Barra do Bugres, Brazil. eduardo.epa@gmail.com.
authors.forename: Eduardo J O
authors.initials: EJ
authors.lastname: Soares
authors.affiliation: Production Engineering Department, Federal University of Pernambuco, Recife, Brazil. gileno.ferraz@medalliance.com.br.
authors.forename: Gileno Ferraz
authors.initials: GF
authors.lastname: Júnior
authors.affiliation: Production Engineering Department, Federal University of Pernambuco, Recife, Brazil. medeirosdd@gmail.com.
authors.forename: Denise D
authors.initials: DD
authors.lastname: Medeiros
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil; D003695:Delivery of Health Care / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013997:Time Factors; D014600:Utilization Review / Q000706:statistics & numerical data*; D055815:Young Adult