title: Use of Primary Care Services, Care Specialized and Drug Use by Population 65 Years and More in the Community of Madrid, Spain.
abstract: BACKGROUND
  Ageing of the Spanish population results in an increase in health services required. Therefore, determine the frequency of the health services utilization in this age group and analyze their determinants has a great interest.The aim was to analyze the utilization of health services among older people living in two urban neighborhoods of northern Madrid.
  
  
  METHODS
  A cross-sectional population-based study. It is studied a cohort of 1327 individuals ≥ 65 years, stratified by age and sex. Nine utilization indicators were defined. For each indicator frequencies and the association of each with the other variables were calculated by multivariate analysis.
  
  
  RESULTS
  The distribution of indicators expressed as a percentage of the user population is: GP appoiments/month 64.8% (95%CI 62.3 to 67.4); nursing appoiments/month 44.6% (95% CI 41.2 to 47.2); home medical visits/month 3.1% (95%CI 2.2 to 4.1); home nursing visits/month 3% (95%CI 2.1 to 3.9); hospitalization/year 16.4% (95%CI 14.4 to 18.4); appoiments rheumatologist/orthopedic/year 25.1% (95%CI 22.7 to 27.4); physiotherapist appoiments/year 12.9% (95% CI 11.1 to 14.7); podiatrist appoiments/year 30.6% (95%CI 28.1 to 33.1) and polypharmacy (≥5 drugs) 55.7% (95% CI 53 to 58.4). Comorbidity was the best predictor of health care utilization ranging from OR 4.10 (95%CI: 3.07-5,49) to OR 1.39 (95%CI: 0.97-1.99) in polymedicated and visit the physiotherapist respectively. Cardiovascular disease (OR 1.34; 95%CI 1.03-1,76) and diabetes (OR 1.46; 95%CI: 1.05 -2.02) were independently associated with increased use of family doctor. Dependence was the main determinant for home healthcare (OR 3.38; 95%CI: 1.38-8.28) and nurses (OR 9.71; 95%CI: 4.19-22.48) Mood disorders were associated to polypharmacy (OR 2.06; 95%CI: 1,48-2.86) and to visits to family doctor (OR 1.52; 95%CI: 1,13-2.04).
  
  
  CONCLUSIONS
  The comorbidity is the strongest predictor of health services utilization. Cardiovascular diseases and diabetes are independently associated to greater use. Dependence is the main determinant of home care. Mood disorders associated with polypharmacy and increased attendances to the General Practitioner.
authors.affiliation: Centro de salud Fuencarral. Dirección Asistencial Norte. Atención Primaria Madrid and Unidad Docente de Medicina de Familia. Departamento de Medicina. Universidad Autónoma de Madrid. Madrid. md.cano.perez@gmail.com.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Cano Pérez
authors.affiliation: Unidad Docente de Medicina de Familia. Departamento de Medicina. Universidad Autónoma de Madrid. Madrid. España and Centro de Salud Doctor Castroviejo. Madrid.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Castell Alcalá
authors.affiliation: IDIPAZ Instituto de Investigación Sanitaria. Hospital La Paz. Madrid. España.
authors.forename: Rocío
authors.initials: R
authors.lastname: Queipo Matas
authors.affiliation: Centro de Salud Reina Victoria. Dirección Asistencial Norte. Atención Primaria Madrid.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Martín Martín
authors.affiliation: Centro de salud Fuencarral. Dirección Asistencial Norte. Atención Primaria Madrid.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mateo Pascual
authors.affiliation: Unidad Docente de Medicina de Familia. Departamento de Medicina. Universidad Autónoma de Madrid. Madrid. España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Otero Puime
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D019338:Polypharmacy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D013030:Spain
keywords: Aged; Ambulatory Care; Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; General practitioners; Health Care Utilization; Nursing care; Patient Care Planning; Primary Health Care; Spain