factors affecting utilization of health care services pdffactors affecting utilization of health care services pdf

Dr Peivand Bastani and Mr Mohammadtaghi Mohammadpour have equally participated as co-first authors. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Currently, knowledge about the health status and utilization of health-related services among newly arrived Asians is limited. It was revealed that need factors were the most important predictors of utilization. 1987; Govindasamy and Ramesh 1997).Having a larger number of children may cause resource constraints, which . The implication of these divergent values is that while utilization determinants could be easily and comprehensibly ordered in the rural area, such an attempt is fraught with more variability in the urban areas. J Gerontol A Biol Sci Med Sci. (2020) a large number of symptoms may occur following the onset of COVID-19 in old people. Over time, this approach has proved adequate and successful for viewing people's use of health care services. However, finding from the same analytical procedure on data from the urban areas indicated that a model which does not contain the health services factors could be adequate for explaining utilization. The only approximation to the theoretical answer was the 4-stage model comprising predisposing, enabling, need and health services factors designed for the study. 2.1. Health policy priorities, the same as the development of the Age-Friendly University (AFU) Movement [48] and engaging in policy change through investments in social protection [43], are among what was mentioned in the included evidence. Endnote X7.1, by Thomson Reuters, was used as a reference manager software. Factors Affecting the Utilization of Antenatal Care Services in Ibadan, Nigeria. J Aging Soc Policy. Federal government websites often end in .gov or .mil. Factors associated with virtual care access in older adults: a cross-sectional study. utilization of health services in occurrence of disease still remains a major challenge with a significant proportion of the Kenya population embarking on self-medication. Health Care and Health Care Services in Nigeria. Data extraction was performed, and evidence was descriptively illustrated. Through the study the team have identified key factors contributing to the catastrophic cost of TB care and have developed . https://doi.org/10.5888/pcd18.210056. Health Services Factors -The common health services variable to both rural and urban areas was the quality of care which was given expression to by the paramedical services antecedent to health care and cure. 25 Citations Metrics Abstract Sudan has high maternal mortality. OBJECTIVES: To evaluate the current situation of health services utilization of chronic disease patients, and analyze the factors affecting the medical services utilization according to the framework of Andersen's behavior model, so as to provide a reference basis for rational allocation of resources, improvement of . 2020;54(3):42136. From choosing baby's name to helping a teenager choose a college, you'll make . 2021;41(2):34553. Behavioral models have been used in different perspectives and in various sizes in the past. These main themes are the sub themes of access and utilization of healthcare services among the elderly during COVID-19 pandemic is provided in Table 2. These also suffer the limitations identified above. After refining for duplicates, 722 cases were eliminated. To this purpose, after familiarization with the extracted data via continuous and mutual reviewing of the content, the research team tried to seek meaningful units according to the research question and created and labelled the initial codes. In this regard, evidence shows that some older peoples demographic characteristics, together with visual and auditory abilities, and their physical and mental capabilities, can highly affect their tendency and ability to accept and use tele health care [59]. Please follow instructions carefully. At the same time, as Banerjee (2020) stated, the fear and uncertainty resulting from the pandemic can cause older people to suffer more senses of loss, anxiety, fear, loneliness, or sometimes, self-neglect and indifference [58]. https://doi.org/10.1093/ageing/afaa260. And finally, the economic determinants are the last sub-theme in this area. PubMed Central Thank you so kindly. Although this may appear a short gun analytical approach, it was nonetheless effective in determining the relative importance of each of the model components. JAMA Intern Med. Health Inf Libr J. The elderly's economic dependence [6, 50] can also be noticeable as an effective factor on the access and utilization of health services. However, the presence of health facilities alone is not enough to guarantee use as other socioeconomic factors could influence access and utilization. Reynolds L. The COVID-19 pandemic exposes limited understanding of ageism. For achieving more sensitivity, the logical operators OR /AND were used to combine the related keywords. Broadly, scoping reviews attempt to initially assess the scope of those available evidence to determine the nature and conceptual boundaries of the topic [7]. Parker R L, Hinman AR. Public Health Rev. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Health for all Nigerians: some revolutionary management dimensions. According to WHO( 2004) the majors factors which prevent women in developing countries from accessing postnatal care which include; distance from the health facilities, cost related problems such as direct fees and the cost of transportation, drugs and supplies, multiple demands on women's time, lack of power in decision making within the family. Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. Article Planning of different categories of health care facilities in different locations should be based on utilization rates while proper management of established facilities should aim to improve health seeking behavior of people. As shown in Table 2 all the model components were adequately represented in the factor pattern that emerged. BP has designed the study, finalized the search strategy and implemented the thematic analysis, MM and MB have searched and screened the articles and extracted the initial codes for data charting. Int J Environ Res Public Health. Vahia VN, Shah AB. 2021;16(4):e0251085. Murphy M, Baba T M. Rural dwellers and health care in Northern Nigeria. The first was factor analysis which worked with 27 variables measured at the ordinal and interval levels while cross tabulation analyzed data on four (4) nominal variables. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants. A qualitative study on the elderly and accessibility to health services during the COVID-19 lockdown in Buenos Aires, Argentina - part 2. Medwave. The thematic analysis led to seven main themes as follows: Social determinants, access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures. These items and their digital literacy and education level and the need for developing the applications and devices so that both the older people and their caregivers can benefit them are among the considerable recommendations in this area. At the same time, it shouldn't be forgotten that in such a population, there is always a potential for social and digital exclusion [22]. Ranjan A, Muraleedharan VR. For instance, a higher rate of death has been reported among the homeless population, those living in deprived areas or overcrowded shelters, those who work closely with others, those with poorer health conditions, and the elderly population [55]. Asian J Psychiatr. Mistry SK, Ali A, Yadav UN, Ghimire S, Hossain MB, Das Shuvo S, et al. (2017) have proposed that health policies such as health reforms, allocated health budgets and the degree of communication between different levels of the health sector have a positive association with equality in access to healthcare services among the elderly [60]. https://doi.org/10.1017/S1041610220000770. https://doi.org/10.1016/j.jagp.2020.04.015. Two major analytical procedures were employed based on the characteristics of the data sets obtained. These determinants include access to health services both related to the diagnosis and treatment of COVID-19 and the routine services non-related to COVID-19. In the case of religion, one could expect that extreme views which disagree with use of health care services would be completely ameliorated by majority of positive thinking towards scientific medical care. Michalowsky B, Hoffmann W, Bohlken J, Kostev K. Effect of the COVID-19 lockdown on disease recognition and utilization of healthcare Services in the Older Population in German: a cross-sectional study. PubMed Going by the value of 0.60 taken as significance level, eight variables loaded substantially on the first factor, two on each of the second, third, fourth, fifth and sixth factors and only one variable on each of the seventh and eighth factors. Unequal impact of structural health determinants and comorbidity on COVID-19 severity and lethality in older Mexican adults: considerations beyond chronological aging. A better understanding of these impacts can be significant for the health policymakers and the health care providers for better planning and provision of inpatient services, Intensive Care Units (ICUs) and hospitalizations and outpatient and routine care services for older people. Fem Leg Stud. 2020;17(15):5380. Furthermore, according to Qureshi (2002), demographic factors and social and economic determinants can affect the political directions and the provision of health services for the elderly and the number of allocated resources to the older populations health needs [62]. tend to exhibit patterns of more frequent use of maternal health services than women in the lower socioeconomic groups, factors such as education appear to be important mediators (Addai, 2000; Addai, 1998; Leslie and Gupta, 1989). There is a strong relationship between birth order and utilization of maternal and child health care services (Elo 1992; Nigussie et al. Serafini G, Bondi E, Locatelli C, Amore M. Aged patients with mental disorders in the COVID-19 era: the experience of northern Italy. Although the chi-square tests for all the two locations indicated that the values are significant permitting a 5% chance of error, it would amount to over-interpretation if values below the 0.10 level were accepted. Archives of Public Health However, communalities of 60% and above became handy in identifying the relatively more important variables. Integrating intersectionality into the Exposome paradigm: a novel approach to racial inequities in uterine fibroids. Int Psychogeriatr. The immediate objectives of the study are three-fold: This study concerns the factors that guide the use of health care services at all levels - individual, family or community. The two results considered together showed sex, perhaps, as a fair predictor of service use. Older people require access to non-COVID related services during the pandemic. They include studies on factors associated with patient satisfaction with care in an outpatient department (OPD) in Cross Rivers State of Nigeria22; on the magnitude of access problems at time of need, in Lagos metropolis23; and on factors affecting utilization of antenatal care services in Ibadan24. Palliative Care for Cancer Patients during the COVID-19 pandemic, with special focus on Lung Cancer. Psychiatr Pol. Each of these factors varies in its intensity from area to area in Nigeria. I feel indebted to the authorities of the University of Ilorin, Ilorin, and Ibrahim Badamosi Babangida University, Lapai, Niger State, Nigeria, the approving and appointing authorities of the sabbatical leave respectively. Since each of these variables can influence utilization behavior, they have the advantage of reminding us that health care delivery systems will require pluralistic models. Each or any set of the variables could be, as indeed has been, used to construct models to determine empirically the extent to which any of them may be operative in a particular situation. "Will you hear my voice? In this regard, it is essential for an old person to accept the situation and have a positive attitude. 25 Altmetric Metrics Abstract Background Adolescent mothers aged 15-19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20-24 years, mostly due to their unique biological, sociological and economic status. Consequently, only sex for urban areas and ethnicity for rural areas could be regarded as important in determining utilization in the respective locations. 2021;51(5):81820. Factor loadings having values close to zero show lack of association while those close to -1 and +1 indicate fairly strong association. Another theme explored in this study is the challenges related to the accommodation of the old populations. Several studies also suggest that different socio-economic and demographic factors significantly affect utilization of ANC services. The procedure involved stratifying the State into rural and urban areas. 1. Change of Use in Community Services among Disabled Older Adults during COVID-19 in Japan. This was the approach employed for the study at hand but modified by the inclusion of a fourth stage, health services factors, defined as issues having to do with actions and conducts tending towards the welfare of others. Based on the studies' data, these services are presented as nine sub-themes of access to homecare, tele health services, routine/outpatient healthcare services, oral, mental and palliative services, medications, and chronic and other primary healthcare services. https://doi.org/10.1093/gerona/glaa163. 2020;5(4):2902. 3). A total of 4308 articles were identified through the initial database search; 50 articles were included in the review as passing the eligibility criteria. Attah EB. ", Balancing feasibility with breadth and comprehensiveness of the scoping process. Increasing evidence suggests that the observed discrepancy between potential and actual utilization cannot be explained by only one factor but many. However, this kind of accommodation can barely affect and worsen the condition of morbidity of the diseases, particularly during the COVID-19 pandemic. Millenson ML. 2020;63(5):64650. 5, the mutual relationship between the access of the elderly to COVID-19 related services and non COVID-19 related is centrally mentioned that can be affected by the personal determinants the same as the elderlys accommodation challenges and their perceived attitude of aging. Seven main themes emerged from the thematic analysis, as determinants of elderly's access and utilization of healthcare services during COVID-19 pandemic. services at the health facility among other factors inhibiting service delivery at the grassroots. However a factor can be meaningful if two or more variables overlap. Assessing the Effects of Predisposing, Enabling and Illness- Morbidity Characteristics on Health Service Utilization. age, sex, religion, occupation and education have the least significant role in utilizing health care services.Conclusions: Utilization of health care. Len S, Giacaman RA. Frontiers Oncol. Int J Equity Health. Also, the factor pattern that emerged may not conform to expectation particularly as no theoretical answer is imposed on the factor model initially. Your privacy choices/Manage cookies we use in the preference centre. The main keywords were agreed by the research team considering the research question. Bethesda, MD 20894, Web Policies Moreover, the extensive social networks that can be accessed by the elderly was among an essential item in this regard [53]. Utilization of service is the actual coverage and it is categorized into ambulatory medical care services (outpatient and home); inpatient services (hospital); and preventive services7. Giebel C, Lord K, Cooper C, Shenton J, Cannon J, Pulford D, et al. Emeharole PO. 2020;32(10):11257. Qureshi H. Social and political influences on services for older people in the United Kingdom in the late 20th century. At best therefore, the influence of religion remains unclear. Hamiduzzaman et al. Peters M, Godfrey C, McInerney P, Soares C, Khalil H, Parker D. The Joanna Briggs institute reviewers' manual 2015: methodology for JBI scoping reviews. Part of 2020;11(4):9881008. Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS. Its features include large representative samples, large number of variables and suitable but sophisticated techniques oriented towards successful research effort. For example, a model9 identified six aspects of symptoms which were combined with cultural and psychological costs of treating symptoms. PLoS ONE. At the same time, the policymakers should be aware of the negative impacts of decreasing the demand and supply for non-COVID-19 healthcare services [47] that can directly threaten the continuity of the services for old people. Rosenstock I. However, while patients in the urban areas expressed more loyalty to a provider, the rural residents seemed to be fascinated by those qualities that were lacking in the facilities located in their areas. In this review, the approach proposed by Levac, Colquhoun and OBrien (2010) [9] was applied. Cite this article. Suchman EA. Improving Access to Care in America. This approach included six main steps for conducting the scoping reviews as follows: Clarifying and linking the purpose and research question, This scoping review was designed to answer the question that "what are the main factors affecting the access and utilization of health services among the elderly population during COVID -19 pandemic? Moore RC, Hancock JT. In the United States of America, hospitals and related health facilities require formal utilization review procedures as condition for participation under health plans and some kind of utilization review process in each institution seeking accreditation. Article Marmot M, Allen J, Goldblatt P, Herd E, Morrison J. https://doi.org/10.1111/imj.15328. Google Scholar. This study explores the existence of this disparity and its implication for planning and managing healthcare delivery systems. This chapter will address those factors. Table 3-Total Sample revealed that all values of Cramer's v, Tau c and Pearson's were very small (<0.215). Despite all studies being conducted in conflict-affected regions, only nine studies explicitly identified conflict as a direct barrier to accessing ANC. Australia: The Joanna Briggs Institute; 2015. According to a cohort study in Portugal, the older patients have a twice larger need for admission in the ICUs than other age groups [56]. Moreover suffering from chronic disease was the most important variable in health care utilization. J Aging Soc Policy. This implies that factors with eigenvalues greater than the average of unity were regarded as the minimum number of factors. Determinants of health care utilization in the management of Health Care Services: case study of Kwara State, Nigeria. [24] have noted inequities in oral health care and dental services during COVID-19 for older patients. Article Following the systematic search, applying the aforementioned search strategy, a total of 4308 articles were retrieved from the four databases. There is at present increasing evidence, especially in the developing world, that many more who attempt to obtain such services are not getting them for a number of reasons. The communalities reflect the variation of all the respondents associated with each original input variable. Glob Health. Nonetheless, the use of telehealth services among the elderly can raise various concerns of their lack of digital literacy, increasing misinformation and lack of confidence or the ability to use the technology. The first8 was in fact motivated by the need to review planning efforts and their appropriateness viewed from the context of health services utilization. The aim of the study is to examine the factors affecting utilization of healthcare services in Kenya and draw policy recommendations based on the findings. Smoli , ipin I, Meimurec P. Access to healthcare for people aged 50+in Europe during the COVID-19 outbreak. Bartholomaeus JD, Inacio MC, Williams H, Wesselingh SL, Caughey GE. Then the emergent sub-themes and the main themes were categorized into final codes. Sustainable access and improved utilization to healthcare services are vital towards the physical, social, and mental health and of older people [1]. Google Scholar. The variables representing the predisposing factors included age, sex, family size, education and belief; those representing enabling factors were proximity, availability, health insurance and family income. Figure2 provides an illustration of the frequency of the included articles, based on the location the study was conducted (Fig. Reconnecting: strategies for supporting isolated older adults during COVID-19 through tele-palliative care. Hamiduzzaman M, De Bellis A, Abigail W, Kalaitzidis E. The social determinants of healthcare access for rural elderly women-A systematic review of quantitative studies. Although the health services factors seemed to be of the least importance, they nonetheless established the fact that health care services users would make a choice given the opportunity. 2021;18:E65. This cannot be done outside the imperatives of utilization. Limited access to routine health care [10] and reduced accessibility of health care for older patients [24, 30, 35] has potentially contributed to an increase in the number of delayed or missed medical appointments [30] and medical comorbidities [30, 35] among the elderly. The site is secure. Am J Geriatr Psychiatr. Cultural determinants, the same as cultural, social and language factors [18] are also can be effective in the access and utilization of health services among the elderly. Table 1 shows the factor pattern produced by the factor analysis and the accompanying statistics enumerated above, Varimax Rotated Factor Pattern (Total Sample), Source: Compiled from Analysis of Field Survey, 2011. Use of health services. The order of importance of the factors is need, enabling, predisposing and health services. Therefore, these two statistics were used in interpreting the variables and the factors respectively. In regard to oral health services, Leon et al. Therefore, the present study aims to explore the factors affecting the elderlys access and utilization to health services during the pandemic through a comprehensive investigation of available literature mainly to support health planners, providers and policymakers. The decision to include both symptom and disease is informed by differences in decision criteria about seeking care that can possibly follow a mere symptomatic feeling of ill-health and actually being diagnosed with an ailment. In developing countries, attempts have been directed towards promoting utilization particularly among the rural populations but success has been limited. J Aging Soc Policy. Older Adults, Social Technologies, and the Coronavirus Pandemic: Challenges, Strengths, and Strategies for Support. Creating a continuous learning environment for older people and improving their digital literacy is vital. It proposes that utilization pattern can be better understood by a 4-stage behavioral model comprising predisposing, enabling, need and health services (characteristics) factors. Studies have pointed to developing telehealth for old patients [11, 29, 33, 35, 39] while the others have mentioned new ways to use telehealth services similar to video visits [18], digital image prescriptions [20], E-Prescribing, online health services [22], tele palliative care [23] and teledentistry [24]. 2021;22(1):125. https://doi.org/10.1186/s12875-021-01471-3. Social determinants include a wide range of factors, according to the included evidence. Most often, researchers resort to the use of rule of thumb in deciding what values of factor loadings and communalities can be regarded as high enough for acceptability. 2). In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. The order of influence of the model components was derived by reference to factor loadings and communalities used as interpretation tools. and transmitted securely. This can clarify the need for particular attention to access mental health services during the pandemic, especially among the elderly. Also, cross tabulation results indicated sex, as perhaps the only significant variable for utilization. These factors were regarded as the underlying construct of all the input variables. Barriers to telehealth access among homebound older adults. The PRISMA flowchart that illustrates the aforementioned process is presented in Fig. However, most economic and socio-psychological models contain elements of these other approaches.10,11,12 Economic models seek to find the relationship between utilization patterns based on socio-demographic factors and a set of economic variables which include income, insurance coverage, prices of health services and free care for all or certain categories of illnesses.13 Socio- psychological studies emphasize those factors such as values and attitudes, information influences, social distance, learned inclinations and other linked socio group structures as affecting the individual's definitions of illness and the subsequent decision to consult a physician.14 These relatively larger models are also beset by problems of reliability and replication. Adopting the varimax rotation of the correlation matrix, factor pattern with associated factor loadings emerged from orthogonal rotation of the correlation matrix. The sampling procedure had those features that tend to polarize service utilization along rural/urban, public/private and hospital/clinic dimensions implicitly built into it for the right analysis.