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Use of primary care services
by the elderly
Lic. Niurys Fernández Larrea; Lic. Ana María Ibarra Salas; Mariano Bonet Gorbea, M.D.; Pedro A. Murla Alonso, M.D.; Lic. Mayilé Cañizares Pérez; Lic. Vicente I. Prieto Díaz
ABSTRACT: Aging is a medical and social problem in Cuba, as it is worldwide. We carried out a descriptive cross-sectional study aimed at characterizing the use of primary care services by the elderly in the Centro Habana municipality-which is the Havana municipality with the highest proportion of elderly among its inhabitants. A complex sampling method ("bietapic conglomerate") was used. The first selection units (FSU) were the municipality's Family Doctors' Offices, and the second selection units (SSU) were the 1,138 families selected for the study. Our unit of analysis were the old people in these families who had sought medical attention in the last 30 days of the period studied. In order to determine the use of primary care services by these people, we used an indicator formulated by the authors. The study revealed a 26.8 use index for primary care services, which means that some 27 out of 100 patients seen by family doctors in the Centro Habana Municipality are old people. The most common illnesses for which these patients sought medical care were: high blood pressure, psychiatric disorders, diabetes mellitus and digestive disorders. Two out of three elderly people seeking medical care in this municipality are women.
Subject
Headings: USE OF PRIMARY CARE SERVICES,
ELDERLY AND PRIMARY CARE
Introduction
Aging
has become a medical and social problem in today's world. As the elderly
population grows, so do demands on health care services, since these people
are more vulnerable to chronic diseases, disabilities and stress. (1)
Older people also experience a certain degree
of physical vulnerability due to decreased sensory and mental capabilities
as well as to a certain level of neurovegetative dystonia. This age
group suffers from a relatively high incidence of cardiovascular disease;
respiratory, endocrine and locomotion disorders; cancer; and accidents.
(2)
Old age is not a disease in itself.
However, there is a greater probability of illness, and a higher risk of
negative consequences from illness in old age than in other stages of life.
(3)
Studies conducted in developed countries
reveal that people over 60 make use of 1-8% of long-term medical care services;
30-40% of hospital bed-days in acute care wards; and a fairly high percentage
of general medical service facilities.(4)
Objective
The aim of this study was to characterize the use or primary care services by older people in the Centro Habana Municipality.
Working Definitions:
Older
people
People over 60 years of age. Older people who make use of health
care services
Older persons who seek medical assistance for an ailment or disease, or for control of a chronic disease
Material and Methodology
A
descriptive study was carried out in which the universe was represented by
the people over 60 in the Centro Habana Municipality in the period October-December,
1997.
A sample was obtained by means of a complex
sampling method (stratified bietapic conglomerate). The first selection
units (FSU) were the municipality's Family Doctors' Offices, and the second
selection units (SSU) were the 1,138 families used in the study. Our
unit of analysis were the older people in these families who had sought
primary care attention within the last 30 days of the period studied.
Samples were drawn from each Popular Council
(zone) within the municipality, taking into account the fact that statistical
reports show that 30% of medical services are used by older people. (5)
A design effect (DEFF) of 1.5 was applied. The maximum sampling error
researchers agreed to accept was 10% of the estimated parameter.
The sample size for the municipality was
1,138 families, divided into Popular Council zones as illustrated by the
following chart:
Popular Council |
Total Number of Families |
Families Studied |
Colón |
5440 |
170 |
Pueblo Nuevo |
7140 |
222 |
Cayo Hueso |
7480 |
236 |
Los Sitios |
7990 |
250 |
Dragones |
8330 |
260 |
Total (whole Municipality) |
36380 |
1138 |
With the information obtained from the doctor's logs the index of utilization of the services of family doctors by older people was calculated in the following way:
- Index of utilization of primary care services by older people = Number of people over 60 seen by family doctors in the last 30 days/total number of cases seen by the doctor in the last 30 days x 100.
Furthermore, the utilization of primary care services was also classified according to chief complaints, most frequent diseases, sex, age groups seeking primary care services.
Computer data was processed using the EPI6 and SPSS programs. Frequency descriptors were used and cross-reference analysis applied to variables of interest.
Results
The
utilization index for primary care services by older people was 26.8; that
is, that 27 out of every 100 patients seen by family doctors in the
Centro Habana Municipality are over 60. The Popular Council with the
highest index was Cayo Hueso, and the one with the lowest index was Pueblo
Nuevo (Table 1).
Table 1 . Index of Utilization of
Primary Care Services by Popular Councils
POPULAR COUNCIL UTILIZATION INDEX FOR PRIMARY CARE SERVICES |
(%) |
Colón |
24.0 |
Los Sitios |
27.2 |
Pueblo Nuevo |
21.8 |
Dragones |
24.7 |
Cayo Hueso |
39.9 |
Total ( whole Municipality) |
27.6 |
Analysis of physicians' logs showed that the chief complaint in people over 60 seeking primary care services in the Centro Habana Municipality was hypertension (36.6%), followed by psychiatric xisorders (6.1%), diabetes mellitus (5.3%) and digestive disorders (4.1%). A small fraction of these patients sought medical attention for infectious diseases (scabies, respiratory infections, etc.).
Significant was the result that women constitute 70.3% of people over 60 seen at primary care facilities, while only 29.7% were men. The mean age for older people seeking medical attention from family doctors was 71.35; and the median was 70 years. (Table 2).
Table 2: Distribution by Age of Older People Seeking Primary Care
Of the older patients seen by family doctors, 70% sought medical assistance for one of the above-mentioned diseases, and 30% for control and follow-up of already-diagnosed chronic diseases. In both cases, more women sought care, constituting 70.3% of patients seen.
Of these follow-ups, 70.6% were for hypertension, 7.1% for diabetes mellitus, 3.4% for ischemic cardiopathy, while 4.1% of the patients were healthy.
Discussion
The demand for medical assistance by older people currently accounts for nearly one third of family doctors' total number of working hours. This portion should increase as the population ages. Consequently, we believe that the strategy proposing the creation of Gerontological Doctors' Services in polyclinics at the primary level in each health district will complement current services and thus provide adequate comprehensive and specialized medical attention for the elderly.
It is logical that the chief complaint among patients was hypertension, since there is a high prevalence of this disease in the municipality studied (26.3 x 10,000 inhabitants). (6)
The fact that two thirds of the older people seeking medical attention at the primary level were women should be further evaluated, since despite this fact, the mortality rate is higher for men. Therefore, if men do not seek medical care on their own, new strategies must be devised to assure better attention and follow-up of elderly men.
Conclusions
Among the older patients seeking medical attention from family doctors, there is a higher prevalence of women; most are between 60 to 74 years of age; and their chief complaints fare hypertension, diabetes mellitus, psychiatric disorders and digestive problems.
References
1.
WHO. Aplicaciones de la epidemiología al estudio de los ancianos. Serie
de informes 2. PAHO. Las condiciones
de Salud de las Américas. Volumen 1. Publicación Científica 3. Datos estadísticos poblacionales
de la dirección provincial de salud pública de Ciudad 4. Oficina Nacional de Estadísticas.
Estudios y datos sobre la población cubana. Centro 5. WHO/PAHO. Hacia el bienestar
de los ancianos. Publicación científica. No. 492. 6. Fernández Larrea, Niurys.
Estado de salud de los ancianos del municipio Centro
técnicos no. 706. WHO. Geneva. 1984.
No. 549. Washington D.C. 1994.
Habana. 1997.
de Estudios de Población y Desarrollo. Mayo 1997.
Washington, D.C. 1985.
Habana empleando indicadores poblacionales. Tesis
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Editorial Ciencias Médicas: Article approved for publication in the Revista Cubana de Medicina General Integral journal.
