Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.
Quebec National Institute of Public Health, Quebec, QC, Canada.
BMC Health Serv Res. 2021 Mar 6;21(1):202. doi: 10.1186/s12913-021-06194-w.
Frequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire population covered by a universal health system.
Using a linkage of administrative databases, we conducted a population-based cohort study of all adults in Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in the total population during the 2014-15 fiscal year. We used ajusted logistic regressions to model the association between frequent use of health services and multimorbidity, depending on socioeconomic status.
Frequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency departments and general practitioners. Socioeconomic status modified the association between multimorbidity and frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general practitioner.
Even in a universal healthcare system, the gap between socioeconomic groups widens as a function of multimorbidity with regard to visits to the specialist physicians. Further studies are needed to better understand the differential use of specialized care by the most deprived individuals.
高频次使用医疗保健的患者给医疗体系带来了沉重的负担。多种合并症和较低的社会经济地位等因素与高频次使用门诊服务（急诊室、全科医生和专科医生）有关。然而，这两个因素的综合影响仍知之甚少。我们的目标是确定在全民医保体系覆盖的人群中，多种合并症和社会经济地位之间是否存在交互作用，从而影响到门诊服务的高频次使用者的风险。
我们使用行政数据库的链接，对加拿大魁北克省的所有成年人进行了一项基于人群的队列研究。在 2012 年 4 月 1 日至 2014 年 3 月 31 日的两年期间评估了多种合并症（定义为不同疾病的数量），并使用经过验证的物质剥夺指数来估计社会经济地位。在 2014-15 财政年度，特定类别的门诊服务中，就诊次数最多的 5%的患者被视为高频次使用者。我们使用调整后的逻辑回归模型，根据社会经济地位，来模拟健康服务的高频次使用与多种合并症之间的关联。
高频次使用者（占总人口的 5.1%）占所有门诊就诊的 25.2%。社会经济地位越低，慢性病负担越重，急诊和全科医生的就诊次数越多。社会经济地位改变了多种合并症与专科医生高频次就诊之间的关联：社会经济地位较低的人较少看专科医生。在最贫困和最不贫困人群之间，调整后的高频次使用比例差异从无任何慢性疾病的 0.1%到有 4 种或以上慢性疾病的 5.1%不等。然而，在急诊或全科医生高频次就诊方面，没有观察到这种比例差异。
即使在全民医保体系中，随着多种合并症的出现，社会经济群体之间的差距也会因专科医生就诊而扩大。需要进一步研究以更好地了解最贫困人群对专科护理的差异化使用。
