Wu Yu-Tzu, Prina Matthew, Matthews Fiona
Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.
Prev Med Rep. 2022 Apr 5;27:101786. doi: 10.1016/j.pmedr.2022.101786. eCollection 2022 Jun.
Primary care services can play an important role in addressing health inequalities and challenges of population ageing. The aim of this study is to investigate whether the availability of local primary care services can support satisfaction with health services and self-rated health in older people. This study was based on a population-based cohort study, Understanding Society: the UK Household Longitudinal Study, focusing on people aged ≥ 50 at Wave 3 (2011-2013; N = 14498) and Wave 6 (2014-2016; N = 13025) in England. Locations of primary care services, including general practitioner (GP) practices and other community health services, were identified from National Health Service Digital and linked to residential areas of the study participants. Multilevel Poisson regression modelling was used to investigate the associations between the availability of local primary care services, satisfaction with health services and self-rated health adjusting for sociodemographic factors, deprivation and urban/rural settings. Participants who had more GP practices in local areas were less likely to report dissatisfaction with health services in Wave 3 (IRR: 0.67; 95% CI: 0.52, 0.85) and Wave 6 (IRR: 0.74; 95% CI: 0.59, 0.92). No associations with self-rated health were found in both waves. These associations were similar across deprivation levels and urban/rural settings. The results suggest that increasing availability of local primary care services may improve satisfaction but not health in older people. To optimise the supportive role of primary care services in healthy ageing, future research should identify complex needs of health and social care in older people and their experience of using the services.
初级保健服务在应对健康不平等和人口老龄化挑战方面可以发挥重要作用。本研究的目的是调查当地初级保健服务的可及性是否能够支持老年人对医疗服务的满意度以及自评健康状况。本研究基于一项基于人群的队列研究——“理解社会：英国家庭纵向研究”，聚焦于第三轮（2011 - 2013年；N = 14498）和第六轮（2014 - 2016年；N = 13025）中年龄≥50岁的英格兰人群。从英国国家医疗服务体系数字化信息中确定初级保健服务的地点，包括全科医生诊所和其他社区卫生服务，并将其与研究参与者的居住区域相联系。采用多水平泊松回归模型，在对社会人口学因素、贫困程度和城乡环境进行调整的基础上，研究当地初级保健服务的可及性、对医疗服务的满意度和自评健康状况之间的关联。在当地有更多全科医生诊所的参与者在第三轮（风险比：0.67；95%置信区间：0.52，0.85）和第六轮（风险比：0.74；95%置信区间：0.59，0.92）中报告对医疗服务不满意的可能性较低。在两轮研究中均未发现与自评健康状况存在关联。这些关联在不同贫困水平和城乡环境中相似。结果表明，增加当地初级保健服务的可及性可能会提高老年人的满意度，但不会改善其健康状况。为了优化初级保健服务在健康老龄化中的支持作用，未来的研究应确定老年人复杂的健康和社会护理需求以及他们使用这些服务的体验。
