Kamuzu University of Health Sciences, Blantyre, Malawi.
University of Bergen, Oslo, Norway.
Trans R Soc Trop Med Hyg. 2024 Mar 4;118(3):137-147. doi: 10.1093/trstmh/trad068.
Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50 y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.
确保患有多种疾病的老年人能够获得基本医疗保健（PHC）对于预防健康状况恶化至关重要。然而，中低收入国家（LMICs）中≥50 岁的老年人在有效获得和利用 PHC 方面面临挑战。本研究采用安德森-纽曼健康服务利用理论框架进行了系统评价，以评估影响老年人获得 PHC 的因素的证据。该框架预测，一系列因素（倾向因素、促成因素和需求因素）会影响一般人群对卫生服务的利用。确定了 7 篇出版物，并采用叙述性分析方法揭示了该领域研究的局限性。促进因素包括家庭支持、接近 PHC 设施、服务提供者友好和老年人功能状态的改善。障碍包括 PHC 服务的距离长且不连贯、卫生专业人员较少以及缺乏以患者为中心的护理。确定了以下需求：增加卫生专业人员数量、在一个屋檐下提供 PHC 服务以及定期筛查服务。需要在基础设施发展、服务提供的协调以及服务提供者能力建设方面进行更多投资，以改善 LMICs 中老年人获得和利用 PHC 服务的机会。
