Alves Gleica Soyan Barbosa, Herkrath Fernando José, Parente Rosana Cristina Pereira, Pinheiro Rita Dariene da Silva, Vettore Mario Vianna
Laboratório de Situação de Saúde e Gestão do Cuidado de Populações Indígenas e outros grupos vulneráveis- SAGESPI, Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane, Teresina St. 476 Adrianópolis, Manaus, Amazonas, Brazil.
Universidade Federal do Amazonas, Instituto de Ciências Exatas e Tecnologia, Nossa Sra. do Rosário St. 3863 Tiradentes, Itacoatiara, Amazonas, Brazil.
BMC Health Serv Res. 2025 Jul 2;25(1):886. doi: 10.1186/s12913-025-12945-w.
Health care utilisation is determined by complex interactions. Older adults living in rural areas appear to face greater barriers to health care, particularly in areas of the Amazon region. The aim of this study was to examine the relationships between predisposing, enabling, and need characteristics, and utilisation of medical services among elderly people living in rural areas in Amazon region, Brazil.
A household-based cross-sectional study with 285 elderly people aged 60 years or older living in a rural community in the Amazonas state, Brazil, was conducted. Interviews were used to collect data on predisposing (demographics), enabling (socioeconomic and health services factors), and need characteristics (self-reported health measures). The outcome was utilisation of medical services in the public health system in the last 12 months. Structural equation modelling was guided by Andersen’s behavioural model.
Utilisation of medical services in the last 12 months was reported by 64% of the participants. Lower age (β = -0.138), poor internal housing conditions (β = 0.184), lower frequency of home visits by community health workers (β = -0.129), seeking the same health care service (β = 0.264) and regular use of medication (β = 0.212) directly predicted utilisation of medical services. Significant indirect effects were detected between predisposing (sex, being married, functional dependence), enabling (income, number of goods, external housing conditions, registration in primary care, distance between household and primary care unit), need characteristics (number of chronic diseases) and utilisation medical services in the last 12 months.
The determinants of utilisation of medical services among elderly people living in rural areas are complex and interconnected encompassing demographics, socioeconomic factors, characteristics of the health services, number of chronic diseases and regular use of medication.
The online version contains supplementary material available at 10.1186/s12913-025-12945-w.
医疗保健的利用取决于复杂的相互作用。生活在农村地区的老年人似乎面临着更大的医疗保健障碍，尤其是在亚马逊地区。本研究的目的是探讨巴西亚马逊地区农村老年人的易患因素、促成因素、需求特征与医疗服务利用之间的关系。
在巴西亚马逊州的一个农村社区对285名60岁及以上的老年人进行了一项基于家庭的横断面研究。通过访谈收集有关易患因素（人口统计学）、促成因素（社会经济和卫生服务因素）和需求特征（自我报告的健康指标）的数据。结果是过去12个月内在公共卫生系统中的医疗服务利用情况。结构方程模型以安德森行为模型为指导。
64%的参与者报告了过去12个月内的医疗服务利用情况。年龄较小（β = -0.138）、住房内部条件差（β = 0.184）、社区卫生工作者家访频率较低（β = -0.129）、寻求相同的医疗服务（β = 0.264）和定期用药（β = 0.212）直接预测了医疗服务的利用情况。在易患因素（性别、婚姻状况、功能依赖）、促成因素（收入、物品数量、外部住房条件、初级保健登记、家庭与初级保健单位之间的距离）、需求特征（慢性病数量）与过去12个月内的医疗服务利用之间检测到显著的间接影响。
农村老年人医疗服务利用的决定因素复杂且相互关联，包括人口统计学、社会经济因素、卫生服务特征、慢性病数量和定期用药情况。
在线版本包含可在10.1186/s12913-025-12945-w上获取的补充材料。
