Which socio-economic factors influence patients' choice to opt for the ED or the GPC during out-of-hours : an explorative study in Flanders

Background: Overcrowding of emergency departments (ED) during out-of-hours health care is a common problem in many Western countries. An appealing alternative for ED’s is the general practices cooperatives (GPC): regional networks of GP’s during the out-of-hours. The aim of this study is to investigate the socio-economic determinants of patients’ choice to opt for one of both health care providers. Methods: We gathered patient level data between May and December 2012 in Flanders (Belgium) from three emergency departments and three general practices cooperatives. Chi square analyses were used in order to study the bivariate relationship between opting for a health care facility (ED or GPC) and various socio-economic factors. To determine the independent association, a logistic regression analysis was conducted. Results: Self-referral to the ED is significantly associated with: being male, being younger, being less educated, having a (lower educated) partner and living in a rural area. Conclusion: The results of this study show that opting for the ED during the out-of-hours is, in general, related to a lower socio-economic status. Therefore the government should focus on patients with a lower socio-economic status when disseminating information on the organisation of health care with an emphasis on the accessibility of the primary health care during out-of-hours. To meet the needs for health care during these out-of-hours, a possible solution could be an integrated facility of GPC and ED with one access to medical care for all patients

Unique health care utilization patterns in a homeless population in Ghent

Background: Existing studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary care by homeless people compared to the general population. Homeless people are importantly hindered and/or steered in their health care use by barriers directly related to the organisation of care. Our goal is to describe the accessibility of primary health care services, secondary care and emergency care for homeless people living in an area with a universal primary health care system and active guidance towards this unique system. Methods: Observational, cross-sectional study design. Data from the Belgian National health survey were merged with comparable data collected by means of a face-to-face interview from homeless people in Ghent. 122 homeless people who made use of homeless centres and shelters in Ghent were interviewed using a reduced version of the Belgian National Health survey over a period of 5 months. 2-dimensional crosstabs were built in order to study the bivariate relationship between health care use (primary health care, secondary and emergency care) and being homeless. To determine the independent association, a logistic model was constructed adjusting for age and sex. Results and Discussion: Homeless people have a higher likelihood to consult a GP than the non-homeless people in Ghent, even after adjusting for age and sex. The same trend is demonstrated for secondary and emergency care. Conclusions: Homeless people in Ghent do find the way to primary health care and make use of it. It seems that the universal primary health care system in Ghent with an active guidance by social workers contributes to easier GP access

The social gradient in doctor-patient communication

Objective: In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. Methods: A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. Results: Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. Conclusion: This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication. Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. Practice implications: By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established

Op bezoek bij de huisarts: gerapporteerd gebruik, gepercipieerde kwaliteit en toegankelijkheid van de huisartsenzorg bij financieel kwetsbare welzijnszorggebruikers

info:eu-repo/semantics/publishe

Beschrijving van de KANS steekproef: representativiteit, demografische en socio-economische kenmerken, gezondheidstoestand en zorggebruik

info:eu-repo/semantics/publishe

KANS cijferrapport: beschrijvende analyse van de gegevens uit de eerste bevraging: socio-demografisch profiel, zorggebruik, zorgtevredenheid, gezondheid, welzijn en sociale contacten van maatschappelijk kwetsbare welzijnszorggebruikers

info:eu-repo/semantics/publishe

Kans theoretische achtergronden en onderzoeksopzet

info:eu-repo/semantics/publishe