Campbell, M. Karen

Koval, John J

Ryan, Bridget L.

Stewart, Moira

Thind, Amardeep

French

Koval, John

Scholarship@Western

 Canadian Research Data Centre Network  Does Access to a Family Physician Matter for Adolescents?  Primary health care is known to have positive effects on population health and may reduce at-risk behaviours and health problems in adolescence. Unfortunately, there is little research examining how this age group uses primary health care services. Adolescence is a critical developmental stage in the life cycle and understanding patterns of utilization among adolescents and young adults can help design policies that are more responsive to their specific needs. This paper addresses three policy-relevant questions regarding their use of primary health care services. 1. Is equity an issue?  We examined whether care by a family doctor, geographic location, household income, and need were related to use patterns. 2. Are there significant differences in the use of health care services throughout adolescence? We examined whether age affected use, distinguishing among early adolescence (age 12 to 14), middle adolescence (age 15 to 19), and young adulthood (age 20 to 24). 3. Are there differences in the factors affecting use of services (at least one visit to a physician in the last twelve months) compared to intensity of use (increasing number of visits)? We first examined use and non-use and then level of use among users, distinguishing between low use (one to three visits) and high use (four or more visits). About this CRDCN Research Highlight  This Research Highlight draws on the article by B.L. Ryan, M. Stewart, M.K. Campbell, J. Koval and A. Thind (2011). “Understanding Adolescent and Young Adult Use of Family Physicians Services: A Cross-Sectional Analysis of the Canadian Community Health Survey,” BMC Family Practice 12(118). Data were accessed and the analysis done at  the University of Western Ontario Research Data Centre. It was prepared in collaboration with the authors by Sarah Fortin, Knowledge Transfer Coordinator at the Canadian Research Data Centre Network (CRDCN), an infrastructure created to improve researchers’ access to Statistics Canada detailed micro-data, to expand the pool of skilled quantitative researchers and to improve communication between social scientists and research users. Research Highlight Number 2, March 2012 __________________________________________________________________________________________________________________________________________ To know more about the CRDCN or find a research data centre visit our website at www.rdc-cdr.ca  Figure   2 Policy Implications  The clearest policy-relevant message that arises from these findings is that there are distinct stages in adolescence which should be considered in the design and delivery of health care programs or services. Our results suggest that while efforts to encourage the adoption of a given health behaviour (e.g., vaccination for sexually transmitted infections) may successfully be directed to young adults, they also have to be directed to parents in the case of younger adolescents. In their case, parents are still the primary decision-maker in health matters. Lack of understanding regarding the role parents still play at this stage can result in not addressing parental concerns about safety and parental autonomy and in missing the healthcare objective.  Contrary to conventional wisdom, access to a regular doctor is as important to adolescents as it is to adults; school services or health clinics do not appear to be an often-used alternative.  When designing a new health care policy or program, policy-makers must be clear with respect to which outcome (use or intensity of use) it is meant to achieve. Researchers must also consider this important distinction when modeling health care use.  Canada’s universal healthcare system is successful in overcoming income barriers to access and in providing health services based on needs. Nonetheless, provincial variation in use deserves more attention.  Results  Consistent with the adult literature, having a family physician is highly associated with being a user of primary health care services throughout adolescence. The difference in the probability of being a user between those with and without a regular doctor was approximately 20 percent.  Adolescents from Quebec were less likely to be either users or high users of primary health care services.  Household income was not associated with either use or intensity of use.  The presence of an increasing number of chronic conditions was strongly associated with use in early and middle adolescence and with high use in all age groups.  Females were more likely to be users than males in middle adolescence and the difference was not totally attributable to contraceptive needs.  The factors associated with use in early and middle adolescence were in keeping with parental involvement while the factors in young adulthood show their emerging independence.  The factors associated with use were different than those associated with intensity of use. For instance, stress was not significantly related to use in middle adolescence and young adulthood but it was significantly associated with high use. Having a regular physician was related to use. but not to high use. Research Highlight ________________________________________________________________________________________________________________________________________ To know more about the CRDCN or find a research data centre visit our website at www.rdc-cdr.ca  Figure   3   A Word about the Survey Sample The 2005 Canadian Community Health Survey (CCHS) is a multi-stage stratified cluster design, population-based, cross-sectional health survey administered to Canadians 12 years of age and older. For this study, only adolescents and young adults (ages 12 to 24 years) were included. The sample sizes for the analysis were: 12 to 14 year olds - 4985, 15 to 19 year olds - 8718, and 20 to 24 year olds - 6681. Cases included in the analysis were compared to those excluded because of missing data to determine if they varied by age, sex, and province of residence. The differences noted were not significant. Because it is not possible to measure temporality in a cross-sectional study, it was not possible to determine causal relationships, only associations between the outcomes and the independent variables. Another limitation is linked to the fact that health outcomes were self-reported. In the past, some studies have found under-reporting of health practice in adolescence while others have not found this to be a large problem. Research Highlight __________________________________________________________________________________________________________________________________ To know more about the CRDCN or find a research data centre, visit our website at www.rdc-cdr.ca  

English

Does Access to a Family Physician Matter for Adolescents?

 Canadian Research Data Centre Network  Does Access to a Family Physician Matter for Adolescents?  Primary health care is known to have positive effects on population health and may reduce at-risk behaviours and health problems in adolescence. Unfortunately, there is little research examining how this age group uses primary health care services. Adolescence is a critical developmental stage in the life cycle and understanding patterns of utilization among adolescents and young adults can help design policies that are more responsive to their specific needs. This paper addresses three policy-relevant questions regarding their use of primary health care services. 1. Is equity an issue?  We examined whether care by a family doctor, geographic location, household income, and need were related to use patterns. 2. Are there significant differences in the use of health care services throughout adolescence? We examined whether age affected use, distinguishing among early adolescence (age 12 to 14), middle adolescence (age 15 to 19), and young adulthood (age 20 to 24). 3. Are there differences in the factors affecting use of services (at least one visit to a physician in the last twelve months) compared to intensity of use (increasing number of visits)? We first examined use and non-use and then level of use among users, distinguishing between low use (one to three visits) and high use (four or more visits). About this CRDCN Research Highlight  This Research Highlight draws on the article by B.L. Ryan, M. Stewart, M.K. Campbell, J. Koval and A. Thind (2011). “Understanding Adolescent and Young Adult Use of Family Physicians Services: A Cross-Sectional Analysis of the Canadian Community Health Survey,” BMC Family Practice 12(118). Data were accessed and the analysis done at  the University of Western Ontario Research Data Centre. It was prepared in collaboration with the authors by Sarah Fortin, Knowledge Transfer Coordinator at the Canadian Research Data Centre Network (CRDCN), an infrastructure created to improve researchers’ access to Statistics Canada detailed micro-data, to expand the pool of skilled quantitative researchers and to improve communication between social scientists and research users. Research Highlight Number 2, March 2012 __________________________________________________________________________________________________________________________________________ To know more about the CRDCN or find a research data centre visit our website at www.rdc-cdr.ca  Figure   2 Policy Implications  The clearest policy-relevant message that arises from these findings is that there are distinct stages in adolescence which should be considered in the design and delivery of health care programs or services. Our results suggest that while efforts to encourage the adoption of a given health behaviour (e.g., vaccination for sexually transmitted infections) may successfully be directed to young adults, they also have to be directed to parents in the case of younger adolescents. In their case, parents are still the primary decision-maker in health matters. Lack of understanding regarding the role parents still play at this stage can result in not addressing parental concerns about safety and parental autonomy and in missing the healthcare objective.  Contrary to conventional wisdom, access to a regular doctor is as important to adolescents as it is to adults; school services or health clinics do not appear to be an often-used alternative.  When designing a new health care policy or program, policy-makers must be clear with respect to which outcome (use or intensity of use) it is meant to achieve. Researchers must also consider this important distinction when modeling health care use.  Canada’s universal healthcare system is successful in overcoming income barriers to access and in providing health services based on needs. Nonetheless, provincial variation in use deserves more attention.  Results  Consistent with the adult literature, having a family physician is highly associated with being     a user of primary health care services throughout adolescence. The difference in the probability of being a user between those with and without a regular doctor was approximately 20 percent.  Adolescents from Quebec were less likely to be either users or high users of these services.  Household income was not associated with either use or intensity of use.  The presence of an increasing number of chronic conditions was strongly associated with use in early and middle adolescence and with intensity of use in all age groups.  Females were more likely to be users than males in middle adolescence and the difference was not totally attributable to contraceptive needs.  The factors associated with use in early and middle adolescence were in keeping with parental involvement while the factors in young adulthood show their emerging independence.  The factors associated with use were different than those associated with intensity of use. For instance, stress was not significantly related to use in middle adolescence and young adulthood but it was significantly associated with intensity of use. Having a regular physician was related to use but not to intensity of use.   Research Highlight ________________________________________________________________________________________________________________________________________ To know more about the CRDCN or find a research data centre visit our website at www.rdc-cdr.ca  Figure   3   A Word about the Survey Sample The 2005 Canadian Community Health Survey (CCHS) is a multi-stage stratified cluster design, population-based, cross-sectional health survey administered to Canadians 12 years of age and older. For this study, only adolescents and young adults (ages 12 to 24 years) were included. The sample sizes for the analysis were: 12 to 14 year olds - 4985, 15 to 19 year olds - 8718, and 20 to 24 year olds - 6681. Cases included in the analysis were compared to those excluded because of missing data to determine if they varied by age, sex, and province of residence. The differences noted were not significant. Because it is not possible to measure temporality in a cross-sectional study, it was not possible to determine causal relationships, only associations between the outcomes and the independent variables. Another limitation is linked to the fact that health outcomes were self-reported. In the past, some studies have found under-reporting of health practice in adolescence while others have not found this to be a large problem. Research Highlight __________________________________________________________________________________________________________________________________ To know more about the CRDCN or find a research data centre, visit our website at www.rdc-cdr.ca   Réseau canadien des Centres de données de recherche RCCDRAvoir un médecin de famille durant l’adolescence: Est-ce que ça change quelque chose ? On sait que les services de santé de première ligne ont des effets positifs sur la santé de la population et peuvent contribuer à réduire les comportements à risque ainsi que les problèmes de santé au cours de l’adolescence. Malheureusement, on a peu étudié la manière dont ce groupe d’âge utilise ces services. L’adolescence étant un stade critique de développement dans le cycle de vie, il importe de mieux comprendre comment les adolescents et les jeunes adultes utilisent  ces services de manière à concevoir des politiques qui répondent mieux à leurs besoins. Cet article aborde trois questions qui contribueront à atteindre cet objectif: 1. L’équité constitue-t-elle un enjeu ?  Nous avons évalué si l’accès à un médecin de famille, le lieu de résidence, le revenu du ménage et les besoins influençaient l’utilisation des services. 2. Existe-t-il des différences dans l’utilisation des services au cours de l’adolescence ? Nous avons évalué si l’âge influençait l’utilisation des services en distinguant trois périodes : le début de l’adolescence (12 à 14 ans), le milieu de l’adolescence (15 à 19 ans) et le début de l’âge adulte (20 à 24 ans). 3. Les facteurs qui influencent l’utilisation des services (au moins une visite chez un médecin au cours des 12 derniers mois) et l’intensité d’utilisation (un nombre croissant de visites) sont-ils les mêmes ? Nous avons d’abord étudié l’utilisation et la non-utilisation des services, puis l’intensité d’utilisation parmi les usagers en distinguant entre faible utilisation (une à trois visites) et grande utilisation (quatre visites ou plus). À propos de ce document    Ce numéro d’En évidence résume l’article de B.L. Ryan, M. Stewart, M.K. Campbell, J. Koval and A. Thind (2011). “Understanding Adolescent and Young Adult Use of Family Physicians Services: A Cross-Sectional Analysis of the Canadian Community Health Survey,” BMC Family Practice 12(118). Il a été préparé en collaboration avec les auteurs par Sarah Fortin, coordonnatrice-transfert des connaissances pour le Réseau canadien des Centres de données de recherche (RCCDR), une structure créée afin de donner aux chercheurs un meilleur accès aux micro-données détaillées de Statistiques Canada, afin d’élargir le bassin de chercheurs qualifiés en statistiques sociales et afin d’améliorer la communication entre les spécialistes en sciences sociales et les utilisateurs de la recherche.  Les données ont été consultées et l’analyse a été effectuée au Centre de données de recherche de l’Université Western Ontario.  En évidence Numéro 2, mars 2012  __________________________________________________________________________________________________________________________________________ Pour en savoir plus au sujet du RCCDR ou trouver un centre de données de recherche, visitez notre site Web à  www.rdc-cdr.ca/fr Figure  2 Un mot sur l’échantillon de l’enquête  L’Enquête sur la santé dans les collectivités canadiennes 2005 (ESCC) est une enquête transversale portant sur la santé. Basée sur un échantillonnage en grappes stratifié à plusieurs degrés représentatif de la population, elle porte sur les Canadiens âgés de 12 ans et plus. Seuls les adolescents et les jeunes adultes (12 à 24 ans) ont été pris en compte pour la présente étude. Les tailles des différents échantillons utilisés pour l’analyse étaient les suivantes : 12 à 14 ans : 4 985; 15 à 19 ans : 8 718; et 20 à 24 ans : 6 681. Les cas compris dans l’analyse ont été comparés à ceux qui ont été exclus en raison de données manquantes afin de déterminer s’ils variaient en fonction de l’âge, du sexe et de la province de résidence. Les différences observées n’étaient pas significatives.  Comme il n’est pas possible de mesurer la temporalité dans le cadre d’une enquête transversale, il n’était pas possible de déterminer des relations de causalité, mais seulement des associations, entre les résultats et les variables indépendantes. Une autre limitation est liée au fait que l’état de santé est évalué et rapporté par les répondants. Dans le passé, certaines études ont constaté une sous déclaration des pratiques en matière de santé à l’adolescence, alors que d’autres n’ont pas trouvé que cela constituait un problème important.  Résultats  Conformément aux travaux de recherche concernant les adultes, le fait d’avoir un médecin de famille est fortement associé au fait d’être un utilisateur des services de santé primaires tout au long de l’adolescence. La probabilité d’être un utilisateur était d’environ 20 pour cent supérieur parmi les adolescents  qui avaient un médecin régulier.  Les adolescents du Québec étaient moins susceptibles d’être des utilisateurs ou de grands utilisateurs.  Le revenu des ménages n’était pas un facteur significatif.  Ni  l’utilisation, ni l’intensité d’utilisation des services y étaient associées.  La présence d’un nombre croissant de problèmes de santé chroniques était fortement associée à l’utilisation des services au début et au milieu de l’adolescence ainsi qu’à l’intensité d’utilisation dans   tous les groupes d’âge.  Les filles âgées de 15 à 19 ans  étaient plus susceptibles d’être des utilisatrices que les garçons du même âge et la différence n’était pas totalement imputable aux besoins de contraception.  Les facteurs associés à l’utilisation des services au début et dans le milieu de l’adolescence étaient en lien avec l’engagement parental, alors que les facteurs concernant le début de l’âge adulte montraient l’indépendance émergeante de ces individus.  Les facteurs associés à l’utilisation des services étaient différents de ceux associés à l’intensité d’utilisation. Par exemple, le stress n’était pas lié de manière significative à l’utilisation des services dans le milieu de l’adolescence et chez les jeunes  adultes, mais il était associé de manière significative à l’intensité d’utilisation. De même, le fait d’avoir un médecin régulier était lié à l’utilisation des services, mais pas à l’intensité d’utilisation. En évidence ____________________________________________________________________________________________________________ Pour en savoir plus au sujet du RCCDR ou trouver un centre de données de recherche, visitez notre site Web à www.rdc-cdr.ca/fr  Figure  3  Implications de politique  Le message le plus clair, en lien avec les politiques, qui ressort de ces résultats est qu’il y a des stades distincts dans l’adolescence qui devraient être pris en considération lors de la conception et de la prestation des programmes ou services de santé. Si les efforts visant à encourager l’adoption d’un comportement donné (par exemple la vaccination contre les infections sexuellement transmissibles) peuvent cibler avec succès  les jeunes adultes, nos résultats suggèrent que ces efforts doivent également être dirigés vers les parents en ce qui concerne les adolescents plus jeunes. Dans leur cas en effet, les parents sont encore les principaux décideurs en matière de santé. Ne pas prendre en considération le rôle qu’ils jouent encore à ce stade peut faire en sorte que le programme ne réponde pas aux préoccupations parentales concernant la sécurité et l’autonomie parentale et, ultimement, rate son objectif.   Contrairement aux idées reçues, le fait d’avoir accès à un médecin régulier est aussi important pour les adolescents que pour les adultes; les services en milieu scolaire ou les cliniques de santé ne semblent pas être des alternatives fréquemment utilisées.  Lorsqu’ils conçoivent une nouvelle politique ou un nouveau programme en matière de soins de santé, les responsables politiques doivent être clairs en ce qui concerne le résultat qu’ils visent à obtenir (utilisation ou intensité d’utilisation des services). Les chercheurs doivent également tenir compte de cette importante distinction lorsqu’ils modélisent l’utilisation des services de soins de santé.  Le système universel de santé canadien réussit à surmonter les obstacles liés aux revenus susceptibles de compromettre l’accès aux services et à fournir des soins de santé fondés sur les besoins. Cependant, les variations provinciales relatives à l’utilisation des services méritent davantage d’attention. En évidence __________________________________________________________________________________________________________________________________ Pour en savoir plus au sujet du RCCDR ou trouver un centre de données de recherche, visitez notre site Web à  www.rdc-cdr.ca/fr  

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Does Access to a Family Physician Matter for Adolescents?

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