The use of primary care services among senior citizens with somatic illnesses in rural areas of Norway - One year follow up

Abstract

Bacground: Few studies are published focusing on older people, their health, functioning and use of primary health services in different areas of Norway. Purpose: To investigate use of primary health services in a rural area, explained by municipality belonging, adjusted for socio-demographic variables, degree of morbidity, level of functioning and mental health among somatic ill senior citizens. Material and methods: In a cross sectional study 484 hospitalized patients (≥ 65 year) were included, of whom 451 (226 women) participated in a year follow up, registering use of primary health care (the outcome). Estimated unit health services costs by SINTEF Health Research were used in the mean cost calculation. The risk of using more primary health care than the mean cost pr. patient (or not) compared to the reference municipality, was analyzed by logistic regression. The independent variables were assessed by MiniMental State Examination, Hospital Anxiety and Depression scale, Lawton and Brody's scales of self-maintaining and instrumental activities and Charlson Comorbidity Index. Results: The risk of nursing home service use above mean cost pr. patient was significantly less for the participants in Rendalen (OR 0.23, 95% CI = 0.08-0.63), Folldal (OR 0.25, 95%CI 0.07-0.89) and Røros (OR 0.25, 95% CI = 0.10-0.60) compared to Tynset. No significant association in municipality belonging and in-home nursing or General Practitioner costs were found. Compared to Tynset, the odds for using more than mean total health costs was significantly reduced in Rendalen (OR 0.31, 95% CI 0.13-0.74), Folldal (OR 0.35, 95% CI 0.12- 1.00) and Tolga (OR 0.22, 95% CI 0.07- 0.68). Conclusion: The cost of nursing home service and total health care service pr patient varied in the municipalities of residence among recently hospitalized senior citizens in a rural area. Even if it was adjusted for age, gender and health, functional and social variables, confounding factors may exist, making further research necessary. Relevance The society is facing an aging population in need of customized and effective health services. Factors possibly associated with differences in use and provided health care as required among older people should be identified and studied.