A cross-sectional study of ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

Abstract

Background: Multimorbidity is frequently encountered in primary care and is associated with an increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients’ use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen’s model to explore factors associated with this use. Method: In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model’s three categories : predisposing factors ( patient’s age, sex, marital status, educational level), enabling factors (health literacy (HLS EU 6), deprivation (DipCare)), and need factors (patient’s quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions and number of medications). Logistic regressions (for dichotomous variables) and negative binomial regressions (for count variables) were calculated to identify predictors of multimorbid patients’ healthcare use. Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0); 48.3% men; 15.1% (127/843) used homecare; 34.9% (294/843) used other health services; median patient–GP contacts (previous year), 11 (IQR 7–16); mean number of specialist’s involved 1.9 (SD 1.4). In the complete Andersen model, not having an informal caregiver (OR 0.50, 95%CI 0.28–0.88), using more medications (OR 1.13, 95%CI 1.05–1.21), and being less independent (OR 2.47, 95%CI 1.36–4.51) were all factors positively associated with homecare services use. Social deprivation was related with a decrease in homecare services use (OR 0.75, 95%CI 0.62–0.89).” Conclusion: Multimorbid patients in primary care reported a high use of ambulatory healthcare services variably associated with the Andersen model’s factors: Healthcare use was associated with objective medical needs, but also on contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patients’ profile