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      Calidad de vida relacionada con la salud como variable explicativa del consumo de consultas en atención primaria: un análisis por sexo Translated title: Health-Related Quality of Life as an Explanatory Variable of Primary Care Consultations: sex Differences

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          Abstract

          Fundamentos: Es conocida la asociación inversa que existe entre la calidad de vida relacionada con la salud (CVRS) y el consumo de consultas. Sin embargo, el sexo es considerado habitualmente como variable de confusión, y son escasos los estudios que han analizado explícitamente las diferencias de sexo en esta cuestión. El objetivo fue conocer la influencia de la CVRS sobre el uso de consultas de Atención Primaria en las personas >65 años, en un análisis diferenciado por sexo. Métodos: La selección de participantes se realizó a lo largo de 2013, 191 mujeres y 155 varones de ≥65 años fueron estudiados mediante entrevista y análisis de historias clínicas. Se utilizó el Cuestionario EuroQol-5D y fueron analizadas variables demográficas, clínicas y de apoyo social. Se elaboraron 2 modelos de regresión múltiple, uno dirigido a las mujeres y otro a los varones. Resultados: La CVRS se correlacionó de forma negativa con el consumo de consultas (Rho-Spearman=-0,22; p=0,0001), con una OR cruda de 1,85 (IC95%: 1,2-2,9). La asociación se mantuvo significativa al ajustar tanto por variables demográficas [OR=1,99 (IC95%: 1,2-3,2)], como por variables clínicas [OR=1,79 (IC95%: 1,1-2,9)] o de apoyo social [OR=1,83 (IC95%: 1,1-2,9)]. En el análisis de regresión, los valores del coeficiente estandarizado (β) asociado a la CVRS fueron 0,22 (IC95%: -36,7- -6,9) en las mujeres, y 0,03 (-15,6-23,1) en los varones. Conclusiones: En las mujeres de ≥65 años la CVRS es la variable con mayor capacidad explicativa de consumo de consultas, tras ajustar por variables demográficas, clínicas y de apoyo social. Por el contrario, en los varones su influencia es prácticamente nula.

          Translated abstract

          Background: It is well known the inverse relationship between health-related quality of life (HRQoL) and the use of consultations. However, most studies deal sex as a confounding variable rather than to explicitly investigate sex differences. The study aims to know the influence of HRQoL of the elderly on the use of Primary Care consultations in a sex analysis. Methods: Throughout 2013, 191 women and 155 men aged 65 years or older were enrolled in the study and assessed with interviews and analysis of medical records. We used the EuroQol-5D to assess the HRQoL and several demographic, clinical and social support variables were also analyzed. Two multiple linear regression models were developed. Results: HRQoL showed a negative correlation with the use of consultations (Spearman's rho=-0,22; p=0,0001) and a crude OR value of 1,85 (95% CI:1,2-2,9). The association remained significant after adjusting for demographic [OR=1,99 (95% CI: 1,2-3,2)], clinical [OR=1,79 (95% CI: 1,1-2,9)] or social support covariates [OR=1,83 (95% CI: 1,1-2,9)]. In regression analysis, the values of standardized coefficient (β) related to HRQoL were 0,22 (95% CI:-36,7- -6,9) in females and 0,03 (95% CI:-15,6-23,1) in males. Conclusions: In women ≥65 years, HRQoL shows the greatest explanatory power of use of consultations, after adjusting for demographic, clinical and social support covariates. By contrast, its influence on men is negligible.

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          Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?

          The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
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            Gender differences in the utilization of health care services.

            Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                February 2015
                : 89
                : 1
                : 61-73
                Affiliations
                [03] Limpias orgnameCentro de Salud Bajo Asón orgdiv1Consultorio de Limpias
                [01] Muriedas orgnameCentro de Salud Camargo-Interior
                [06] Vitoria orgnameOsakidetza orgdiv1Centro de Salud Zabalgana
                [08] Santander orgnameHospital Universitario Marqués de Valdecilla orgdiv1Servicio de Hospitalización Domiciliaria
                [02] Suances orgnameCentro de Salud Suances
                [07] Playa Blanca orgnameCentro de Salud Playa Blanca
                [04] Santander orgnameCentro de Salud Vargas
                [05] Santander orgnameInstituto Cántabro de Servicios Sociales orgdiv1Centro de Atención a la Dependencia de Cueto
                Article
                S1135-57272015000100007 S1135-5727(15)08900100007
                a9ad0aed-b572-46c9-b64f-7d03fcebb1a8

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 13
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                SciELO Public Health

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                Primary health care,Género y salud,Atención Primaria de Salud,Calidad de vida,Anciano,Visita a consultorio médico,Sex differences,Quality of life,Elderly,Office visits

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