Social capital and frequent attenders in general practice: a register-based cohort study

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Abstract

Background

Frequent attendance to primary care constitutes a large use of resources for the health care system. The association between frequent attendance and illness-related factors has been examined in several studies, but little is known about the association between frequent attendance and individual social capital. The aim of this study is to explore this association.

Methods

The analysis is conducted on responders to the North Denmark Region Health Profile 2010 ( n = 23,384), individually linked with information from administrative registers. Social capital is operationalized at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148 weeks.

Results

Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79–0.94)] and social network [OR 0.88 (0.79–0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99–1.11) and OR 1.01 (0.92–1.11) respectively]. None of the associations were statistically significant for men.

Conclusion

This study suggests that for women, some aspects of social capital are associated with frequent attendance in general practice, and the statistically significant dimensions belonged to both cognitive and structural aspects of social capital. This association was not seen for men. This indicates a multifaceted and heterogeneous relationship between social capital and frequent attendance among genders.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5230-2) contains supplementary material, which is available to authorized users.

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Most cited references 24

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Gender differences in the utilization of health care services.

K D Bertakis, R Azari, L J Helms … (2000)

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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General practice and primary health care in Denmark.

Kjeld Pedersen, John Andersen, Jens Søndergaard (2012)

General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized by 5 key components: (1) a list system, with an average of close to 1600 persons on the list of a typical GP; (2) the GP as gatekeeper and first-line provider in the sense that a referral from a GP is required for most office-based specialists and always for in- and outpatient hospital treatment; (3) an after-hours system staffed by GPs on a rota basis; (4) a mixed capitation and fee-for-service system; and (5) GPs are self-employed, working on contract for the public funder based on a national agreement that details not only services and reimbursement but also opening hours and required postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges. Practice units are fairly small: close to 2 GPs per unit plus nurses and secretaries. The units are fully computerized, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies etc. Over the past few years a decrease in solo practices has been seen and is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas.

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Social capital and self-rated health: a contextual analysis.

I Kawachi, B. Kennedy, R Glass (1999)

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Author and article information

Contributors

Alexander A. Pasgaard: +45 22 66 11 15 , a.pasgaard@gmail.com

Maiken H. Mæhlisen: maikenhm9@hotmail.com

Charlotte Overgaard: co@hst.aau.dk

Linda Ejlskov: lej@hst.aau.dk

Christian Torp-Pedersen: ctp@hst.aau.dk

Henrik Bøggild: boggild@hst.aau.dk

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 2 March 2018

Publication date PMC-release: 2 March 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 310

Affiliations

[1 ]ISNI 0000 0001 0742 471X, GRID grid.5117.2, Public Health and Epidemiology Group, Department of Health Science and Technology, , Aalborg University, ; Niels Jernes Vej 14, DK-9220 Aalborg East, Denmark

[2 ]ISNI 0000 0004 0646 7349, GRID grid.27530.33, Unit of Epidemiology and Biostatistics, , Aalborg University Hospital, ; Sdr. Skovvej 15, DK-9000 Aalborg, Denmark

Article

Publisher ID: 5230

DOI: 10.1186/s12889-018-5230-2

PMC ID: 5834840

PubMed ID: 29499678

SO-VID: fe9a4f5c-0112-468a-afd5-1dc2b6141815

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 October 2017

Date accepted : 28 February 2018

Funding

Funded by: Aalborg Municipality

Award ID: 873076

Award Recipient : Alexander A. Pasgaard

Custom metadata

ScienceOpen disciplines: Public health

Keywords: primary health care,general practitioners,health care utilization,social capital

Data availability:

ScienceOpen disciplines: Public health

Keywords: primary health care, general practitioners, health care utilization, social capital

Social capital and frequent attenders in general practice: a register-based cohort study

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Abstract

Background

Methods

Results

Conclusion

Electronic supplementary material

Related collections

Global Health Next Generation Network

Most cited references 24

Gender differences in the utilization of health care services.

General practice and primary health care in Denmark.

Social capital and self-rated health: a contextual analysis.

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