Condicionantes en la utilización de los servicios de atención primaria. Evidencias empíricas e inconsistencias metodológicas
Factors conditioning primary care services utilization. Empirical evidence and methodological inconsistencies
M. Sáez
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Grup de Recerca en Estadística, Economia Aplicada i Salut (GRECS). Universitat de Girona. Girona. España
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Evidencias empíricas e inconsistencias metodológicas" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "412" "paginaFinal" => "419" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Sáez" "autores" => array:1 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Sáez" "email" => array:1 [ 0 => "marc.saez@udg.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Grup de Recerca en Estadística, Economia Aplicada i Salut (GRECS). Universitat de Girona. Girona. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Campus de Montilivi. 17071 Girona. España." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factors conditioning primary care services utilization. Empirical evidence and methodological inconsistencies" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2002-09-19" "fechaAceptado" => "2003-04-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec268719" "palabras" => array:4 [ 0 => "Atención primaria" 1 => "Utilización" 2 => "Necesidad" 3 => "Inconsistencias metodológicas" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec268720" "palabras" => array:4 [ 0 => "Primary care" 1 => "Utilization" 2 => "Need" 3 => "Methodological inconsistencies" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En España, el grado y las características de la utilización de los servicios sanitarios de atención primaria está siendo objeto de análisis desde, por lo menos, los años ochenta. Uno de los motivos principales es averiguar hasta qué punto dicha utilización se corresponde con unas necesidades de atención sanitaria. De hecho, se ha establecido como prioridad generalmente aceptada un servicio de salud adecuado para los pacientes que más lo necesitan.</p> <span class="elsevierStyleSectionTitle">Factores condicionantes de la utilización</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La evidencia muestra que las características del individuo, sobre todo su estado de salud, son las que se relacionan principalmente con la utilización de servicios de atención primaria. Otras características personales, como el sexo y la edad, podrían actuar como moduladores de la necesidad de atención. Algunas variables familiares y/o culturales, así como las variables relacionadas con el profesional sanitario y otras institucionales, podrían explicar también parte de la variabilidad observada en la utilización de los servicios de atención primaria. Respecto a las variables socioeconómicas, como la renta, se produce una situación paradójica. De forma añadida, existe una evidencia empírica que demuestra que la renta constituye el principal determinante, tanto de la utilización como del gasto sanitario. Cuando se analizan los datos individuales, sin embargo, dicha variable no está relacionada con la utilización de servicios de atención primaria.</p> <span class="elsevierStyleSectionTitle">Inconsistencias metodológicas</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La situación es controvertida, con implicaciones no simplemente metodológicas sino, sobre todo, respecto al análisis de la eficiencia en la utilización de los servicios sanitarios de atención primaria. El problema es que, revisando la bibliografía, se pueden apreciar ciertas inconsistencias metodológicas que podrían explicar, al menos en parte, la disparidad de los resultados obtenidos. Entre otras, cabe citar las siguientes: problemas de diseño, errores de medida, errores de especificación y métodos estadísticos inadecuados.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Como vías de solución citaríamos el diseño de cuasi experimentos, la utilización de grandes bases de datos administrativos, así como de fuentes de datos primarios (diseño); la distinción entre distintos tipos de utilización y entre unidades de análisis alternativas a la visita, y la corrección de errores de medida en las variables explicativas (errores de medida); la consideración de variables explicativas relevantes (errores de especificación), y la utilización de modelos multinivel (métodos estadísticos inadecuados).</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority.</p> <span class="elsevierStyleSectionTitle">Factors conditioning use</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization.</p> <span class="elsevierStyleSectionTitle">Methodological inconsistencies</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain methodological inconsistencies that could at least partly explain the disparity of the empirical results. Among others, the following flaws can be highlighted: design problems, measurement errors, misspecification, and misleading statistical methods.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Some solutions, among others, are quasi-experiments, the use of large administrative databases and of primary data sources (design problems); differentiation between types of utilization and between units of analysis other than consultations, and correction of measurement errors in the explanatory variables (measurement errors); consideration of relevant explanatory variables (misspecification); and the use of multilevel models (statistical methods).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:64 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 5 | 8 |
| 2024 Octubre | 57 | 40 | 97 |
| 2024 Septiembre | 41 | 19 | 60 |
| 2024 Agosto | 50 | 38 | 88 |
| 2024 Julio | 40 | 24 | 64 |
| 2024 Junio | 32 | 13 | 45 |
| 2024 Mayo | 38 | 28 | 66 |
| 2024 Abril | 37 | 26 | 63 |
| 2024 Marzo | 40 | 22 | 62 |
| 2024 Febrero | 30 | 49 | 79 |
| 2024 Enero | 22 | 17 | 39 |
| 2023 Diciembre | 26 | 12 | 38 |
| 2023 Noviembre | 29 | 18 | 47 |
| 2023 Octubre | 20 | 13 | 33 |
| 2023 Septiembre | 24 | 14 | 38 |
| 2023 Agosto | 36 | 13 | 49 |
| 2023 Julio | 38 | 20 | 58 |
| 2023 Junio | 42 | 14 | 56 |
| 2023 Mayo | 32 | 11 | 43 |
| 2023 Abril | 32 | 15 | 47 |
| 2023 Marzo | 39 | 34 | 73 |
| 2023 Febrero | 27 | 13 | 40 |
| 2023 Enero | 25 | 21 | 46 |
| 2022 Diciembre | 47 | 42 | 89 |
| 2022 Noviembre | 36 | 52 | 88 |
| 2022 Octubre | 33 | 25 | 58 |
| 2022 Septiembre | 24 | 36 | 60 |
| 2022 Agosto | 36 | 40 | 76 |
| 2022 Julio | 34 | 38 | 72 |
| 2022 Junio | 30 | 33 | 63 |
| 2022 Mayo | 31 | 36 | 67 |
| 2022 Abril | 49 | 34 | 83 |
| 2022 Marzo | 32 | 36 | 68 |
| 2022 Febrero | 35 | 30 | 65 |
| 2022 Enero | 35 | 36 | 71 |
| 2021 Diciembre | 26 | 39 | 65 |
| 2021 Noviembre | 33 | 34 | 67 |
| 2021 Octubre | 32 | 40 | 72 |
| 2021 Septiembre | 26 | 43 | 69 |
| 2021 Agosto | 23 | 26 | 49 |
| 2021 Julio | 29 | 18 | 47 |
| 2021 Junio | 22 | 28 | 50 |
| 2021 Mayo | 16 | 23 | 39 |
| 2021 Abril | 71 | 47 | 118 |
| 2021 Marzo | 45 | 26 | 71 |
| 2021 Febrero | 30 | 11 | 41 |
| 2021 Enero | 23 | 23 | 46 |
| 2020 Diciembre | 22 | 20 | 42 |
| 2020 Noviembre | 21 | 9 | 30 |
| 2020 Octubre | 38 | 12 | 50 |
| 2020 Septiembre | 22 | 15 | 37 |
| 2020 Agosto | 37 | 12 | 49 |
| 2020 Julio | 27 | 8 | 35 |
| 2020 Junio | 24 | 8 | 32 |
| 2020 Mayo | 25 | 6 | 31 |
| 2020 Abril | 41 | 23 | 64 |
| 2020 Marzo | 29 | 14 | 43 |
| 2020 Febrero | 26 | 16 | 42 |
| 2020 Enero | 37 | 28 | 65 |
| 2019 Diciembre | 20 | 10 | 30 |
| 2019 Noviembre | 25 | 8 | 33 |
| 2019 Octubre | 23 | 9 | 32 |
| 2019 Septiembre | 20 | 3 | 23 |
| 2019 Agosto | 20 | 15 | 35 |
| 2019 Julio | 15 | 9 | 24 |
| 2019 Junio | 15 | 4 | 19 |
| 2019 Mayo | 14 | 10 | 24 |
| 2019 Abril | 14 | 6 | 20 |
| 2019 Marzo | 8 | 13 | 21 |
| 2019 Febrero | 15 | 9 | 24 |
| 2019 Enero | 10 | 11 | 21 |
| 2018 Diciembre | 4 | 14 | 18 |
| 2018 Noviembre | 12 | 10 | 22 |
| 2018 Octubre | 20 | 20 | 40 |
| 2018 Septiembre | 22 | 12 | 34 |
| 2018 Agosto | 18 | 8 | 26 |
| 2018 Julio | 24 | 8 | 32 |
| 2018 Junio | 21 | 7 | 28 |
| 2018 Mayo | 26 | 13 | 39 |
| 2018 Abril | 14 | 4 | 18 |
| 2018 Marzo | 16 | 6 | 22 |
| 2018 Febrero | 16 | 6 | 22 |
| 2018 Enero | 10 | 2 | 12 |
| 2017 Diciembre | 15 | 10 | 25 |
| 2017 Noviembre | 15 | 14 | 29 |
| 2017 Octubre | 13 | 13 | 26 |
| 2017 Septiembre | 18 | 10 | 28 |
| 2017 Agosto | 8 | 7 | 15 |
| 2017 Julio | 20 | 14 | 34 |
| 2017 Junio | 35 | 9 | 44 |
| 2017 Mayo | 31 | 14 | 45 |
| 2017 Abril | 21 | 16 | 37 |
| 2017 Marzo | 21 | 13 | 34 |
| 2017 Febrero | 11 | 2 | 13 |
| 2017 Enero | 15 | 3 | 18 |
| 2016 Diciembre | 32 | 8 | 40 |
| 2016 Noviembre | 31 | 8 | 39 |
| 2016 Octubre | 31 | 17 | 48 |
| 2016 Septiembre | 15 | 3 | 18 |
| 2016 Agosto | 32 | 5 | 37 |
| 2016 Julio | 14 | 5 | 19 |
| 2016 Febrero | 1 | 0 | 1 |
| 2015 Diciembre | 1 | 0 | 1 |
| 2015 Septiembre | 1 | 0 | 1 |
| 2015 Julio | 2 | 6 | 8 |
| 2015 Mayo | 0 | 1 | 1 |
| 2015 Abril | 5 | 0 | 5 |
| 2015 Marzo | 0 | 6 | 6 |
| 2015 Febrero | 2 | 2 | 4 |
| 2015 Enero | 1 | 1 | 2 |
| 2014 Diciembre | 2 | 1 | 3 |
| 2014 Noviembre | 5 | 1 | 6 |
| 2014 Octubre | 3 | 1 | 4 |
| 2014 Septiembre | 4 | 1 | 5 |
| 2014 Agosto | 12 | 4 | 16 |
| 2014 Julio | 11 | 4 | 15 |
| 2014 Junio | 6 | 2 | 8 |
| 2014 Mayo | 4 | 2 | 6 |
| 2014 Abril | 5 | 2 | 7 |
| 2014 Marzo | 5 | 1 | 6 |
| 2014 Febrero | 5 | 1 | 6 |
| 2014 Enero | 12 | 3 | 15 |
| 2013 Diciembre | 10 | 2 | 12 |
| 2013 Noviembre | 17 | 4 | 21 |
| 2013 Octubre | 16 | 2 | 18 |
| 2013 Septiembre | 18 | 3 | 21 |
| 2013 Agosto | 27 | 4 | 31 |
| 2013 Julio | 26 | 2 | 28 |
| 2003 Agosto | 884 | 0 | 884 |
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