Socioeconomic inequalities in out-of-hours primary care use: an electronic health records linkage study
Open accessAbstract
Background: Low socioeconomic position (SEP) is related to higher healthcare use in out-of-hours primary care services (OPCSs). We aimed to determine whether inequalities persist when taking the generally poorer health status of socioeconomically vulnerable individuals into account. To put OPCS use in perspective, this was compared with healthcare use in daytime general practice (DGP). Methods: Electronic health record (EHR) data of 988 040 patients in 2017 (251 DGPs, 27 OPCSs) from Nivel Primary Care Database were linked to socio-demographic data (Statistics, The Netherlands). We analyzed associations of OPCS and DGP use with SEP (operationalized as patient household income) using multilevel logistic regression. We controlled for demographic characteristics and the presence of chronic diseases. We additionally stratified for chronic disease groups. Results: An income gradient was observed for OPCS use, with higher probabilities within each lower income group [lowest income, reference highest income group: odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.45–1.51]. Income inequalities in DGP use were considerably smaller (lowest income: OR = 1.17, 95% CI: 1.15–1.19). Inequalities in OPCS were more substantial among patients with chronic diseases (e.g. cardiovascular disease lowest income: OR = 1.60, 95% CI: 1.53–1.67). The inequalities in DGP use among patients with chronic diseases were similar to the inequalities in the total population. Conclusions: Higher OPCS use suggests that chronically ill patients with lower income had additional healthcare needs that have not been met elsewhere. Our findings fuel the debate how to facilitate adequate primary healthcare in DGP and prevent vulnerable patients from OPCS use.
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Tudor Hart's inverse care law states that people most in need of health care are least likely to seek it or receive it; the law reflects two mutually-reinforcing phenomena-worse health in deprived localities and barriers to accessing healthcare in those same localities.
“Tudor Hart's (71) inverse care law states that people most in need of health care are least likely to seek it or receive it; the law reflects two mutually-reinforcing phenomena—worse health in deprived localities and barriers to accessing healthcare in those same localities (47, 48, 72, 73).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [47]
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“It embraces the patient’s identity, values, personality traits, and socio-cultural background—features a sociologist might call habitus (46)—, their health beliefs (44), health literacy and digital literacy, socio-demographic characteristics (47, 48) and their personal experience of illness or disability.”
Background
- Authors
- Jansen, T., Hek, K., Schellevis, F. G., Kunst, A. E., & Verheij, R. A.
- Affiliations
- Netherlands Institute for Health Services Research (NL)
- Amsterdam Public Health (NL)
- Tilburg University (NL)
- Corresponding author
- Jansen, Tessa
- Venue
- European Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-08-18
- Volume
- 30
- Issue
- 6
- Pages
- 1049-1055
- ISSN
- 1101-1262 (ISSN-L)
- 1464-360X
- OpenAlex
- W3064008025
- Cited by
- 5
- References
- 34
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 1 · 2021: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Journal of Public Health (publishedVersion)
- Research portal (Tilburg University) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Funders
- Nivel Primary Care Database
- The Netherlands Ministry of Public Health, Welfare and Sports
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- socioeconomic disparities, out-of-hours primary care, household income, health care utilization, chronic disease, income gradient, primary care access, vulnerable patients
- MeSH terms
- Humans, Income, Netherlands, Primary Health Care, Socioeconomic Factors, After-Hours Care, Electronic Health Records
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