|Year : 1996 | Volume
| Issue : 1 | Page : 14-21
Utilisation of health services by the primary health care centres-registered elderly people in Burraidah city, Saudi Arabia
Mohammed A Al Mahdi1, Ahmed G Elzubier2, Nabil Y Kurashi2
1 Department of Family & Community Medicine, Ministry of Health, Western Region, Saudi Arabia
2 Department of Family & Community Medicine, College of Medicine & Medical Sciences, King Faisal University, Saudi Arabia
|Date of Web Publication||31-Jul-2012|
Mohammed A Al Mahdi
P. O. Box 8376, Alnuzha, Makkah
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: To assess the pattern of and factors associated with geriatrics' utilisation of health services.
Design: A cross-sectional, study involving a random sample of 266 elderly subjects registered in the primary health care centres in Burraidah city, Saudi Arabia.
Setting: The primary health care centres in Qassim Region, Saudi Arabia.
Methods: Data was collected from PHC centres-registered elderly subjects at their homes. Information including utilisation of primary health centres, hospital admissions and duration of hospital stay were recorded.
Results : The response rate was 96.7%. Twenty percent of the sample had not used any health services facility during the previous year. Two-thirds of subjects made visits to the primary health care centres, majority of them having made 6 visits or less. Significant factors positively associated with those visits were female, advancing age, and having a family. Three-quarters of the sample did not have hospital admissions. Significant factors positively associated with admissions were diabetes mellitus, hypertension, paralysis, advanced age, and living with a family.
Conclusions: Geriatric health services utilisation by the study sample is affected by family ties and the high prevalence of chronic diseases. Subjects living alone or crippled by immobility may not be able to utilise available health services properly. Community based geriatrics services can help this vulnerable group.
Keywords: Geriatrics, Health services utilisation, Saudi Arabia.
|How to cite this article:|
Al Mahdi MA, Elzubier AG, Kurashi NY. Utilisation of health services by the primary health care centres-registered elderly people in Burraidah city, Saudi Arabia. J Fam Community Med 1996;3:14-21
|How to cite this URL:|
Al Mahdi MA, Elzubier AG, Kurashi NY. Utilisation of health services by the primary health care centres-registered elderly people in Burraidah city, Saudi Arabia. J Fam Community Med [serial online] 1996 [cited 2021 May 12];3:14-21. Available from: https://www.jfcmonline.com/text.asp?1996/3/1/14/98585
| Introduction|| |
The global increase in people of 65 years and over had attracted the attention of the world to the magnitude of the problems of providing health care for the elderly.  The proportion of the geriatric population in developed countries reached between 12 and 18% of the total population. ,, A similar trend is noted in developing countries,  and Saudi Arabia is not an exception. The increase in the geriatric population has definitely brought with it problems of health needs, health services utilisation, and specialised geriatric health care facilities which are well established in the Western World.
The geriatric population in Saudi Arabia are traditionally cared for within the health services available for other age groups. The benefits they derive or any deficiencies from this care provided has not been documented. Consequently health care services utilisation assessment may form the first step in evaluating the question of geriatric care. This study attempts to assess the pattern of, and factors associated with utilization of health services by the PHC centres-registered elderly people, in Burraidah city, Saudi Arabia. Owing to the paucity of information regarding geriatrics care in Saudi Arabia, in general, it is hoped that this study will form a basis for further large scale studies in this area.
| Subjects and Methods|| |
This is a cross-sectional study that was conducted in Burraidah, in the central region of Saudi Arabia, during the year 1993 - 94. The study population was the elderly whose ages were 65 years and over, and who were enrolled in the PHC registries in Burraidah. The total number registered was 2289 subjects distributed in 23 PHC centres Males constituted 62% of this total. The PHC centres-registered elderly people represent 1.6% of the total population of Burraidah city. In the 1974 population census, elderly people constituted 5.8% of the city's population. Hence this study sample is not representative of the city population.
A two-stage sampling procedure was performed whereby 5 PHC centres were randomly selected. From these centres a 1-in-2 systematic sample of geriatric subjects was drawn. The targeted sample size was 275 subjects ( 12%). The sample size was determined according to the time and facilities available to the authors. Of this sample 266 subjects completed the study with a response rate of 96.7%.
All selected subjects were interviewed at their homes by pre-trained interviewers.
Data was collected using a structured questionnaire form. These data included the following information:
The questionnaire was subjected to a split-halves (Spearman-Brown) reliability method. The result showed a reliability range of 77.9%.
- Demographic information such as age according to the date of birth on official documents, gender, marital status, occupation, source of income, type of living companion(s), house ownership and literacy status.
- Health aspects such as the presence of chronic diseases; namely hypertension, diabetes mellitus, paralysis, osteoarthritis, other miscellaneous diseases, and mobility status.
- Information related to the utilisation of health services in the previous year, in the form of the number and regularity of follow-up visits made by the subject to the PHC centres, number of admissions to the hospital and duration of stay, and number of visits made to all health facilities. A subject was considered to be regular in his/her follow-up visits to the PHC centre if subjects complied with their appointments for follow-up whenever required.
The data was entered and analysed in a personal computer using Epi-info Version 5.0 and SPSS/PC+ statistical packages. , Frequency distributions were generated and Chi- squared test, with Yates correction as appropriate, was used to test for the significance of differences between categorical data. A p-value of 0.05 or less was considered as indicative of statistical significance. Means for age, number of visits and duration of hospital stay were expressed as mean ± 1 standard error of the mean (M+ ISEM). Multiple logistic regression analysis was performed to assess the factors associated with the patterns of health services utilisation by the geriatric subjects. For that purpose, visits to the PHC centres, to all health facilities and admissions to hospital were treated as dependent variables and re-coded as 1 for visits and 0 for no visits made. The independent variables involved were age, gender, marital status, occupation, source of income, house-hold status, living companions, literacy status, mobility, presence of chronic diseases such as hypertension, diabetes mellitus, osteoarthritis, paralysis, and miscellaneous other diseases.
| Results|| |
Sample characteristics: The total number of geriatric subjects involved in the study was 266 of whom males and females constituted 197 (74.1%) and 69 (25.9%), respectively. The overall mean age was 73.7 ± 0.42 years, and that of males and females was 74.6 ± 0.42 and 73.4 ± 0.42 years respectively. Three-quarters (76%) of the sample were married, while 23% were widowed or widows, and 1% were either divorced or never got married. Subjects who were unemployed amounted to 45.0%. About 73.3% of subjects relied on income from self-acquired earnings and social security while the rest relied on family support. Three-quarters (74.4%) of subjects lived in extended family setting and/or with spouses, the rest either lived alone or in a nuclear family. There were 69.2% of subjects who owned their homes while the rest either lived in their children's homes or in rented ones. Regarding affliction with chronic diseases, hypertension affected 21.8%, diabetes mellitus 26.3%, paralysis 1.1%, osteoarthritis 53.0%, 32% of subjects had miscellaneous chronic diseases, and 6% of the subjects were immobile.
Visits to all health facilities: One-fifth of the sample (20.7%), comprising 23.3% and 13% of males and females, respectively, had not made visits to any health facility during the previous year. Of those who had (79.3%) males and females comprised 76.6% and 86.9%, respectively. The mean number of visits per year for males and females was 7.6 t 0.85 and 7.3 1 1.03 visits, respectively. There were 51. 7% who had made 6 visits or less. 26.5% had made between 7 and 12 visits and 21. 8% had made 13 visits or more during the previous year [Table 1].
|Table 1: Number of visits made by geriatric subjects to all health facilities|
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Visits to PHC centres : Visits to PHC centres alone, in the previous year, were made by 67% of the sample, comprising 64% and 75.4% of males and females, respectively. The mean number of visits made to the PHC centres was 4.7 1 0.54 visits per year, (4.9 1 0.70 and 3.9 ± 0.55 visits for males and females, respectively). About one-third of the sample (33.1%) had not made any visit to the PHC centres within the previous year. The majority of geriatric subjects (66.8%) had made 6 or less visits, 21.3% had made between 7 and 12 visits, and 11.8% had made 13 visits or more [Table 2].
|Table 2: Number of visits made by and regularity of follow-up of geriatric subjects at the PHC centres|
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Regularity of follow-up visits at the PHC centres: Regularity of follow-up visits to the PHC centres was assessed by observing compliance with the follow-up appointments. A regular pattern of visits to the PHC centres was observed in 51.5% of the geriatric subjects with a significant predominance of females over males in that respect ( 62.3% and 47.7%, respectively; P < 0.03) [Table 2].
Hospital admissions: Three-quarters of the geriatric subjects (75.9%) had no history of hospital admission during the previous year. Of the remaining one-quarter, 73.4°% had one, and 26.6% had two or more hospital admissions. Regarding the duration of hospital stay, 37.5% were admitted for 7 days or less, 25.0% were admitted for between 8 and 14 days, and 37.5% were admitted for 15 days or more. The overall mean duration of hospital stay was 3.9 1 0.69 days ( 3.9 ± 0.72 and 4.2 ± 1.7 days for males and females respectively [Table 3].
|Table 3: Number and duration of hospital admissions in the previous year among geriatric subjects|
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Multiple regression analysis : Multiple regression analysis showed that the presence of hypertension or diabetes mellitus were positively associated with a high frequency of visits made to all health facilities (P < 0.008 and P < 0.008, respectively, and R  = 0.05739 implying that 6% of the variation was explained by those two factors). On the other hand, the presence of diabetes mellitus, and mobility were positively associated with a high frequency of visits to the PHC centres (P < 0.004 and P < 0.02, respectively, R  =
0.04598, implying that about 5% of the variation was explained by those two factors). There was also a positive association between the number of hospital admissions and hypertension ( P < 0.04), diabetes mellitus (P < 0.04), paralysis (P < 0.01 ), advancing age (P < 0.04), and living with a family (P < 0.004); R  = 0.12423, implying that about 10% of the variation was explained by those variables [Table 4].
|Table 4: Multiple regression analysis for vriables affecting total nunber of visits to all health care facllities, PHC centres and number of hospital admissions in the previous year|
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Regarding regularity of follow-up visits, to the PHC centres; females, advancing age, and living with a family were found to be positively associated variables (P < 0.0001, < 0.01, and < 0.005. respectively). On the other hand, having diabetes mellitus or having hypertension was negatively associated with regular follow-up (P < 0.0007, and < 0.0007, respectively) [Table 5]
|Table 5: Multiple regression analysis of variables associated with regularity of follow-up visits by geriatric subjects to PHC centres|
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| Discussion|| |
The pattern of utilisation of health care facilities shows that the majority of the geriatric subjects visit their PHC doctors annually, and that the mean number of visits is high; i.e., 16 visits to PHC centres,  and 13 days of hospital stay. , Our findings show that the corresponding pattern in Burraidah is much lower. The finding is significant in that with their multiple and chronic health problems, the elderly are more likely to overstay in hospitals when admitted. This finding may probably reflect the lack of specialised geriatric wards in Saudi hospitals, as well as the lack of concerted geriatric health services which are very important for the welfare of the geriatric subjects in the region. Another explanation may be that such subjects may prefer to utilise private medical facilities in and outside the area; or that they are not adequately utilising health services because of lack of health education. All these assumptions will no doubt require verification by more elaborate studies.
Regarding hospital admissions the utilisation rates shown by our study were similar to those shown by Ebrahim  , but were much less than those shown by Pathy et a1  , although differences in methodologies do exist. The striking finding in our study was that more males than females tended to be admitted into hospitals. This may be explained by the fact that males are more free than females to visit more than one governmental or private health care facility, where they can be admitted for various reasons. Also it is probable that females tend to avoid being admitted because of family ties and the fact that their children's take care of their situation could encourage them to stay out of hospital except for acute conditions  ; yet the gender distribution in this study, which could represent sample bias may be responsible for this finding. However, a further comparison of hospital admissions between geriatric subjects and younger ones is necessary to show how much hospital beds-occupancy is due to geriatric subjects alone.
The duration of hospital stay shown by this study is short, compared with those shown by other studies done elsewhere. , The usual duration of hospital stay for geriatric subjects is three times than that of young ones.  Such variation could be attributed to the availability of geriatric wards or geriatric hospitals in developed countries which allows for more prolonged and planned in-patient geriatric care.
The multiple logistic regression analysis done in our study has shown that being a female of advancing age were variables that were positively associated with regularity of follow-up at the PHC centres which is in conformity with other studies carried elsewhere. ,
Multiple regression analysis also revealed that the geriatric subjects' visits to the PHC centres were positively associated with having diabetes mellitus and by being mobile. The association with diabetes mellitus is accounted for, by the high prevalence of the disease in the Saudi community. - On the other hand the association with mobility, highlights the need for an outreach to those geriatric populations whose impaired mobility will deprive them of a much needed health care necessary to reduce their morbidity and mortality.
The study apparently reveals contradicting findings regarding the negative association of hypertension and diabetes with regularity of follow-up on one hand, and the positive association of these diseases with visits to health facilities. Since regularity of follow-up is related to constant visits to one health care facility, the more probable explanation of this contradiction may be that patients shop around in various health facilities units without attaching themselves to a particular one.
The study also revealed the positive association of living with a family, or having a spouse, with the high rate of hospital admissions. This reflects the role of the family in geriatric health care, since a family caring for its elderly members will be quick to take them to hospital when they fall ill. This is a feature of non-industrialised communities, which has the advantage of having fewer admissions to nursing homes  . By relying on the use of community-based health care, there will be still fewer emergency or prolonged hospitalisation. 
The authors are aware that this study may suffer from the limitation that it involved elderly subjects who are registered in the PHC centres, and hence is not representative of all elderly people in the community. It is hoped that the study could stimulate more studies in the area of geriatrics care.
| Conclusions|| |
Geriatric health services utilisation by the elderly is affected by family ties and the high prevalence of chronic diseases. Subjects living alone or crippled by immobility may not be able to utilise available health services properly. Community-based geriatrics services can help this vulnerable group.
| Acknowledgment|| |
The authors are grateful to Dr. Talal Al-Biary, Director, Ministry of Health, Qassim Region, and to his staff for the kind assistance that enabled us to carry out this study.
| References|| |
|1.||Economic Commission for Western Asia. 1970 - 1979 Statistical Abstract of the Region of the Economic Commission for Western Asia. Beirut : The Commission 1981. |
|2.||Thompson MP, Tollison JW. Caring for the elderly. In: Rakel RE, ed. Textbook of Family Practice. London: Oxford University Press, 1991. |
|3.||Burton JR, Solomon DH. Geriatric medicine: A true primary care discipline [editorial]. J Am Geriatr Soc 1993; 41: 459 - 62. |
|4.||Wilcock GK, Gray JA, Longmore JM, editors. Geriatric problems in general practice. London: Oxford University Press, 1991. |
|5.||Grundy E. The Epidemiology of Ageing. In: Brocklehurst JC, Tallis RC, Fillet HM, editors. Textbook of Geriatric Medicine and Gerontology. London: Churchill Livingstone, 1992: 3 - 20. |
|6.||Dean AG, Dean JA, Burton AH, Dicker RC. Epi - Info, Version 5.0: a word processing, database, and statistics program for Epidemiology; and microcomputers. USD, incorporated, Stone Mountain, Georgia, 1990. |
|7.||SPSS/PC+ statistical package (computer program), Version 4.0 SPSS Inc; 1984 - 1990. |
|8.||Pathy M, Bayer A, Harding K, Dibble A. Randomised trial of case finding and surveillance of elderly people at home. Lancet 1992; 340: 890 - 3. |
|9.||lliffe S, Tai S, Haines A, Gallivann S, Goldenberg E, Boorof A. Are elderly people living alone and at risk group? BMJ 1992; 305: 1001-4. |
|10.|| . Ebrahim S, Hedly R, Sheldon M. Low levels of ill health among elderly non - consulters in general practice. BMJ 1984: 289: 1274 - 5. |
|11.||Abdal Ati H. The family structure in Islam. Indianapolis: ATP, 1977. |
|12.||Wasson JH, Sauvigne A, Mogielnicki RP, Frey W, Sox C, Gaudette C, et al. Continuity of Outpatient Medical Care in Elderly Men: A Randomised Trial. JAMA 1984; 252(17): 2413-7. |
|13.||Davison W. A General Introduction to Aging. In: Brocklehurst J, editor. Geriatric pharmacology and therapeutics. Oxford: Blackwell Scientific Publications, 1984: 1016. |
|14.||Taylor B. Patient use of mixed appointment system in an urban practice. BMJ 1984; 288: 119-21. |
|15.||Fatani HH, Mira SA, Elzubier AG. The prevalence of diabetes mellitus in urban Saudi Arabia. In: Diabetes Mellitus. Nilliyanantw VA, Vannasaneg A, editors. Third Proceedings of World Congress on Diabetes in the Tropics and Developing Countries. Bangkok: Crystal House 1985; 8- 16. |
|16.||Fatani HH, Mira SA, Elzubier AG. Prevalence of diabetes mellitus in rural Saudi Arabia. Diabetes Care 1987; 10: 180 - 3. |
|17.||Abu-Zeid HA, AlKossab AC. Prevalence and health care features of hyperglycaemia in semi urban-rural communities in southern Saudi Arabia. Diabetes Care 1992; 15(4): 484-9. |
|18.||El-Hazmi MAF, Warsy AS. A comparative study of hyperglycaemia in different regions of Saudi Arabia. Annals of Saudi Medicine 1989; 9: 435 - 8. |
|19.||Pearlman D, Crown W. Alternative Sources of Social Support and Their Impacts on Institutional Risk. Gerontologist 1992; 32: 527-35. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]