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Factors associated with the utilization of primary care emergency centers in a Spanish region with high population dispersion: a mixed-methods study
National School of Public Health, Health Institute Carlos III, Madrid, Spain ; CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.
National School of Public Health, Health Institute Carlos III, Madrid, Spain ; CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.
National Centre of Tropical Medicine, Health Institute Carlos III, Madrid, Spain.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7234-3510
2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, 368- p.Article in journal (Refereed) Published
Abstract [en]

Background: Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers' perceptions regarding PCEC utilization. Methods: A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase: 14 in-depth-interviews of rural-based PCEC providers. Results: Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p < 0.001). Healthcare providers perceived that distance to hospital increased PCEC utilization, and distance to PCEC decrease its use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours. Conclusions: The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.

Place, publisher, year, edition, pages
BioMed Central, 2014. Vol. 14, 368- p.
Keyword [en]
Primary care emergency center, Health services utilization, Mixed-methods approach, Spain
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-94139DOI: 10.1186/1472-6963-14-368ISI: 000341387800001OAI: oai:DiVA.org:umu-94139DiVA: diva2:753783
Available from: 2014-10-09 Created: 2014-10-06 Last updated: 2017-12-05Bibliographically approved

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