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To what extent does sociodemographic composition of the neighbourhood explain regional differences in demand of primary out-of-hours care: a multilevel study

机译：邻里的社会人口统计学组成在多大程度上解释了基本门诊医疗需求的地区差异：一项多层次研究

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Background In the Netherlands, primary out-of-hours (OOH) care is provided by large scale General Practitioner (GP) cooperatives. GP cooperatives can be contacted by patients living in the area surrounding the GP cooperative (catchment area) at hours when the patient’s own general practice is closed. The frequency of primary OOH care use substantially differs between GP cooperative catchment areas. To enable a better match between supply and demand of OOH services, understanding of the factors associated with primary OOH care use is essential. The present study evaluated the contribution of sociodemographic composition of the neighbourhood in explaining differences in primary OOH care use between GP cooperative catchment areas. Methods Data about patients’ contacts with primary OOH services (n?=?1,668,047) were derived from routine electronic health records of 21 GP cooperatives participating in the NIVEL Primary Care Database in 2012. The study sample is representative for the Dutch population (for age and gender). Data were matched with sociodemographic characteristics (e.g. gender, age, low-income status, degree of urbanisation) on postcode level. Multilevel linear regression models included postcode level (first level), nested within GP cooperative catchment areas (second level). We investigated whether contacts in primary OOH care were associated with neighbourhood sociodemographic characteristics. Results The demand of primary OOH care was significantly higher in neighbourhoods with more women, low-income households, non-Western immigrants, neighbourhoods with a higher degree of urbanisation, and low neighbourhood socioeconomic status. Conversely, lower demand was associated with neighbourhoods with more 5 to 24?year old inhabitants. Sociodemographic neighbourhood characteristics explained a large part of the variation between GP cooperatives (R-squared ranging from 8% to 52%). Nevertheless, the multilevel models also showed that a considerable amount of variation in demand between GP cooperatives remained unexplained by sociodemographic characteristics, particularly regarding high-urgency contacts. Conclusions Although part of the variation between GP cooperatives could not be attributed to neighbourhood characteristics, the sociodemographic composition of the neighbourhood is a fair predictor of the demand of primary OOH care. Accordingly, this study provides a useful starting point for an improved planning of the supply of primary OOH care.
机译：背景技术在荷兰，大型全科医生（GP）合作社提供基本的非工作时间（OOH）护理。在全科医生封闭的情况下，居住在GP合作社周边地区（集水区）的患者可以联系GP合作社。 GP合作社集水区之间主要的OOH护理使用频率显着不同。为了使OOH服务的供需之间更好地匹配，必须了解与主要OOH护理使用相关的因素。本研究评估了社区的社会人口学组成对解释GP合作集水区之间主要OOH护理使用的差异的贡献。方法2012年参加NIVEL初级保健数据库的21名GP合作社的常规电子健康记录获得了患者与主要OOH服务的接触数据（n？=？1,668,047）。该研究样本代表了荷兰人口（年龄）和性别）。数据与邮政编码级别的社会人口统计学特征（例如性别，年龄，低收入状态，城市化程度）相匹配。多级线性回归模型包括邮政编码级别（第一级），嵌套在GP合作集水区（第二级）内。我们调查了原始OOH护理中的接触者是否与邻里社会人口统计学特征相关。结果在妇女较多，低收入家庭，非西方移民，城市化程度较高且社区社会经济地位较低的社区，对基本OOH护理的需求显着增加。相反，需求降低与5至24岁居民较多的社区有关。社会人口统计学的邻里特征解释了GP合作社之间的很大一部分差异（R平方范围从8％到52％）。尽管如此，多层次模型还显示，GP的合作社之间的需求变化仍然无法通过社会人口统计学特征来解释，尤其是在紧急情况下。结论尽管GP合作社之间的部分差异不能归因于邻里特征，但邻里的社会人口统计学组成可以很好地预测基本OOH护理的需求。因此，这项研究为改进初级OOH护理的供应计划提供了有用的起点。

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