Coordination of care and health care utilization features of the patients applying to system specialists in a university hospital

Introduction and aim Patient characteristics in use of health care can have important implications for improving the coordinated care. It is the overall aim of this study to assess the utilization of specialists in a university hospital and specialist consultations without contact to a family physician. We also aimed to describe the first access points of the tertiary level care users to a health care system without gatekeeping function, namely to family physicians (FPs), specialists working in the ambulatory sector or secondary level hospitals, and direct users. Finally, we assessed the socio-demographic characteristics of the hospital care users. Materials and methods The study was a descriptive cross-sectional survey. Data on use of health care were obtained from interviews with 1573 patients, aged 18-95 years, among who were 318 parents of children, attending to the outpatient clinics of Adnan Menderes University hospital between May and June, 2013. Main outcomes were the first contact point of the current reason for encounter, the decision making for visiting the hospital specialists and the desire of visiting a family physician after leaving the hospital. Statistical analyses included descriptive statistics and univariate comparisons as well as multivariate logistic regression models. Results Of the 1573 participants, 62% were female and 82.6% knew their FPs. During the12 months before the survey, 79.5% consulted a family physician at least once. Main reasons for the hospital specialist use were a disease or symptom of disease (half) and a follow up consultation (one third). 17.7% of the patients did not consult to any other physician before applying to the hospital (direct users). Overall, 59.5% of the patients visited to hospital specialist without having consulted a family physician for the current reason for encounter. The rate of participants who thought of visiting to their FPs after leaving the hospital in order to give information on their hospital visits was 24.5%. Those who turned to their FPs within the last 12 months, who visited to their FPs for the current reason for encounter and who counselled to a FP in making decision on their health were more likely to think of desiring to visit their FPs after leaving the hospital in order to give information on their hospital visits. Conclusion People who live in rural area, have education less than 12 years, know their FPs, counsel to a FP in making decision on their health and who have turned to their FPs within the last 12 months more often go to their FPs before and after a hospital specialist consultation. It seems to be important for FPs to develop good relations with their registered population in improving the coordination of care. Keywords: tertiary care, utilization, access to health care, coordination