What are the determinants of specialized outpatient and dental care use among adults with disabilities living in institutions? Findings from a National Survey in France

Publication date: Available online 20 February 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Diane Naouri, Clémence Bussière, Nathalie Pelletier-Fleury
ObjectiveTo explore the determinants of specialized outpatient care use (general practitioners excluded) among disabled people living in institutions.ParticipantsPeople living in institution for adults with cognitive, sensory, and mobility disabilities.DesignCross sectional studySettingFrench National Health and Disability Survey – Institution SectionInterventionNot applicableMain outcome measuresWe used different measures of disability severity, available in the survey: 1) the continuous score of limitations based on a measure we constructed according to self-reported level of difficulty performing 18 tasks without aid; 2) the Katz Index; and 3) the respondent's self-reported perception of functional limitation. Logistic regressions were performed to examine the determinants of the likelihood of having consulted a specialized outpatient care physician or a dentist at least once in the past year.ResultsAmong the 2528 individuals, 45% and 28% had respectively consulted a specialized outpatient care physician or a dentist at least once in the previous year. After adjusting for health care needs, higher functional limitation scores, dependency in all six activities of daily living and self-reported perceptions of severe functional limitation were significantly associated with a lower likelihood of having consulted a specialized outpatient care physician (respectively AOR=0.95 (0.94-0.96), AOR=0,29 (0.23-0.38) and AOR=0.51 (0.42-0.62)) or a dentist (respectively AOR=0.95 (0.94-0.96), AOR=0.29 (0.21-0.39) and AOR=0.55 (0.44-0.67)) at least once in the previous year. Being a male, reporting a lack of family support, and having a low socio-economic status also significantly influenced specialized outpatient care use.ConclusionsRegardless of the method used to define and measure disability, a high degree of disability negatively influence specialized outpatient care use after adjusting for health care need. Further studies are needed to better understand the reasons why this association between the degree of functional limitation and unmet medical needs is also a reality among people with disabilities living in institutions.



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