The influence of patient characteristics on healthcare-seeking behavior : a multilevel analysis of 70 primary care practices in urban-suburban regions in Malta

Abstract

Background: Social homogeneity and an almost indiscernible rural-urban difference are generally assumed to be strong factors that reduce any tendency for health inequities in a small island community. A strong primary health care system is one of the components that protect populations against inequities. Aim: The aim of this study was to examine healthcare- seeking behaviour in urban and suburban regions in Malta. Methods: The dataset of the Maltese arm of the QUALICOPC Project was analysed. A descriptive, cross- sectional study was designed. Seventy practicing general practitioners were selected randomly from the Malta Medical Council Family Medicine register after systematically removing the inactive practices. Ten patients presenting quasi-randomly in each primary care clinic completed a self- administered questionnaire. The chi-square test was used to test for differences in demographic and health care characteristics between the urban and suburban primary health care service. Generalized Linear and Latent Mixed Models (GLLAMM) were used to perform the multilevel analysis using Stata/SE version 12. Results: None of the 4 predictors (patients’ primary or secondary educational level, age and gender) emerged to be significant for coping better with illness after GP visit. 82% of the total variance in this response (Yes/No) was between patients, 13% was between clinics and 5% between regions. General practitioners offered more health promotion services and asked more about polypharmacy when their patients were older. Conclusion: Such findings provide information for policy makers to improve equity and resource allocations within the setting of urban Malta to help improve patients’ outcomes, particularly for the at-risk or vulnerable population.