The influence of social surroundings on consultation of private care, emergency department, hospital out-patient departments, and primary health care 1384 Consultations made by a defined population in a residential area

The influence of social surroundings on the clients' consultationof four different caregivers (primary health care centre, emergencydepartment, hospital out-patient departments, and private care)was studied prospectively. The study had the advantage of beingpopulation-based, focusing on different social surroundingsin the same residential area, and taking into considerationfour different caregivers. This was a new approach to the studyof health care utilization. We chose a single residential area,whose borders coincided with the catchment area of the localprimary health care centre. This population (n=5085) made 1384consultations to the above-mentioned four caregivers duringseven weeks In the autumn of 1988. The residential area wascomposed of sub-areas with different social surroundings withrespect to the form of tenure. People living In socially disadvantagedmultioccupancy blocks consulted the emergency department moreoften than expected (age- and sex-standardized Relative Risk(RR)= 1.50, 95% confidence interval (Cl) = 1.02–2.21).The population in the socioeconomically most disadvantaged multioccupancyblock made few consultations to private care (RR=0.53, 95% Cl=0.30–0.91)but more to primary health care (RR=4.45, 95% Cl=3.11–6.36).The conclusion was that the population living in socially disadvantagedsurroundings in multioccupancy blocks had an increased riskof consulting the emergency department and primary health care.They had less risk of consulting hospital out-patient departmentsand private care. This result is of importance as it might providehealth planners with information about the influence of socialsurroundings on care utilization. The family physician and thedistrict nurse might play a central role in the meeting of theincreasing demands of care utilization in socially disadvantagedresidential areas.