Investigating the utilization of healthcare services to manage respiratory tract infections (RTIs) among Qatari patients attended selected primary healthcare centers in Qatar

Abstract

Background: Respiratory-Tract-Infections (RTIs) are a common cause for most of the GP consultations and antibiotic use at primary care. The study aims to investigate the pattern, distribution, and determinants of several healthcare services use (RTI-related GP visits, antibiotic use, other medication uses and tests and investigations) to manage RTIs among local Qatari patients presented at the selected Primary Health Care Centers (PHCCs) in Qatar. Methods: A retrospective cross-sectional study was conducted in the selected seven (7) Primary Health Care Centers in Qatar for which a complete primary healthcare services data is available on the CERNER system from July 2015 to December 2017. We analyzed electronic data on RTIs-related GP consultations, antibiotic use, other medication uses, and tests and investigations recorded by the PHCC. Trends were investigated by employing linear regression analysis, including months and seasonal dummies as independent-variables. The rates of services use (per 1000 total cause visits) were presented by age-categories, gender, and comorbidity-status. We also analyzed individual patient-level count data on RTI-related 4 selected healthcare services use. A separate negative binomial regression model was used to identify determinants of healthcare services use. Results: A total of 171,447 RTI visits made by 58,786 patients during July-2015 to December-2017. The Mean age ±SD of participants is 24.80±18.5 years, among them 38.79% falls to age group 5-19 and 33.53% belongs to 20-44. Of the total patients, 48.91% are male and the rest are female. Highest number of patients with a comorbidity of Diabetes (12.85%), followed by Hypertension (10.54%). We have found no difference in the month-to-month rates of RTI-related GP visits (per 1000 total visits) over the study period (non-significant decreasing trend). However, there was a significant decreasing trend in the monthly rates of antibiotics consumption and an increasing trend in the tests/investigations done but there was no clear increasing or decreasing trend in the monthly rates of other medications use. As expected, we found lower number of RTI related healthcare services use during the summer months. After the bi-variate analysis of individual patient-level data of selected 4 health care services across age-categories, gender and various comorbidity status, we found healthcare services varied significantly across age-categories (younger patients relatively used more healthcare services compared to older patients) and whether patients had one of the five comorbidities. We have also found that age and comorbidity status (whether patients had a comorbidity or not) were important predictors for determining individual patient-level healthcare services use. Conclusion: In this study, antibiotic consumption for RTIs significantly decreased, as did consultation rates but investigations use rate significantly increased. The large seasonal variation indicates additional likelihoods to decrease healthcare service use. After the bi-variate analysis of individual patient-level data of selected 4 healthcare services across age-categories, gender and various comorbidity status, healthcare services varied significantly across age-categories and whether patients had one of the five comorbidities. We have also found that age and comorbidity status (whether patients had a comorbidity or not) were important predictors for determining individual patient-level healthcare services use. So, the first ever study investigating the utilization of healthcare services use by RTI patients presented at the 7 PHCC healthcare centers in Qatar, which may help policymakers to comprehend the scale of the utilization and to plan a better management of RTIs at primary care setting in Qatar.