Utilisation of medical healthcare services among elderly people living in a rural Amazonian community, Brazil: a cross-sectional study

Background : Health care utilisation is determined by complex interactions. Older adults living in rural areas appear to face greater barriers to health care, particularly in areas of the Amazon region. The aim of this study was to examine the relationships between predisposing, enabling, and need characteristics, and utilisation of medical services among elderly people living in rural areas in Amazon region, Brazil. Methods : A household-based cross-sectional study with 285 elderly people aged 60 years or older living in a rural community in the Amazonas state, Brazil, was conducted. Interviews were used to collect data on predisposing (demographics), enabling (socioeconomic and health services factors), and need characteristics (self-reported health measures). The outcome was utilisation of medical services in the public health system in the last 12 months. Structural equation modelling was guided by Andersen’s behavioural model. Findings : Utilisation of medical services in the last 12 months was reported by 64% of the participants. Lower age (β = -0.138), poor internal housing conditions (β = 0.184), lower frequency of home visits by community health workers (β = -0.129), seeking the same health care service (β = 0.264) and regular use of medication (β = 0.212) directly predicted Utilisation of medical services. Significant indirect effects were detected between predisposing (sex, being married, functional dependence), enabling (income, number of goods, external housing conditions, registration in primary care, distance between household and primary care unit), need characteristics (number of chronic diseases) and utilisation medical services in the last 12 months. Conclusions : The determinants of utilisation of medical services among elderly people living in rural areas are complex and interconnected encompassing demographics, socioeconomic factors, characteristics of the health services, number of chronic diseases and regular use of medication.