Barriers to accessibility and organizational barriers to health care for older people

INTRODUCTION. The aging of the population and the resulting increased proportion of older patients with chronic, non-communicable diseases represent one of the greatest challenges for the healthcare system in many countries. At the same time, a high level of medical care, including transportation, must be guaranteed for older people. This makes it crucial to research both organizing challenges associated with the development of well-functioning processes directly at the medical facility and accessibility when receiving medical care.

OBJECTIVE. To research the main variables affecting organizational and medical access barriers for patients who are over working age in the Russian Federation.

MATERIAL AND METHODS. In the present work we used the questionnaire survey method with a questionnaire consisting of three blocks and 89 questions. The statistical analysis of the data was carried out using the programs Statistica for Windows Version 10.0, Stata and R-Studio. The Pearson test of agreement (Chi-criterion) was used to compare the distributions of qualitative characteristics. A generalized linear model with a logit link function was used to test the hypothesis about the influence of individual respondent characteristics on the probability of falling into quartiles. To test the hypothesis about the influence of individual sociodemographic factors on the probability of getting into the top 25% of the distribution based on the mean of the scores, a generalized linear model with a logit function of the relationship was used.

RESULTS. A total of 3,942 respondents took part in the survey. All persons older than working age faced some obstacles in obtaining medical care, and the prevalence of problematic situations ranged from 12.5% (problems with movement due to the inconvenient location of the practice) to 74.3% (absence the right specialist and the need to see another one). medical organization). Factors that influence the severity of the barriers are described (living in rural areas, presence of financial problems and low social integration, older age).

DISCUSSION. The results obtained in this work are comparable to a number of studies conducted in the Russian Federation and worldwide.

CONCLUSION. Overcoming accessibility and organizational barriers requires management and organizational decisions on the part of regional health protection authorities, municipalities, and employees of medical organizations and social services.

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