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Inequity in access to digital public primary healthcare in Sweden: a cross-sectional study of the effects of urbanicity and socioeconomic status on utilization

Eriksson, Jon LU ; Calling, Susanna LU ; Jakobsson, Ulf LU orcid ; Wolff, Moa LU ; Borgström Bolmsjö, Beata LU and Milos Nymberg, Veronica LU orcid (2024) In International Journal for Equity in Health 23.
Abstract
Background
Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online.

Methods
We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare... (More)
Background
Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online.

Methods
We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables.

Results
Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045).

Conclusions
Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal for Equity in Health
volume
23
article number
72
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85190373661
  • pmid:38622678
ISSN
1475-9276
DOI
10.1186/s12939-024-02159-7
language
English
LU publication?
yes
id
88206a36-b880-444f-9bff-4096b848991c
date added to LUP
2024-04-15 19:31:04
date last changed
2024-09-20 04:58:29
@article{88206a36-b880-444f-9bff-4096b848991c,
  abstract     = {{Background<br/>Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online.<br/><br/>Methods<br/>We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables.<br/><br/>Results<br/>Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045).<br/><br/>Conclusions<br/>Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare.}},
  author       = {{Eriksson, Jon and Calling, Susanna and Jakobsson, Ulf and Wolff, Moa and Borgström Bolmsjö, Beata and Milos Nymberg, Veronica}},
  issn         = {{1475-9276}},
  language     = {{eng}},
  month        = {{04}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{International Journal for Equity in Health}},
  title        = {{Inequity in access to digital public primary healthcare in Sweden: a cross-sectional study of the effects of urbanicity and socioeconomic status on utilization}},
  url          = {{http://dx.doi.org/10.1186/s12939-024-02159-7}},
  doi          = {{10.1186/s12939-024-02159-7}},
  volume       = {{23}},
  year         = {{2024}},
}