Programme no. 533-OP
Public Health
Development and evaluation of a comprehensive health care utilization diary
Wolfram Herrmann*1, Alexander Haarmann2, Schröder Kevin3
1Institute of General Practice and Family Medicine,Otto-von-Guericke-University of Magdeburg,Magdeburg,Germany;Institute of General Practice and Family Medicine,Charité-Universitätsmedizin Berlin,Berlin,Germany, 2Institute of General Practice and Family Medicine,Otto-von-Guericke-University of Magdeburg,Magdeburg,Germany, 3Institute of General Practice and Family Medicine,Otto-von-Guericke-University of Magdeburg,Magdeburg,Germany
* = Presenting author
Objectives:

To develop and evaluate a health care utilization diary inspired by event diaries.

Background:

Health care utilization is an important aspect of health services research and influences GPs' daily work. However, secondary analysis of routine data gives only a limited view of health care utilization and survey data have their methodological shortcomings because of recall bias and lack of details.

Results:

In the three waves 5 of 8, 136 of 230 and at least 64 of 234 persons took part respectively. In the second wave, 67% of the participants mentioned at least one complaint during a one month period. 18% had at least one encounter with a physiotherapist, 72% had at least one and 10% at least four contacts with a physician in one month.

The calendar-like questionnaires showed a good reliability (r=.89 for physiotherapy) and a good validity (r=.77 for physiotherapy). However, we detected inconsistencies in a substantial part of the forms (36%) of the second wave. Thus, we revised the form and shortened the time period from one month to two weeks for the third wave. By the abstract deadline the third wave had just ended, a first check of the forms looks promising. We are going to present the final results at the congress.

Material/Methods:

We developed a health care utilization diary based on results from a qualitative study. The diary consists of socio-demographic questions, calendar-like questionnaires to check for different sorts of therapies, hospital admissions, health complaints and of a comprehensive diary to document each visit to a physician in a given time period.

We evaluated the diary in three waves. In between each wave the diary was improved by the results of the former wave. The sample consisted of volunteers, mainly recruited from primary care practices. The participants were called by phone after filling out the diary to check for comprehensibility, problems and validity. Reliability was checked by a split-half of the diary (odd/even days) and use of the Spearman-Brown-equation. Validity was checked by the Kendall correlation coefficient between the summative results of the diary and the answers on survey questions by phone.

Conclusion:

A health care utilization diary can give deeper insights into the actual health care utilization on different levels of health care. Calendar-like questionnaires to check appointments are easy to administer. More complicated forms asking more specific questions pose problems for filling out. With our step-by-step approach of constructing and evaluating this health care diary we hope to develop a reliable and valid instrument for research purposes.

Points for discussion:

To what extent is routine data on health care utilization available in your country?

What does a measurement instrument of health care utilization in diary form add to the already available information from your point of view?