A population-based nationwide cross-sectional study on preventive health services utilization in Portugal--what services (and frequencies) are deemed necessary by patients?

BACKGROUND: Most of the strategies to induce a more rational use of preventive health services are oriented to the medical side of the doctor-patient relationship. However, the consultation model has changed, and patients now have a more important role in medical consultation. The aim of this study was to assess which healthcare services are deemed necessary, and with what frequency, by adults from the general Portuguese population. DESIGN: Population-based nationwide cross-sectional study Setting: Portuguese population Participants: One thousand Portuguese adults, surveyed by computer-assisted telephone interviewing and selected by a stratified cluster sampling design. MEASUREMENTS: Proportions and population prevalence estimates were determined for each healthcare service, taking into account whether respondents considered them necessary, and with what frequency. RESULTS: Respondent ages ranged between 18 and 97 years, and 520 of 1000 (52%) respondents were women. Among Portuguese adults, 99.2% (95% confidence interval (CI): 98.5 to 99.6) believe that they should undergo general routine blood and urine tests, to be repeated every 12.0 months on average (95% CI: 11.4 to 12.6); 87.4% (95% CI: 85.3 to 89.3) of the respondents reported having actually performed these tests. Of the 15 services surveyed, 14 were considered periodically necessary by more than 60% of respondents. Among the respondents, 37.7% (95% CI: 34.5 to 41.1) reported using healthcare services by their own initiative. CONCLUSIONS: The majority of Portuguese adults believe that they should utilize a great number of healthcare services, on a nearly annual basis; most actually follow this schedule. Our findings indicate a tendency towards the overuse of resources. Adequate patient-oriented strategies regarding the use of medical tests and preventive interventions--with appropriate information and discussion of risks and harms--are urgently needed, and crucial for achieving a more rational use of healthcare services and for preventing the consequences of over-testing.