Healthcare service utilisation among adults with coronary artery disease in rural Aluva, South India: a community-based cross-sectional study.

ABSTRACT

OBJECTIVES: To assess the pattern and determinants of healthcare service utilisation among adults with coronary artery disease (CAD) in a rural setting in Kerala, India. DESIGN: A community-based cross-sectional analysis conducted within a study cohort. SETTING: The study was conducted from January 2022 to March 2022 within the ENDIRA Cohort (Epidemiology of Non-communicable Diseases In Rural Areas) in the rural part of Aluva municipality of Ernakulam district, Kerala, India, which comprises five adjacent panchayats with a population of approximately 100, 000 individuals. PARTICIPANTS: Patients with CAD aged 35-80 years from the ENDIRA cohort with a history of at least one event of myocardial infarction in the past decade. OUTCOME MEASURES: The main outcome measured was the inadequacy of healthcare service utilisation among patients with CAD. The factors evaluated included age, gender, socioeconomic status, insurance, out of pocket expenses, choice of health care facility for follow up, distance from health centre as well as reported alcohol use, tobacco use and healthcare satisfaction RESULTS: The study encompassed 623 participants with a mean age of 65.12 (±8.55) years, of whom 71% were males. The prevalence of inadequate utilisation of health services was 58.7%. The independent predictors of underutilisation included reported alcohol consumption (adjusted OR (AOR) 2.36; 95% CI 1.41 to 3.95), living more than 20 km from healthcare facilities (AOR 1.96; 95% CI 1.14 to 3.37) as well as the preferences for specific doctors and adequate services at healthcare facilities (AOR 3.43; 95% CI 1.46 to 8.04). The patients with monthly CAD medication expenses exceeding Rs4000 had 0.26 times lesser odds to underuse healthcare services (AOR 0.26; 95% CI 0.10 to 0.65). CONCLUSION: The study reveals a suboptimal pattern of healthcare service utilisation among patients with CAD. Ensuring community access to standardised, high-quality follow-up care is crucial for enhancing healthcare utilisation following CAD.