What Are the Determinants of Specialized Outpatient and Dental Care Use in Adults With Disabilities Living in Institutions: Findings From a National Survey in France

Objective: To explore the determinants of specialized outpatient care use (general practitioners excluded) in people with disabilities living in institutions.

Design: Cross-sectional study.

Setting: National health and disability survey.

Participants: People (N=2528) living in institutions for adults with cognitive, sensory, and mobility disabilities.

Interventions: Not applicable.

Main outcome measures: We used different measures of disability severity available in the survey: (1) the continuous score of limitations based on a measure we constructed according to self-reported level of difficulty performing 18 tasks without aid; (2) the Katz Index; and (3) the respondent's self-reported perception of functional limitations. Logistic regressions were performed to examine the determinants of the likelihood of having consulted a specialized outpatient care physician or a dentist at least once in the previous year.

Results: Of the 2528 individuals, 45% (1141) and 28% (697) had respectively consulted a specialized outpatient care physician or a dentist at least once in the previous year. After adjusting for health care needs, higher functional limitation scores, dependency in all 6 activities of daily living, and self-reported perceptions of severe functional limitations were significantly associated with a lower likelihood of having consulted a specialized outpatient care physician (adjusted odds ratio [AOR], .95 [95% confidence interval {CI}, .94-.96]; AOR, .29 [95% CI, .23-.38]; and AOR, .51 [95% CI, .42-.62], respectively) or a dentist (AOR, .95 [95% CI, .94-.96]; AOR, .29 [95% CI, .21-.39]; AOR, .55 [95% CI, .44-.67], respectively) at least once in the previous year. Being a man, reporting a lack of family support, and having a low socioeconomic status also significantly affected specialized outpatient care use.

Conclusions: Regardless of the method used to define and measure disability, a high degree of disability negatively affects specialized outpatient care use after adjusting for health care need. Further studies are needed to better understand the reasons why this association between the degree of functional limitation and unmet medical needs is also a reality for people with disabilities living in institutions.