Reviewer's report
Title:Primary Health Care Use from the Perspective of Gender and Morbidity
Burden
Version:1Date:15 April 2014
Reviewer: Kimmo Räsänen
Reviewer's report:
This paper is clearly structured, well written and is based on a large sample of six
PHC centres' adult patients in Aragon, Spain in whole year 2008.The aim of the
paper was to analyze the differences in the utilization of PHC between men and
women taking into account their morbidity burden. Electronic medical records
and standardized measures (ICHPC 2 and ADGs) were used as a source of
data. The results are presented logically, and figures are illustrative and
informative. The used statistics are appropriate.
The main finding of the research was that the overall higher use of PHC by
women seems to be associated with their higher morbidity burden.
However, there are some limitations in the study, which the authors also notice in
the end of the discussion. 1) The results may be underestimate of the morbidity
burden of the population, as they are based on medical records. 2) There might
be a vicious circle; people visiting more often PHC might have more diagnosed
diseases, and 3) socioeconomic characteristics were not taken into account.
Before publishing the below comments should be addressed on.
Major Compulsory Revisions
1. As the authors state by themselves there might be a vicious circle in which
people going more often to the Centres are more likely to have more diseases
diagnosed. Every visit probably will generate at least one ICHHP 2 diagnoses?
Could it be possible to make a baseline analysis of the existing ADGs at the
beginning of the study period (before 2008), and group the patients (ADGs in the
beginning 0, 1, 2, 3, etc.) and start the analysis from that point.
Minor Essential Revisions
2. In Methods section in paragraph 5 there is a sentence: A visit was defined as a
contact of the patient with the health team. What does a contact include? Only
face to face visits, or also telephone or e-mail contacts?.
3. In Results in the first paragraph the study sample is stated to be 79,089
patients. However, when counted form Table 1 (bottom line) the number is
78,935. A clarification for this difference is needed.
4. In the Results section paragraph 4 while explaining the contents of Table 1,
the authors state that in all age and morbidity groups the number of visits was
higher for men. However, in table you can see that in several occasions this is
not the case (< 30 yrs,1 ADG; 31-50 yrs, 2 and 4 ADGs; 51-70 years, 3 ADGs;
>70 yrs, 1,3 and 5 ADGs.
5. Table 1 should be revised (without both vertical and horizontal lines)
Discretionary Revisions
6. Two first sentences of Methods section could be reformulated joint as follows:
An observational retrospective study was carried out using the information from
electronic medical records gathered at six PHC Centres in Aragon Spain. The
studied population included all patients over 14 years of age who attented, at
least once in 2008, one of the participating PHC Centres.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.