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Continuity of care is important for the health of aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision of non-urgent care, at-risk patients depending upon regular consultations with general practitioners (GPs) faced confusion about the possibility of seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting of a quantitative component followed by a qualitative component, to understand at-risk patients' health services use during the COVID-19 pandemic in Switzerland. Quantitatively, we used electronic medical records data from 272 GPs and 266,796 patients. Based on pre-pandemic data, we predicted weekly consultation counts as well as weekly measurement counts (blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol) per 100 patients that would be expected in 2020 in absence of a pandemic and compared those to actual observed values. Qualitatively, we conducted 23 semi-structured interviews with 24 GPs (∼45 min) and 37 interviews with at-risk patients (∼35 min). Quantitative results demonstrate a significant decrease in consultation and measurement counts during the first shutdown period, with consultation counts quickly returning to normal and moving within expected values for the rest of 2020. Qualitative data contextualize these findings with GPs describing constantly implementing material, administrative, and communication changes. GPs reported communication gaps with the authorities and noted a lack of clear guidelines delineating how to define "at-risk patients" and what cases were "urgent" to treat during shutdowns. Patient interviews show that patient-level factors, such as fear of contracting coronavirus, perceptions that GPs were overburdened, and a sense of solidarity, influenced patients' decisions to consult less at the beginning of the pandemic. Findings demonstrate communication gaps during pandemic periods and provide valuable lessons for future pandemic preparedness, particularly the need for contingency plans for the overall healthcare system instead of plans focusing only on the infectious agent itself.

Background: Some local areas in England stopped gluten free prescriptions for coeliac disease. An explanatory mixed methods study investigated the impact of these changes. Methods: A cross-sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on use of prescriptions and health care services, and the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis and the interviews by thematic analysis. Findings from the interviews guided the survey analysis. Results: Dietary burden was significantly different between prescribing and non-prescribing areas, with little impact on other aspects of quality of life. Survey participants in non-prescribing areas who felt more impacted by the prescription changes reported lower quality of life. Satisfaction with and use of services was lower in non-prescribing areas. Interviews indicated that after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten free prescriptions to be available, in particular for staple foods. Conclusions: The main quality of life impact was on Dietary burden. It is encouraging that most participants in this study maintained a good quality of life. However, issues of worse experiences of care, lower follow up opportunities, and inequity arose, and these should be taken into consideration in decisions on gluten free food prescriptions. The new guidelines for the National Health Service (NHS) in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in this study.

Background Telehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear. Objective The aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions. Methods We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results We included 127 RCTs in the meta-analysis. Of these RCTs, 82.7% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95% CI 0-30) and 37 (95% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95% CI −1.76 to −0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95% CI −1.42 to −0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger effects. Conclusions Small to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically significant.

Objectives: We aimed to explore the impact of the Swiss shutdown in spring 2020 on the intensity of health services use in general practice. Methods: Based on an electronic medical records database, we built one patient cohort each for January-June 2019 (control, 173,523 patients) and 2020 (179,086 patients). We used linear regression to model weekly consultation counts and blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts per 100 patients and predicted non-shutdown values. Analyses were repeated for selected at-risk groups and different age groups. Results: During the shutdown, weekly consultation counts were lower than predicted by −17.2% (total population), −16.5% (patients with hypertension), −17.5% (diabetes), −17.6% (cardiovascular disease), −15.7% (patients aged 80 years). Weekly BP counts were reduced by −35.3% (total population) and −35.0% (hypertension), and HbA1c counts by −33.2% (total population) and −29.8% (diabetes). p-values

Background Homelessness is associated with substantial morbidity. Data linkages between homeless and health systems are important to understand unique needs across homeless populations, identify homeless individuals not registered in homeless databases, quantify the impact of housing services on health-system use, and motivate health systems and payers to contribute to housing solutions. Methods We performed a cross-sectional survey including six health systems and two Homeless Management Information Systems (HMIS) in Cook County, Illinois. We performed privacy-preserving record linkage to identify homelessness through HMIS or ICD-10 codes captured in electronic medical records. We measured the prevalence of health conditions and health-services use across the following typologies: housing-service utilizers stratified by service provided (stable, stable plus unstable, unstable) and non-utilizers (i.e., homelessness identified through diagnosis codes—without receipt of housing services). Results Among 11,447 homeless recipients of healthcare, nearly 1 in 5 were identified by ICD10 code alone without recorded homeless services (n = 2177; 19%). Almost half received homeless services that did not include stable housing (n = 5444; 48%), followed by stable housing (n = 3017; 26%), then receipt of both stable and unstable services (n = 809; 7%). Setting stable housing recipients as the referent group, we found a stepwise increase in behavioral-health conditions from stable housing to those known as homeless solely by health systems. Compared to those in stable housing, prevalence rate ratios (PRR) for those without homeless services were as follows: depression (PRR = 2.2; 95% CI 1.9 to 2.5), anxiety (PRR = 2.5; 95% CI 2.1 to 3.0), schizophrenia (PRR = 3.3; 95% CI 2.7 to 4.0), and alcohol-use disorder (PRR = 4.4; 95% CI 3.6 to 5.3). Homeless individuals who had not received housing services relied on emergency departments for healthcare—nearly 3 of 4 visited at least one and many (24%) visited multiple. Conclusions Differences in behavioral-health conditions and health-system use across homeless typologies highlight the particularly high burden among homeless who are disconnected from homeless services. Fragmented and high use of emergency departments for care should motivate health systems and payers to promote housing solutions, especially those that incorporate substance use and mental health treatment.

PURPOSE: The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC). MATERIAL AND METHODS: This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n = 283) and post-intervention (n = 257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider). RESULTS: Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02-2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05-2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77-1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81-1.92)]. CONCLUSIONS: Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.

Heart failure (HF) is becoming increasingly prevalent and affects both men and women. However, women have traditionally been underrepresented in HF clinical trials. In this study, we aimed to analyze sex differences in the comorbidity, therapy, and health services&rsquo, use of HF patients. We conducted a cross-sectional study in Arag&oacute, n (Spain) and described the characteristics of 17,516 patients with HF. Women were more frequent (57.4 vs. 42.6%, p &lt, 0.001) and older (83 vs. 80 years, p &lt, 0.001) than men, and presented a 33% lower risk of 1-year mortality (p &lt, 0.001). Both sexes showed similar disease burdens, and 80% suffered six or more diseases. Some comorbidities were clearly sex-specific, such as arthritis, depression, and hypothyroidism in women, and arrhythmias, ischemic heart disease, and COPD in men. Men were more frequently anti-aggregated and anti-coagulated and received more angiotensin-converting-enzyme (ACE) inhibitors and beta-blockers, whereas women had more angiotensin II antagonists, antiinflammatories, antidepressants, and thyroid hormones dispensed. Men were admitted to specialists (79.0 vs. 70.6%, p &lt, 0.001), hospital (47.0 vs. 38.1%, p &lt, 0.001), and emergency services (57.6 vs. 52.7%, p &lt, 0.001) more frequently than women. Our results highlight the need to conduct future studies to confirm the existence of these differences and of developing separate HF management guidelines for men and women that take into account their sex-specific comorbidity.

ObjectivesTo measure the use of healthcare services and assistive devices by centenarians in five countries.DesignCross-sectional study using a survey questionnaire.SettingCommunity-dwelling and institutionalised centenarians living in Japan, France, Switzerland, Sweden and Denmark.Participants1253 participants aged 100 or in their 100th year of life, of whom 1004 (80.1%) were female and 596 (47.6%) lived in institutions.Main outcome measuresRecent use of medical visits, nursing care at home, home-delivered meals, acute care hospital stays overnight, professional assessments such as sight tests, mobility aids and other assistive devices. A set of national healthcare system indicators was collected to help interpret differences between countries.ResultsThere was considerable variability in the healthcare services and assistive devices used by centenarians depending on their country and whether they were community-dwelling or institutionalised. In contrast to the relatively homogeneous rates of hospitalisation in the past year (around 20%), community-dwelling centenarians reported widely ranging rates of medical visits in the past 3 months (at least one visit, from 32.2% in Japan to 86.6% in France). The proportion of community-dwellers using a mobility device to get around indoors (either a walking aid or a wheelchair) ranged from 48.3% in Japan to 79.2% in Sweden. Participants living in institutions and reporting the use of a mobility device ranged from 78.6% in Japan to 98.2% in Denmark.ConclusionsOur findings suggest major differences in care received by centenarians across countries. Some may result from the characteristics of national healthcare systems, especially types of healthcare insurance coverage and the amounts of specific resources available. However, unexplored factors also seem to be at stake and may be partly related to personal health and cultural differences.

Background: There are approximately two billion workers in the informal economy globally. Compared to workers in the formal economy, these workers are often marginalised with minimal or no benefits from occupational health and safety regulations, labour laws, social protection and/or health care. Thus, informal economy workers may have higher occupational health risks compared to their formal counterparts. Our objective was to systematically review and meta-analyse evidence on relative differences (or inequalities) in health services use and health outcomes among informal economy workers, compared with formal economy workers. Methods: We searched PubMed and EMBASE in March 2020 for studies published in 1999–2020. The eligible population was informal economy workers. The comparator was formal economy workers. The eligible outcomes were general and occupational health services use, fatal and non-fatal occupational injuries, HIV, tuberculosis, musculoskeletal disorders, depression, noise-induced hearing loss and respiratory infections. Two authors independently screened records, extracted data, assessed risk of bias with RoB-SPEO, and assessed quality of evidence with GRADE. Inverse variance meta-analyses were conducted with random effects. Results: Twelve studies with 1,637,297 participants from seven countries in four WHO regions (Africa, Americas, Eastern Mediterranean and Western Pacific) were included. Compared with formal economy workers, informal economy workers were found to be less likely to use any health services (odds ratio 0.89, 95% confidence interval 0.85–0.94, four studies, 195,667 participants, I2 89%, low quality of evidence) and more likely to have depression (odds ratio 5.02, 95% confidence interval 2.72–9.27, three studies, 26,260 participants, I2 87%, low quality of evidence). We are very uncertain about the other outcomes (very-low quality of evidence). Conclusion: Informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression. The evidence is uncertain for relative differences in the other eligible outcomes. Further research is warranted to strengthen the current body of evidence and needed to improve population health and reduce health inequalities among workers.

Objective: The relationship of socioeconomic position with the use of health services may have changed with the emergence of the economic crisis. This study shows that relationship before and during the economic crisis, in Germany and in Spain. Methods: Data from the 2006 and 2011 Socio-Economic Panel carried out in Germany, and from the 2006 and 2011 National Health Surveys carried out in Spain were used. The health services investigated were physician consultations and hospitalization. The measures of socioeconomic position used were education and household income. The magnitude of the relationship between socioeconomic position and the use of each health services was estimated by calculating the percentage ratio by binary regression. Results: In Germany, in both periods, after adjusting for age, sex, type of health insurance and need for care, subjects belonging to the lower educational categories had a lower frequency of physician consultations, while those belonging to the lower income categories had a higher frequency of hospitalization. In the model comparing the two lower socioeconomic categories to the two higher categories, the percentage ratio for physician consultation by education was 0.97 (95%CI 0.96–0.98) in 2006 and 0.96 (95%CI 0.95–0.97) in 2011, and the percentage ratio for hospitalization by income was 1.14 (95%CI 1.05–1.25) in 2006 and 1.12 (95%CI 1.03–1.21) in 2011. In Spain, no significant socioeconomic differences were observed in either period in the frequency of use of these health services in the fully adjusted model. Conclusion: The results suggest that the economic crisis did not alter accessibility to the health system in either country, given that the socioeconomic pattern in the use of these health services was similar before and during the crisis in both countries. This work was supported by the Ministerio de Economía y Competividad (ES), no. CSO2013-40877-P.

Older people with complex health issues and needs for functional support are increasingly living in different types of residential care environments as alternatives to nursing homes. This study aims to compare the demographics and health-care expenditures of Medicare beneficiaries by the setting in which they live: nursing homes, residential care settings, and at home using data from the 2002 to 2010 Medicare Current Beneficiary Study (MCBS), a nationally representative survey of the Medicare population. All Medicare beneficiaries aged 65 years or older who participated in the fall MCBS interview (years 2002–2010) and were alive for the full year ( N = 83,507) were included in the sample. We found that there is a gradient in health status, physical and cognitive functioning, and health-care use and spending across settings. Minority elderly are overrepresented in facilities and underrepresented in alternative living settings.

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

BACKGROUND: Ethnic minority patients seem to be confronted with barriers when using health services. Yet, care providers are often oblivious to these barriers, although they may share to some extent the burden of responsibility for them. In order to enlighten care providers, as to the potential pitfalls that may exist, there is a need to explore the different factors in the creation of the barriers. OBJECTIVE: Therefore, the objective of this paper is to present an overview of the potential barriers and the factors, which may restrict ethnic minority patients from using health services, according to the literature available. METHODS: Articles published from 1990 to 2003 were identified by searching electronic databases and selected through titles and abstracts. The articles were included if deemed to be relevant to study health services use by ethnic minorities, i.e. the different factors in the creation of a barrier. RESULTS: There were 54 articles reviewed. They reported on studies carried out in different countries and among different ethnic minorities. Potential barriers occurred at three different levels: patient level, provider level and system level. The barriers at patient level were related to the patient characteristics: demographic variables, social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness and personal health practices. The barriers at provider level were related to the provider characteristics: skills and attitudes. The barriers at system level were related to the system characteristics: the organisation of the health care system. CONCLUSION: This review has the goal of raising awareness about the myriad of potential barriers, so that the problem of barriers to health care for different ethnic minorities becomes transparent. In conclusion, there are many different potential barriers of which some are tied to ethnic minorities. The barriers are all tied to the particular situation of the individual patient and subject to constant adjustment. In other words, generalizations should not be made.

Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. ‘Other’ ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal ‘need’, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

Background Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Methods Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. Results All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Conclusions Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0232-y) contains supplementary material, which is available to authorized users.

© 2016 The Author(s). Background: There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years. Methods: A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia. Results: The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government. Conclusions: This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.

Background Today’s rapid growth of migrant populations has been a major contributor to the human immunodeficiency virus (HIV) epidemic. However, relatively few studies have focused on HIV/acquired immunodeficiency syndrome (AIDS)-related knowledge, attitudes, and practice among rural-to-urban migrants in China. This cross-sectional study was to assess HIV/AIDS-related knowledge and perceptions, including knowledge about reducing high-risk sex. Methods Two-phase stratified cluster sampling was applied and 2,753 rural migrants participated in this study. An anonymous self-administered questionnaire was conducted in Guangdong and Sichuan provinces in 2007. Descriptive analysis was used to present the essential characteristics of the respondents. Chi-square test and multiple logistic regression models were performed to examine the associations between identified demographic factors and high-risk sex, sexually transmitted disease (STD) symptoms, and access to HIV screening services among the seven types of workers. Results 58.6% of participants were knowledgeable about HIV/AIDS transmission, but approximately 90% had a negative attitude towards the AIDS patients, and that 6.2% had engaged in high-risk sex in the past 12 months. Logistic regression analysis revealed sex, marital status, income, migration and work experience to be associated with high-risk sex. Among the 13.9% of workers who reported having STD symptoms, risk factors that were identified included female gender, high monthly income, being married, daily laborer or entertainment worker, frequent migration, and length of work experience. Only 3% of migrant workers received voluntary free HIV screening, which was positively associated with monthly income and workplace. Conclusions HIV/AIDS knowledge, attitudes, and practices among rural migrants in China remain a thorny health issue, and use of healthcare services needs to be improved. Low levels of education and knowledge regarding HIV/AIDS among housekeepers and migrant day laborers result in this population likely being engaged in high-risk sex. Government programs should pay more attention to public education, health promotion and intervention for the control of the HIV/AIDS epidemic in China.

Background Periodic physical examination is considered helpful in preventing illness and promoting health among the elderly. Limited information is available about the use of annual physical examinations among the elderly in rural areas, however. This research explores the distribution characteristics of annual physical examination use and its determinants among people aged 60 or over in rural China. Methods A cross-sectional study was undertaken to estimate distribution characteristics of annual physical examination use and to collect data of sociodemographic characteristics, health knowledge level, and health communication channels. Participants were 1128 people aged 60 or over, randomly selected from four different provinces in the East, Mid-East, Mid-West, and West China. Logistic regression determined the predictors of annual physical examination use. Results Participants were predominantly aged 60–79 (44.1%) and 70–79 (42.0%). A total of 716 (63.5%) participants underwent annual physical examinations. Those who reported acquiring health knowledge via bulletin boards and village doctors had a higher probability of using annual physical examinations (OR = 3.15 and 1.53). The probability for civil servants/retired having annual physical examinations was 2.16 times higher than for farmers. Those who had an average level of health knowledge had a higher probability of using annual physical examinations than those at the below-average level (odds ratio: 2.07). Conclusion The government and public health institutions should assist farmers to acquire the habit of having annual physical examinations. Traditional channels, such as bulletin boards, should be used to deliver health information. Village doctors should be supported in delivering health information to the elderly in rural areas.