Primary healthcare utilization patterns among sickle cell disease patients in tribal India: A multi-centric study.

Background: Prevention and management of chronic diseases have been integrated into the primary healthcare system in recent years. However, due to the social, cultural and geographical barriers, patients of one of such chronic illnesses, viz., sickle cell disease (SCD) have poor utilization and access to healthcare services. Hence, this study explored the utilization of outpatient services by SCD patients and associated factors in five SCD-endemic tribal districts of India.

Methods: This cross-sectional quantitative study was conducted on 263 SCD patients or their caregivers and 263 corresponding controls recruited from 5 SCD endemic districts. Data on utilizing outpatient services and health system-related characteristics were collected using a pretested questionnaire. Multiple logistic regression was conducted to explore the association between utilization of outpatient services and independent variables.

Results: About 80% of the patients reported the public healthcare system as a regular source of healthcare. 86% of the patients and 65% of the controls or their families visited primary health centres (PHCs) in the past year. More than two-thirds of the patients (67.7%) and more than half of the controls (50.6%) didn't face any problems accessing PHC services. Patients with 6-10 years of schooling (adjusted odds ratio (AOR)=0.45), annual family income of USD 480 to USD 720 (AOR=0.41) and more than USD 720 (AOR=0.35), >15 kilometres of distance to PHCs (AOR=0.32) are less likely to visit PHCs.

Conclusion: The primary healthcare system was a regular source of medical care for the majority of the population, and utilization of outpatient services at PHCs was high in our study. Hence, this study emphasizes strengthening screening and management of SCD right from the primary healthcare level so that the healthcare needs of SCD patients can be met for the continuum of care.