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Utilización de los servicios de salud: una revisión sistemática sobre los factores relacionados. La utilización de los servicios de salud está determinada por diversos factores. Con la finalidad de estudiar cuales son los factores más importantes y consistentes, fue realizada una revisión sistemática entre los años 1970 y 1999. Se encontró que la media de consultas, la proporción de personas que consultan y la proporción que concentra el mayor número de consultas fue similar. Entre los factores demográficos, niños, mujeres en edad fértil y ancianos utilizan más los servicios. Entre los socioeconómicos, la clase social baja y el grupo con menos educación se asociaron con la utilización. El mayor uso está mediado por una mayor necesidad en salud. Pero según del tipo de sistema, estos grupos menos favorecidos pueden recibir una insuficiente atención. La necesidad en salud es uno de los factores más importantes y si se desea analizar la equidad del sistema, es necesario tener en cuenta el padrón de utilización entre los grupos sociales para el nivel de mayor necesidad en salud. Entre los factores relacionados a los servicios de salud, tener un médico definido determina una utilización más adecuada. Esto puede servir para atenuar las diferencias en la atención médica entre los diferentes grupos sociales. Finalmente, se propone una jerarquía para los factores relacionados. PALABRAS CLAVES: Accesibilidad a los Servicios de salud – Atención Médica – Prestación de Atención de Salud Outpatient health service utilization, associated factors and equity: a population based-study in southern Brazil. Objectives: To analyze: a) the factors that lead persons to visit a doctor; b) their relative importance; and c) the equity of the system, with the aim of assisting the design of interventions to increase accessibility. Methods: A cross-sectional study with 1,260 persons aged 15 or more was carried out between January and May 2000 in Rio Grande, Brazil. Demographic, socio-economic, psychological, health need and regular source of care data were collected. The outcome was visit to a doctor within the previous two months. A hierarchical model approach was used, and data was analyzed using Poisson regression. Adjusted prevalence ratios and 95% confidence intervals were calculated. Results: Health needs measured as self-reported health was the most important factor. The probability of visiting a doctor was three times smaller for persons reporting excellent health, compared to those with poor or regular health. Those with inactivity days had a 59% increase in the probability of the outcome. Having a regular doctor improved the probability of utilizing health services by 70%; having a regular place for care improved it by 64%. Analysis according to the highest level of health need showed that the lowest uneducated socio-economic group made 62% fewer doctor visits. However, a significant interaction was found between income and education, and more years of schooling improved the probability of the outcome. Conclusions: Health need and regular source of care (doctor or place) were the most important factors associated with visiting a doctor. Although there is inequity, years of education modified the prevalence rates of visit to a doctor in the lowest income group. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved. KEY WORDS: Health Services – Accessibility – Utilization – Equity – Continuity of patient care PREVALENCE OF REGULAR DOCTOR, ASSOCIATED FACTORS, AND EFFECT ON HEALTH SERVICES UTILIZATION: A POPULATION-BASED STUDY IN SOUTHERN BRAZIL Background: Prevalence of regular doctor in Brazil, estimated in an Emergency Room, is 30%, but there is limited information about this issue in the general population. Objectives: To assess the prevalence of regular doctor in Brazil, associated factors, and its effects on health services utilization. Research design: Data was obtained from a cross-sectional study, using a questionnaire with demographic, socioeconomic, morbidity and health services utilization questions. The study was carried out in the city of Rio Grande, southern Brazil, between January and May 2000. Subjects: 1260 persons aged 15 or more, were interviewed. Measures: Adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. Poisson regression models were used to analyze the relationships. Results: The study found a 37% prevalence for regular doctor. Adjusted analysis revealed a direct and linear association with income. Women, age, health insurance and chronic health problem, were also associated with the outcome. Having a regular doctor determined a 23% overall increase in the probability of visit to a physician. In women, it produced a 30% increase in the probability of clinical breast examination and 23% increase in cervical cancer prevention visits. In men, it increased the probability of prostate examination by 84%. Conclusions: The prevalence of regular doctor in Brazil is low and directly associated with socioeconomic factors. Men and women with this characteristic have better access to health services. The promotion of regular doctor among the population may improve health care quality and health services access in the poorest groups. KEY WORDS: Regular doctor, Continuity of patient care, Accessibility.