Care Utilization Research Articles

Comparing imputation approaches for immigration status in ED visits: Implications for using electronic medical records.

This study aimed to compare imputation approaches to identify the likely undocumented patient population in electronic health record (EHRs). EHR are a promising source of information on undocumented immigrants' medical needs and care utilization, but there is no verified way to identify immigration status in the data. Different approaches to approximating immigration status in EHR introduce unique biases, which in turn has major implications on our understanding of undocumented immigrant patients. We used a dataset of all emergency department (ED) visits from 2016 to 2019 in the Los Angeles Department of Health Services (LADHS) merged across patient medical records, demographic data, and claims data. We included all ED visits from our patient groups of interest and limited to patients at or over the age of 18 years at the time of their ED visit and excluded empty encounter records (n = 1,106,086 ED encounters). We created three patient groups: (1) US-born, (2) foreign-born documented, and (3) undocumented using two different imputation approaches: a logical approach versus statistical assignment. We compared predicted probabilities for two outcomes: an ED visit related to a behavioral health (BH) disorder and inpatient admission/transfer to another facility. Both approaches provide comparable estimates among the three patient groups for ED encounters for a BH disorder and inpatient admission/transfer to another facility. Undocumented immigrants are less likely to have a BH diagnosis in the ED and are less likely to be admitted or transferred compared to the US-born. Researchers should consider expanding EHR with administrative data when studying the undocumented patient population and may prefer a logical approach to estimate immigration status. Researchers who rely on payer status alone (i.e., restricted Medicaid) as a proxy for undocumented immigrants in EHR should consider how this may bias their results. As Medicaid expands for undocumented immigrants, statistical assignment may become the preferred method.

Social inequalities in the prevalence and treatment of depressive symptoms in Czechia

Abstract Background Depressive symptoms are associated with achieved socioeconomic status (SES) in men and women. The aim of the analysis is to verify this association between severity of depressive symptoms and socioeconomic status in the Czech context. Another aim is to examine the use of psychiatric and psychological treatment among men and women. Methods The data come from the 2019 European Health Interview Survey (EHIS). The Patient Health Questionnaire (PHQ-8) was used to measure the symptoms and severity of depressive symptoms among respondents. Participants were aged 20 and above and resided in households. Binary logistic regression was used to test the relationship for using of treatment and depressive symptoms. Results The weighted prevalence of mild depressive symptoms is determined to be 10.5% (8.0 % in men; 12.8% in women), with severe depressive symptoms recorded at 3.1% (2.6% in men; 3.7% in women) within the Czech population. The psychiatric or psychological treatment is utilized by 3.8% (2.8% in men; 4.7% in women) of the Czech population. Respondents with severe depressive symptoms (37.4%) use care the most, followed by those with mild symptoms (11.9%), and the least by those with none (1.6%). Individuals with tertiary education utilize treatment the most among respondents with moderate and severe depressive symptoms. Respondents differ in the utilization of treatment; however, after stratifying the model only for respondents with mild or severe depressive symptoms, these respondents do not differ in the utilization of treatment. Conclusions SES level is reflected differently in the prevalence and severity of depressive symptoms for men and women. But no difference was found in the use of psychiatric or psychological care in men and women. A treatment gap was found for depressive symptoms in the Czech population. Key messages • The results confirmed the relationship between the utilization of care and depressive symptoms. • It was revealed that respondents did not differ in the utilization of care after the stratification.

Ethnobotanical study of medicinal plants in Dibatie district, Metekel zone, Benishangul Gumuz Regional State, western Ethiopia

BackgroundHerbal medicine has been used for the treatment of human and livestock ailments since ancient times. Numerous rural and urban communities in Ethiopia practice traditional medicine and transfer the knowledge verbally from generation to generation. Thus, this study was conducted to document the traditional medicinal plants and associated indigenous knowledge in Dibatie district, Metekel zone, Benishangul Gumuz Regional State, western Ethiopia.MethodsThree hundred seventy-four (374) informants from 11 kebeles (the smallest administrative units) were selected and participated in the data delivery. The ethnobotanical data collection was carried out using semi-structured interviews, preference ranking, direct matrix ranking, field observation, market surveys, and focus group discussions, including voucher specimen collections. The ethnobotanical data were analyzed using descriptive statistics (frequency and percentage), ranking, comparison, and quantitative ethnobotanical techniques such as informant consensus factor, fidelity level index, Jaccard’s coefficient of similarity, and use value index.ResultsA total of 170 plant species were recorded to treat 79 human and 29 livestock ailments. Fabaceae (with 20 species) and Asteraceae (with 18 species) were the most dominant medicinal plant families in the area. Most remedial plants were herbs (61 species, 35.88%), followed by shrubs (39 species, 22.94%). The majority (135 species, 79.41%) of medicinal plants were harvested from wild sources and mainly possessed multiple remedy parts (41.17%) that are usually prescribed in fresh form (60.13%). The most commonly reported human ailment was snake venom, while blackleg was mostly reported among livestock diseases. The herbal medicines were mostly administered orally (52.20%), followed by dermal (17.62%) application. Embelia schimperi Vatke, Glinus lotoides L., Haplosciadium abyssinicum Hochst., Mucuna melanocarpa Hochst. ex A. Rich., and Phragmanthera macrosolen (Steud. ex A. Rich.) M.G.Gilbert had the highest fidelity level values (100%) against the corresponding ailments.ConclusionThe study area is rich in a diversity of potential medicinal plants and associated indigenous knowledge. Thus, appropriate conservation actions and careful utilization are essential to counteract the rise of anthropogenic threats and to ensure the continuity of plants with the related indigenous knowledge. Additionally, the medicinal plants should be validated through experimentation to integrate local knowledge with modern medications.

Paying for advance care planning in medicare: Impacts on care and spending near end of life

Spending at end of life (EOL) accounts for a large and growing share of healthcare expenditures in the US, and often reflects aggressive care with questionable value for dying patients. Using a novel instrumental variables approach, we conduct the first study on the causal effect of Medicare reimbursement for advance care planning (ACP)—the process of discussing and recording patient preferences for goals of care—on care utilization, spending, and mortality outcomes for critically ill Medicare patients. We find that billed ACP services substantially increase hospice use and hospice spending within a year, accompanied by corresponding increase in one-year mortality. The impacts of ACP services on hospice use and spending are especially prominent among patients with dementia and those of lower socioeconomic status. Among decedents, death is significantly less likely to occur in the hospital, and total and inpatient spending within the last 30 days of life fall significantly. Our findings suggest that paying for ACP services can be effective in improving hospice use for critically ill Medicare patients, with the (possibly intended) consequence of increased one-year mortality.

Community-Based Medications First for Opioid Use Disorder - Care Utilization and Mortality Outcomes.

A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access. Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data. 825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days' supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine (all results p<0.05). Months with an emergency department overdose did not change. Months with an inpatient hospital stay increased (p<0.05). The annual death rate in the first year for the intervention group was 0.45% (3 out of 664) versus 2.2% (222 out of 9893) in the comparison group in the 12 months; a relative risk of 0.323 (95% CI 0.11-0.94). Findings indicated a significant increase in MOUD for the intervention group and a lower mortality rate relative to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical-fentanyl may have lessened the intervention impact as measured in the cohort analysis. Study findings support expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.

Socioeconomic factors and rural-urban differences in patients undergoing emergency laparotomy

Background: Emergency laparotomy (EL) is a common surgical procedure with high rates of mortality and complications. Socioeconomic circumstances and regional differences have an influence on the utilization of care and outcomes in many diagnostic groups, but there are only few studies focusing on their effect in EL population. The aim of this study was to examine the socioeconomic and regional differences in the rate of EL within one tertiary care hospital district. Methods: Retrospective single-center study of 573 patients who underwent EL in Oulu University Hospital between May 2015 and December 2017. The postal code area of each patient’s home address was used to determine the socioeconomic status and rurality of the location of residence. Results: The age adjusted rate of EL was higher in patients from low-income areas compared to patients from high-income areas (1.46 ((95% CI 1,27-1.64)) vs. 1.15 ((95% CI, 0.96-1.34))). The rate of EL was higher in rural areas compared to urban areas (1.29 (95% CI 1.17-1.41 vs. 1.42 (1.18-1.67) ). Peritonitis was more common in patients living in low-income areas. There were no differences in operation types or mortality between the groups. Conclusions: The study findings suggest that there are socioeconomic and regional differences in the need of EL. The patients living in low-income areas had a higher rate of EL and a higher rate of peritonitis. These differences cannot be explained by patient demographics or comorbidities alone.

T164 - Care Utilization Among Patients With Stimulant Use Disorder During COVID-19: A National Cohort Study of U.S. Veterans

T164 - Care Utilization Among Patients With Stimulant Use Disorder During COVID-19: A National Cohort Study of U.S. Veterans

Effect of Surgery Setting for Outpatient Shoulder Procedures on Early Postoperative Complications in a Military Population

There has been a recent push to transition procedures previously performed at hospital-based outpatient surgical departments (HOPDs) to ambulatory surgery centers (ASCs). However, limited data regarding differences in early postoperative complications and care utilization (e.g., emergency department visits and unplanned admissions) may drive increased overall costs or worse outcomes. /Hypothesis: The purpose of this study was to examine differences in early 90-day adverse outcomes and postoperative emergency department visits associated with shoulder surgeries excluding arthroplasties that were performed in HOPDs and ASCs in a closed military health care system. We hypothesized that there would be no difference in outcomes between treatment settings. We retrospectively evaluated the records for 1,748 elective shoulder surgeries from 2015 to 2020. Patients were considered as one of two cohorts depending on whether they underwent surgery in an ASC or HOPD setting. We evaluated groups for differences incomplexity, surgical time, and medical risk. Outcome measures were emergency department visits, unplanned hospital admissions, and complications within the first 90 days after surgery. There was no difference in 90-day postoperative emergency department visits between procedures performed at HOPDs (n = 606) and ASCs (n = 1142). There was a slight increase in rate of unplanned hospital admission within 90 days after surgery in the HOPD cohort, most commonly for pain or overnight observation. The surgical time was significantly shorter (105 vs 119 minutes, p <0.01) at the ASC, but there was no difference in case complexity between the cohorts (p = 0.28). Our results suggest that in appropriate patients, surgery in ASCs can be safely leveraged for its costs savings, efficiency, patient satisfaction, decreases in operative time, and potentially decreased resource utilization both during surgery and in the early postoperative period.

Association of Inpatient Occupational Therapy Utilization With Reduced Risk for Psychiatric Readmission Among Veterans.

The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA). The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition). Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses. Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.

Perceptions of Primary Care Among Women in Treatment for Opioid Use Disorder: A Qualitative Study.

Underutilization of primary care and receipt of preventive health services have been reported among women with opioid use disorder. The aim of this study was to describe perceptions of primary care among women in treatment for opioid use disorder. Between May and June 2022, 27 women who were receiving treatment for opioid use disorder from one opioid treatment program participated in this study. Participants completed one data collection session which involved a brief questionnaire followed by a semi-structured interview. Participants were asked questions about their overall experience with primary care as well as perceived facilitators and barriers to primary care utilization and quality. Interview transcripts were analyzed using an inductive thematic approach. Three themes emerged from the interviews within the domain of "Facilitators to Primary Care," including: (1) coordination of care, (2) continuity of care, and (3) relationship with health care providers. Four themes emerged from the interviews within the domain of "Barriers to Primary Care," including: (1) perceived judgment from health care providers, (2) childcare needs, (3) issues related to location, and (4) issues related to time. Approaches to primary care that help alleviate barriers to care and highlight the aspects of care that are valued may improve quality and utilization of care, thus enhancing the health and well-being of a vulnerable population.

Smarter smiles: The role of AI in modern periodontics

The profound impact of unmet oral health needs on systemic health remains a significant concern, particularly among vulnerable populations. Disparities such as low health literacy and limited access to care contribute to higher rates of oral diseases and poorer health outcomes. These disparities can exacerbate chronic systemic conditions like diabetes, cancer, and cardiovascular disease. Additionally, the absence of standardized practices among dental clinicians regarding the diagnosis, treatment, and management of periodontitis leads to inconsistencies in care utilization. Therefore, prioritizing approaches to care that enhance patient engagement, improve health literacy, and promote standardized care is imperative. Dentistry has historically emphasized delivering comprehensive care by embracing emerging technology and scientific evidence. The integration of AI holds promises in empowering patients through standardized care processes and enhanced access to health information.

Better off by risk adjustment? Socioeconomic disparities in care utilization in Sweden following a payment reform

AbstractReducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be negatively affected by such attempts. To counter these incentives, payments are often risk adjusted based on patient characteristics. However, empirical evidence is lacking on how, or if, risk adjustment affects care utilization. We examine if a novel risk adjustment model in primary care affected socioeconomic differences in care utilization among individuals with a chronic condition. The new risk adjustment model implied that the capitation—the monthly reimbursement paid by the health authority to care providers for each enrolled patient—increased substantially for chronically ill low‐SES patients. Yet, we do not find any robust evidence that their access to primary care improved relative to patients with high SES, and we find no effects on adverse health events (hospitalizations). These results suggest that the new risk adjustment model did not reduce existing health inequalities, indicating the need for more targeted incentives and interventions to reach low‐SES groups.

Continuum of care in maternal and child health in Indonesia.

This paper aims to empirically analyze the socioeconomic and demographic correlates of maternal and child health (MCH) care utilization in Indonesia using the continuum of care (CoC) concept. The concept of CoC has emerged as an important guiding principle in reproductive, maternal, newborn, and child health. Indonesia's maternal mortality rate, neonatal mortality, and under-five mortality rates are among the highest in the Southeast Asian region. Using pooled data from four successive waves of the nationally representative Indonesian Demographic and Health Survey (IDHS) conducted in the years 2002, 2007, 2012, and 2017, we use multivariate regression models to analyze care across four components of the continuum: antenatal care (ANC), institutional delivery, postnatal care for children, and full immunization (IM). CoC at each stage of MCH care has improved continuously over the period 2002-2017 in Indonesia. Despite this, just less than one out of two children receive all four components of the CoC. The overall coverage of CoC from its second stage (four or more ANC visits) to the final stage (full child IM) is driven by the dropouts at the ANC visit stage, followed by the loss of postnatal checkups and child IM. We find that the probability of a child receiving CoC at each of the four stages is significantly associated with maternal age and education, the household's socioeconomic and demographic characteristics, and economic status. Complete CoC with improved, affordable, and accessible MCH care services has the potential to accelerate the progress of Sustainable Development Goal 3 by reducing maternal and childhood mortality risks. Our findings show that in Indonesia, the CoC continuously declines as women proceed from ANC to other MCH services, with a sharp decline observed after four ANC visits. Our study has identified key socioeconomic characteristics of women and children that increase their probability of failing to access care.

Social Determinants of Mental Health among Refugees in Germany - The Influence of Postmigratory Social Isolation and Resources on Psychopathology and Utilization Behavior

The mental health of refugees is influenced by a variety of pre-, peri- and postmigratory factors. It remains largely unclear how social determinants influence the utilization of psychiatric-psychotherapeutic treatment. We applied a questionnaire survey to 189 refugees from a clinical sample in a psychiatric hospital and from a control sample, which was not in treatment. The influence of social factors on psychopathology and utilization of care was analyzed by means of a CHAID algorithm. The total sample was highly stressed (54% PTSD and 41.4% depression symptoms). Patients were more severely affected in all psychometric scales as well as in traumatization and they were less able to draw on resources such as a social network or residence permit. The strongest predictor for psychotherapeutic-psychiatric treatment was social isolation in the living environment. For patients, the lack of a work permit was the strongest predictor of depression symptoms. The results point to the importance of postmigratory social determinants for the mental health of refugees. In particular, stable social relationships, together with formal factors such as work permit and residence title, should help to reduce mental distress and the need for psychiatric treatment.

Abstract P307: Differences in Cardiovascular Disease Burden, Screening, Education, and Care by Clinic Type in the 2022 Health Center Patient Survey (HRSA)

Background: Persons experiencing homelessness (PEH) have a 2-3-fold risk for cardiovascular disease (CVD) mortality. Evidence has repeatedly shown elevated chronic disease burden, reduced access to care, and lower utilization of medication to control CVD risk factors in this setting. Migrant communities also experience reduced access to care and the impacts from deferring care. There are targeted, federally-funded health clinics in place for both settings. However, these systems are frequently overwhelmed and limited by their scope of care to primary care. There is scarce evidence on differences between access, quality, and experiences of care delivered relative to other safety-net models. Method: The 2022 Health Center Patient Survey (HCPS) was collected on behalf of the Health Resources and Services Administration (HRSA). The HCPS is a nationally-representative, three-staged, sample-based survey collected via 1:1 interviews with clinic patients. The survey assessed sociodemographics, health conditions and behaviors, access to and utilization of care, and patients’ experiences with comprehensive services they received at HRSA-funded health centers, including: community health centers (CHC), healthcare for the homeless (HCH) clinics, migrant health centers (MHC), and public housing primary care (PHPC) clinics. A total of 103 unique awardees and 318 health center sites were recruited, and 4,414 patient interviews were completed. Investigators analyzed patient characteristics and multiple survey items related to AHA’s Essential 8 metrics for differences across clinic type. Results: MHC and HCH clinics had fewer elderly patients (~7%) than CHC and PHPC clinics (~17%). There were differences across sex, race, and ethnicity across all four clinic types. Cardiovascular disease history ranged from 4.9% (MHC) to 14.7% (HCH). Reported 7-day physical activity measures, average sleep below 7 hours per day, and Lifetime smoking (&gt;100 cigarettes; OR=4.2, p&lt;0.001) were all greatest among HCH patients. Fewer HCH and MHC patients reported ever having or recent lipid tests (both p&lt;0.001). HCH patients were more likely to report hypertension (p=0.003), but less likely to report receiving nutrition advice (all p&lt;0.05). MHC patients were less likely to be prescribed hypertension medication (p=0.044) and HCH patients were less likely to be taking medication even if it was prescribed (p&lt;0.001). Adjustment for differences in age or CVD history were able to explain some observed differences, but increased the magnitude of other disparities. Conclusion: CVD burden differs across the various HRSA funding mechanisms for clinics, as do demographics and multiple metrics of health behaviors and biomarkers of cardiovascular health. Greater disease burden in HCH and MHC patients is likely compounded by increased risk factors and under performance in providing health education interventions.

The impact of the COVID-19 pandemic on treatment for domestic violence injuries: evidence from medical claims

AbstractPrevious studies have observed heterogeneous changes in domestic violence-related 911 calls, police incident reports, and arrests at the onset of the COVID-19 pandemic. In this study, we use a large-scale medical claims database with coverage of over 100 million patients to examine the impact on domestic violence victims’ use of emergency department care for their injuries in the early weeks of the pandemic compared to the corresponding weeks in previous years. We find a 23–35% decrease in utilization of emergency medical services by domestic violence victims between March and June of 2020. Based on this finding, it is essential to use caution when using medical claims to measure domestic violence in future research covering this time period. Decreases in care utilization also have important implications for the detection, screening, and treatment of domestic violence injuries during future public health crises.

Growing Concern About Unsheltered Homelessness Among Veterans: Clinical Characteristics and Engagement in Health Care Services.

Veteran homelessness has declined in the past decade, but the proportion of unsheltered homeless veterans has increased. We identified characteristics of unsheltered homelessness in a large contemporary veteran cohort and examined outpatient and inpatient encounters before and after intake to US Department of Veterans Affairs (VA) homeless programs. National data from the Homeless Operations Management Evaluation System (HOMES) database and the Corporate Data Warehouse were analyzed on 191 204 veterans experiencing housing instability from January 2018 through December 2021. We used hierarchical multivariate logistic regressions to model associations between sheltered status and veteran correlates. Repeated-measures analysis of variance assessed changes in care utilization after intake in homeless programs. Age <50 years (odds ratio [OR] = 1.3; 95% CI, 1.2-1.4), Hispanic ethnicity (OR = 1.2; 95% CI, 1.1-1.3), some college education (OR = 1.1; 95% CI, 1.0-1.1), and a bachelor's degree (OR = 1.2; 95% CI, 1.1-1.2) were associated with veteran unsheltered homelessness. Unsheltered veterans were more likely to have a VA service-connected disability (OR = 1.4; 95% CI, 1.4-1.5), military sexual trauma (OR = 1.1; 95% CI, 1.0-1.1), and/or combat exposure (OR = 1.1; 95% CI, 1.0-1.1). Unsheltered and sheltered homeless veterans had an increase in outpatient encounters and a decrease in inpatient care after intake to the VA homeless program. Contemporary unsheltered homeless veterans are younger and Hispanic with some college education. Innovative public health approaches that better engage and reduce barriers to entry need to be tested for a diverse unsheltered homeless population.

Understanding Reasons for Cancer Disparities in Italy: A Qualitative Study of Barriers and Needs of Cancer Patients and Healthcare Providers.

The second leading cause of death in Italy is cancer. Substantial disparities persist in the level of care and outcomes for cancer patients across various communities, hospitals, and regions in Italy. While substantial progress has been made in medical research and treatment options, these advancements tend to disproportionately benefit the wealthier, better-educated, and more privileged areas and portions of the population. Therefore, the primary aim of the current study is to explore possible reasons for inequalities in access to and utilisation of care from the perspective of cancer patients, who are recipients of these treatments, and healthcare providers, who are responsible for their administration. After being recruited through social media platforms, patients' organisations, and hospital websites, cancer patients (n = 22) and healthcare providers (n = 16) from various Italian regions participated in online focus group discussions on disparities in access to and provision of care. Video and audio recordings of the interviews were analysed using Thematic analysis. Among cancer patients, 7 themes were identified, while 6 themes emerged from the healthcare providers highlighting encountered barriers and unmet needs in cancer care. Most of these emerging themes are common to both groups, such as geographical disparities, information deficiencies, and the importance of psycho-oncological support. However, several themes are specific to each group, for instance, cancer patients highlight the financial burden and the poor interactions with healthcare providers, while healthcare providers emphasise the necessity of establishing a stronger specialists' network and integrating clinical practice and research. Current findings reveal persistent challenges in cancer care, including long waiting lists and regional disparities, highlighting the need for inclusive healthcare strategies. The value of psycho-oncological support is underscored, as well as the potential of the Internet's use for informational needs, emphasising the imperative for improved awareness and communication to overcome disparities in cancer care.

Cost and utilization analysis of concurrent versus staged testicular prosthesis implantation for radical orchiectomy.

American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We compared outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy. The MarketScan Commercial claims database (2008-2017) was queried for men ages >18 years who underwent radical orchiectomy for testicular mass, stratified as orchiectomy with no implant, CI, or SI. 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison. 8803 patients (8564 no implant, 190 CI, 49 SI; 2.7% implant rate) were identified with no difference in age, Charlson Comorbidity Index, insurance plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648-8554), $7823 (5403-10973), and $5380 (4130-10521), respectively (p<0.001). Median perioperative cost for SI at implantation was $8180 (4920-14591) for a total cost (orchiectomy + implant) of $13650 (5380 + 8180). CI patients were more likely to have follow-up (p = 0.006) with more visits (p = 0.030) compared to the SI group post-implantation but had similar follow-up (p = 0.065) and less visits (p = 0.025) compared to the SI patients' post-orchiectomy period. Overall explant rates were 4.7% for CI and 14.3% for SI (p = 0.04) with a median time to explant of 166 (IQR: 135-210) and 40 days (IQR: 9.5-141.5; p = 0.06). Median cost of removal was $2060 (IQR: 967-2880). CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization to SI.

Intra-urban Differences in Maternal Health Care Service Utilization in Nepal: Results from 2016 Nepal DHS

After restructure of local bodies in Nepal, some rural settings before 2015 fall under urban set tings. It is advantageous to understand the situation of maternal health care utilization among poor and non-poor in the new urban structure. Officially, one-fifth of the total population is poor in the country. The objective of this study is to explore the differentials in utilization of all the care designed during the course of reproduction from the notice of pregnancy to postnatal care within two days of delivery among urban poor and non-poor in Nepal. Differentials and roles in utilization of all care, utilization of full maternal health care service for the healthy pregnancy and childbirth are explored among the two economic groups living in urban setting of Nepal. This study has utilized Nepal demographic and health survey 2016 women’s data file. The data used for the analysis came from the 2016 Nepal Demographic and Health Survey (NDHS). This survey is nationally representative population-based household surveys that collected information on fertility, family planning, maternal and child health etc among other data. Details about the survey designs and sampling procedures of this survey are explained in publicly available final report. Using wealth index used as a proxy for household economic status, the lowest wealth quintile is taken as poor and the remaining as non-poor. Result shows that nearly 10 percentage point differences have been observed in utilizing recommended months of antenatal care visits as well as full antenatal care among poor and non-poor. Such differences remained three times more extensive in receiving de livery care from skilled birth attendants and the postnatal care within two days of delivery among those groups. Even, urban poor women are less likely to receive all components of maternal health care. Results of logistic regression confirm the lower chance of receiving full maternal health care by urban poor. The study concludes that urban setting, as local body of Nepal, needs to address the urban poor especially in utilization of maternal health care in protecting and saving health of mother and the newborn.