Health Service Utilization Costs Research Articles

Significant healthcare resource utilisation in the management of skin and soft tissue infections in the Torres Strait, Australia.

Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery. The research team conducted a retrospective, de-identified audit of health records for a 2-year period, 2018-2019. The aim was to define health service utilisation, episodes of outpatient care, emergency department care, inpatient care and aeromedical retrieval services for SSTIs. Across 2018 - 2019, there were 3509 outpatient episodes of care for SSTIs as well as 507 emergency department visits and 100 hospitalisations. For individuals with an SSTI, the mean outpatient clinic episode cost $240; the mean emergency department episode cost $400.85, the mean inpatient episode cost $8403.05 while an aeromedical retrieval service cost $18,670. The total costs to the health system for all services accessed for SSTI management was $6,169,881 per year, 3% of the total annual health service budget. Healthcare costs associated with SSTIs in the Torres Strait are substantial. The implementation of effective preventative and primary care interventions may enable resources to be reallocated to address other health priorities in the Torres Strait.

Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study.

Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

Treated versus self-reported prevalence of chronic pain and costs of patients' health services utilization: a population-based study of health administrative databases.

To compare treated to self-reported prevalence of chronic pain (CP) and to estimate health services utilization (HSU) costs of patients treated for CP in Alberta, Canada. Patients treated for CP were identified by the physician billing codes of health services for CP from the practitioner claims database in fiscal year 2021/22. The treated prevalence of CP (number of these patients divided by the population) was compared to the self-reported prevalence of CP previously estimated (doi:10.1371/journal.pone.0272638). Costs of patients' HSU included costs for general practitioner (GP), specialist, inpatient, emergency department, outpatient clinic services, and prescription drugs. The treated prevalence of CP was 6.0% (4.4% among males and 7.8% among females) which was 30% to 41% of the self-reported prevalence. The highest treated prevalence (7.2%) was found in the age group of 18-64years, followed by age groups of >64years (7.0%) and <18years (2.1%). The average cost per patient per year was $5096 ($5878 for males and $4652 for females), of which hospitalizations accounted for 65.0%, outpatient clinic visits 16.4%, ED visits 9.5%, prescription drugs 4.7%, GP visits 3.9%, and specialist visits 0.4%. The total cost of patients with CP for the health system was $1.37 billion (∼7% of total health expenditure), of which males accounted for 41.7% and females for 58.3%. Our findings suggest that the economic burden of CP is considerable and that many people with self-reported CP do not use the public healthcare services. This can be multifactorial, including lack of availability and accessibility of publicly funded services, people's lack of awareness of available services, lower utilization due to COVID-19 pandemic, and reliance on self-management, private services, and alternative treatments. Further studies are warranted to inform future policies and health system initiatives aiming to reduce the burden of CP and improve lives of people living with it.

Projecting direct medical costs and productivity benefits of improving access to advanced therapy for rheumatoid arthritis: a projection modelling study

ABSTRACT Introduction: To ensure the sustainability of the AT access improvement, it is important that health system stakeholders have timely, analyzed information accessible for reference and decision-making support. In this study, we projected the direct costs required as well as the expected direct medical cost-offset and productivity benefits resulting from improving the disease control. Methods: We implemented a deterministic, prevalence-based mathematical model to project the annual cost of rheumatoid arthritis (RA) management within the public healthcare system in Malaysia. We also calculated the annual productivity loss due to uncontrolled RA in monetary value. Using the projection model, we compared the projected costs of the status quo scenario vs. several scenarios of improved advanced therapy (AT) access over a 5-year period. Results: We projected that between 10,765 and 11,024 RA patients in Malaysia over the period of 2020–2024 will need access to AT due to treatment failure with conventional synthetic disease modifying antirheumatic drugs (DMARDs). The projected net total medical cost under the status quo scenario were 163.5 million annually on average (approximately MYR 15,000 per patient per year). Cost related to health service utilization represented the heaviest component, amounting to 71.8% followed by drug cost (24.7%). Under the access improvement scenarios, drug cost constituted a higher proportion of the total medical, ranging from 25.6% to 30.4%. In contrast, the cost of health service utilization shown a reverse pattern (reducing to between 66.3% and 70.1%). Productivity costs were also expected to reduce as AT access improved leading to better outcomes. Treatment shifts to targeted synthetic DMARDs in anticipation of price adjustment appeared to have a cost saving advantage to the health system if all other parameters remain unchanged. Discussion: Improving AT access for RA patients towards the aspirational target appeared to be feasible given the current health budget in Malaysia. Broader socio-economic consequences of productivity and income loss should be included as an important part of the policy consideration. The financial implication of different AT utilization mixes and the anticipated price adjustment will likely result in some cost saving to the health system.

COGNITIVE STATUS AND HEALTH CARE UTILIZATION IN AN EMERGENCY DEPARTMENT: EARLY RESULTS OF A LONGITUDINAL PILOT STUDY

Abstract Many people living with Alzheimer’s disease and related dementias (ADRD) never receive a formal disease diagnosis. This compromises wellbeing and increases health services utilization and care costs. Wider screening and assessment for ADRD may increase access to supportive care, improve allocation of medical care, and foster interventions that prevent or delay disease progression. A sample of Medicare-enrolled individuals 65+ (n=60) consecutively presenting to the Oregon Health &amp; Science University (OHSU) emergency department (ED) in Portland, Oregon consented to the study and were administered the TICS, a validated tool for telephone-based assessments of cognition, post-discharge from the ED. Study participants were asked about their physical health via the modified Cumulative Illness Rating Scale (M-CIRS), and their cognitive health via the PROMIS Cognitive Measure Questions on Mental Clarity. Care utilization patterns were measured via review of participants’ electronic health records (EHR) for three years prior to study enrollment focusing on total hospitalizations, ED visits, and primary care (PC) visits.Medicare-enrolled adults 65+ recently discharged from the ED were a feasible population to perform a cognitive assessment. The study enrollment rate was 24.2% (n=60). Enrollment was limited to patients with their PC affiliated with the OHSU health system, which excluded the majority (792, 73.8%) of ED patients Medicare-enrolled, 65+ from our study (1,072). This study provides preliminary evidence to support focusing on older ED patients to administer cognitive assessments, linking outcomes to the EHR, and ultimately providing a platform for future research on impacts of under-diagnosed ADRD on population-level health outcomes and care utilization.

Depression in Rheumatoid Arthritis: A Narrative Review-Diagnostic Challenges, Pathogenic Mechanisms and Effects.

Depression is one of the most frequent comorbidities in rheumatoid arthritis (RA); it takes an important toll on the quality of life of these patients and also leads to a decrease in life expectancy. The current article is a narrative review on depression in RA, with the objective to emphasize and raise awareness on the high prevalence, pathogenic mechanisms, and effects that depression has on RA patients. In RA, the prevalence of depression has been shown to be 2 to 3 times higher than in the general population, with a meta-analysis reporting that 16.8% of RA patients have a major depressive disorder. Future studies are needed to determine the most accurate self-reported depression questionnaires and their ideal threshold for defining depression as compared to diagnostic interview as gold-standard for patients with RA to allow better comparisons across studies. The pathogenesis of depression remains to be fully understood, but recent specialty literature suggests that immune-mediated processes are involved and that there are similarities between the neural networks recruited in inflammation and those implicated in the pathophysiology of depression. Depression in patients with RA is associated with poor long-term outcomes. Multiple studies have shown that depression in RA is associated with increased pain, fatigue, and physical disability. It alters treatment compliance, causes more comorbidities, and leads to higher mortality, partly through increased suicide risk. Depression in RA also increases health service utilization and healthcare costs directly through hospitalization, but also indirectly through loss of work productivity. Assessing depression could be a significant psychomarker of rheumatological outcome in RA.

Comparison of health services utilization, medical costs, and activity limitations between cancer survivors with and without a disability.

21 Background: Cancer survivors are one of the most vulnerable cohorts regarding health status and financial hardship. They are also more likely to have a disability than individuals without a cancer history. No prior research has systematically examined whether and how disability interacts with cancer survivorship. This study examines the association of disability with health services utilization, medical costs, and activity limitations among cancer survivors. Methods: We constructed a nationally representative cohort of cancer survivors using 2015-2019 Medical Expenditure Panel Survey Household Component File. Outcomes included health services utilization, measured by six service types (inpatient, institutional outpatient, office-based physician, office-based non-physician, ED, and prescription), total health care expenditure for all services combined and for each service type, and activity limitations (work at job, housework, and social relationship). Primary independent variables included six binary variables of functional disability conditions (hearing, vision, cognition, ambulation, self-care, and independent living) in the first model and a categorized total number of disabilities (0, 1, 2, 3, ≥4) in the second model. We employed multivariable generalized linear models and two-part models, adjusting for socio-demographics, general health status, and chronic conditions as well as accounting for complex survey design. Results: On average, cancer survivors (n = 9,359; weighted n = 21,046,285) had 0.57 days of hospital stays, 6.07 physician visits, and 16.3 prescriptions annually. The average annual health care expenditure for all services were $10,840, and 7.1% had one or more activity limitation. Notably, 38.8% of cancer survivors had at least one disability condition (ambulation 24.5%, hearing 13.8%, independent living 12.7%, cognition 11.5%). Compared to survivors without any disability, disability in self-care and ambulation was most strongly associated with the higher utilization of inpatient care (adjusted average marginal effect [AME] 0.85 days; 95% confidence interval [CI] 0.44-1.27) and physician visits (AME 1.03 visits; 95% CI 0.53-1.53), respectively. Disability in independent living (AME $5,046; 95% CI $2,638-7,455) and ambulation (AME $3,702; 95% CI $2,029-5,375) substantially increased total health care expenditure of all services. Survivors with four or more disabilities were 21.4 times more likely to have any activity limitations than those without a disability. Conclusions: Disability was associated with higher health services utilization and medical costs, and more activity limitations among cancer survivors, with the magnitude of increase varying by type of disability. Strategies to mitigate cancer disparities and financial hardship should take into account of the patients’ disability profiles.

Expected Cost Savings From Low-Dose Computed Tomography Scan Screening for Lung Cancer in Alberta, Canada

IntroductionThe expensive modern therapeutic regimens for advanced lung cancer (LC) stages have been recently approved. We evaluated whether low-dose computed tomography (LDCT) LC screening of high-risk Albertans is cost saving. MethodsWe used a decision analytical modeling technique with a health system perspective and a time horizon of 3 years to compare benefits associated with reduced health service utilization (HSU) from earlier diagnosis to the costs of screening. Using patient-level data, HSU costs by stage of disease were estimated for patients with LC, including inpatient, outpatient, and physician services, and costs for prescription drugs and cancer treatments. ResultsOf 101,000 people aged 55 to 74 years eligible for screening, an estimated 88,476 scans would be performed in Alberta in 3 years. Given LDCT sensitivity and specificity of 90.5% and 93.1%, respectively, we estimated that a stage shift toward earlier diagnosis would be expected whereby 43% more patients would be identified at stage 1 or 2 as compared with without screening. The estimated cost of screening is $35.6 million (M), whereas the stage shift associated with screening would avoid $42M in HSU costs. The net cost avoidance associated with screening is therefore $6.65M. The probability for the screening to be cost saving is estimated at 72%. ConclusionsThis study has revealed that LDCT LC screening is likely to be cost saving in Alberta. Adoption of this program into the provincial health care system is worth considering provided constraints in the system related to surgical capacity and CT wait times could be addressed.

Health services utilization and cost of abusive head trauma in Taiwan: A population-based retrospective matched cohort study

BackgroundAbusive head trauma (AHT) is a serious health problem that results the highest mortality among children who are maltreated. Many AHT survivors suffer from long-term sequelae and require medical treatment. However, the knowledge of AHT-attributable health services utilization and costs at national level are limited. ObjectiveTo estimate health services utilization and costs attributable to AHT among children aged 0–4 years in Taiwan. Participants and settingSixty-three fatal and 664 survival AHT cases were identified using Taiwan national population database between 2003 and 2015. A total of 2656 non-AHT children were exactly 4:1 matched to the survival cases based on their birth year, gender, the calendar year of the index date, insured location, and health insurance premium (social economic status indicator). MethodsHealth services utilization and costs were calculated on an annual basis for 3 years after the index date. AHT-attributable health services utilization and costs during 3-year follow-up period was evaluated by regression models. ResultsAHT diagnosis was positively associated with inpatient admissions, length of stay, emergency room (ER) visits, and outpatient visits. AHT-attributable medical costs were 1.64–17.27 times, 1.25–5.22 times, and 1.77–2.36 times greater for inpatient, ER, and outpatient during 3-year period than matched controls, respectively. Fatal AHT cases had higher inpatient utilization and greater medical costs than AHT survivors. ConclusionsChildren with AHT had greater health services utilization and higher costs for years. Strategies to reduce the burden of AHT on health care system are imperative.

Health Service Utilization Pattern and Costs Incurred by People Living with HIV/AIDS at the Nkambe District Hospital, Cameroon

Purpose: Even though ART services in Cameroon are highly subsidized, people living with HIV/AIDS still incur a non-ART drug cost. This piece of paper is aimed at investigating the health service utilization pattern and the outpatient and inpatient costs incurred by people living with HIV/AIDS in the Nkambe District Hospital.&#x0D; Methodology: A single facility-based cross-sectional survey was conducted between February and June 2018 at Nkambe District Hospital. A micro-costing analysis was used to determine the direct and indirect cost of treatment and access. Data were collected using an administered questionnaire and secondary data from patients’ files, analyzed using a one-way analysis of variance (ANOVA). A convenient and purposive sample of 346 participants were enrolled (281 outpatients and 65 inpatients).&#x0D; Results: Result shows that, majority of participants (97.5%) were in their follow up visit. 83.3% had been on ART for more than 1year, while more than half (59.5%) visited the hospital every after 3months for ART refilled. 80% of admitted cases were admitted for the first time. An average direct cost of treatment access was 2108.89FCFA ($3.47) for outpatient and 30414.31FCFA ($54.12) for inpatient, giving an annual average cost of 8435.56FCFA ($15) and 121657.24 FCFA ($216.5), respectively.&#x0D; Conclusion: This work concluded that the of ART services is not sufficient to eliminate the economic burden of treatment on HIV patients.&#x0D; Recommendations: Implementing effective community dispensation of ARVs and other differentiated care models like multi-month scripting and home dispensations well as creating more HIV treatment centers is vital. Also, implementation of a user fee policy for other HIV services. Finally, accelerating the process of universal health coverage in Cameroon will go a long way to help HIV patients and their households.

A162 CHRONIC OPIOID THERAPY IS ASSOCIATED WITH INCREASED HEALTH SERVICES UTILIZATION AND DIRECT HEALTHCARE COSTS: A POPULATION-BASED STUDY

BackgroundOpioid use is more common among people living with Inflammatory bowel disease (IBD).AimsInvestigate the associations between receiving chronic opioid therapy and health services utilization and direct healthcare costs among IBD patients receiving chronic opioid therapy.MethodsWe identified prevalent cases of IBD in Ontario (7/2012–3/2017) from population-based health administrative data using previously validated algorithms. Patients with ongoing opioid use for >90 days (chronic opioid recipients) were matched based on age, sex, IBD type, and disease duration with up to 5 IBD patients with no period of chronic opioid use. For the year after becoming a chronic opioid recipient (i.e., from the 91st day of chronic opioid therapy), we determined: 1) the mean (SD) number of IBD-specific, IBD-related, and all-cause outpatient visits, emergency department (ED) visits, and hospitalizations; and 2) total, hospitalization, ED, and outpatient healthcare costs. IBD-specific visits had a diagnostic code for Crohn’s disease or ulcerative colitis; IBD-related visits additionally included diagnostic codes for signs, symptoms, and extra-intestinal manifestations of IBD. Patients were censored at the time of a new cancer diagnosis or upon initiation of palliative care. We used Poisson models to compare the number of healthcare encounters in chronic opioid recipients and patients with no period of chronic opioid therapy then used generalized linear models with a gamma distribution and log-link to compare direct healthcare costs in the two groups. Regression models accounted for matching and were adjusted for income, rural/urban household, and comorbidities (resource intensity using the John Hopkins ACG Index).ResultsWe identified 9913 IBD patients with at least one period of chronic opioid therapy matched to 44,274 without chronic opioid therapy (mean 43 y at chronic opioid use, 43% male, 58% Crohn’s). Patients receiving chronic opioid therapy had significantly more health care encounters (Figure A). Annual per capita total health care cost among chronic opioid recipients was $13,452 (SD 33,777) compared to $5140 (SD 28,999) among patients with no chronic opioid therapy (Figure B). After adjustment, healthcare costs were approximately double in chronic opioid recipients and was consistent for all cost types (overall, hospitalization, ED, and outpatient).ConclusionsIBD patients who were chronic opioid users had significantly more health services utilization and direct healthcare costs compared to patients without periods of chronic opioid use. These associations persisted after adjusting for the resource intensity of any co-occurring conditions. Health services utilization (A) and direct healthcare costs (B) among people with inflammatory bowel disease (IBD) who are chronic opioid users compared to those without a period of chronic opioid use.Funding AgenciesAmerican College of Gastroenterology

A cross-sectional study on the quality of life in migraine and medication overuse headache in a Hungarian sample: understanding the effect of headache characteristics.

Previous studies using generic and disease specific instruments showed that both migraine and medication overuse headache are associated with lower health-related quality of life (HRQoL). The aim of our study was to assess HRQoL differences in migraineurs and in patients with MOH and to examine how headache characteristics such as years with headache, aura symptoms, triptan use, headache pain severity and headache frequency are related to HRQoL. In this cross-sectional study 334 participants were examined (248 were recruited from a tertiary headache centre and 86 via advertisements). The Comp-rehensive Headache-related Quality of life Questionnaire (CHQQ) was used to measure the participants' HRQoL. Data showed normal distribution, therefore beside Chi-squared test parametric tests (e.g. independent samples t-test) were used with a two-tailed p<0.05 threshold. Linear regression models were used to determine the independent effects of sex, age, recruitment method, headache type (migraine vs. MOH) and headache characteristics (presence of aura symptoms, years with headache, headache pain severity, headache frequency and triptan use) separately for each domain and for the total score of CHQQ. Significance threshold was adopted to p0.0125 (0.05/4) to correct for multiple testing and avoid Type I error. Independent samples t-tests showed that patients with MOH had significantly lower scores on all CHQQ domains than migraineurs, except on the social subscale. Results of a series of regression analyses showed that triptan use was inversely related to all the domains of HRQoL after correction for multiple testing (p<0.0125). In addition, headache pain severity was associated with lower physical (p=0.001) and total scores (p=0.002) on CHQQ subscales. Based on the results, different headache characteristics (but not the headache type, namely migraine or MOH) were associated with lower levels of HRQoL in patients with headache. Determining which factors play significant role in the deterioration of HRQoL is important to adequately manage different patient populations and to guide public health policies regarding health service utilization and health-care costs.

Wisconsin healthcare utilization cost among American Indians/Alaskan Natives with and without ADRD

AbstractBackgroundThe annual cost of Alzheimer’s disease and related dementias (ADRD) in the US is $355 billion; that rate is expected to triple by 2050. Individuals ADRD accrue higher healthcare utilization costs than peers without ADRD, including those with comorbid conditions (e.g., cancer, coronary artery disease, diabetes). Although research examining prevalence of ADRD in American Indians/Alaskan Natives (AI/AN) is limited, recent data suggest the prevalence of ADRD in the AI/AN population is 49% higher than in the Non‐Hispanic White population. Only one study has evaluated the healthcare utilization of AI/ANs, which showed greater utilization rates among those with (versus without) ADRD diagnosis and a rapid increase in utilization following ADRD diagnosis. We have yet to comprehensively analyze the additive cost of ADRD within the US among AI/ANs.MethodPost‐paid electronic health record data from Wisconsin Department of Health Services were retrospectively analyzed to compare non‐Tribal and Indian Health Service utilization costs among Medicaid enrolled AI/ANs, ages 40 and older, based on the presence or absence of ADRD throughout data review (7/1/2015 through 7/1/2020). Three separate analyses were completed, separated by payer programs: fee‐for‐service, HMO, and long‐term care. In each analysis, controls (individuals without ADRD) were matched to cases (individuals with ADRD) using exact matching across the subclasses defined by crossings of age group, sex, diabetes status, and emphysema status (Tables 1‐3). Weighted Wilcoxon rank sum tests were then used to compare total payable costs per capita. Tests accounted for both the subclass sampling strata and weights produced through the matching process. Weighted Chi‐square tests of association were also employed to confirm balance was achieved across age groups, sex, diabetes status, and emphysema status in the matching process; no weighted imbalances occurred.ResultAmong all three programs, AI/ANs with dementia had significantly higher healthcare utilization costs than those without dementia, after matching for age, gender, diabetes and emphysema status.ConclusionAI/ANs with ADRD accrued at $25,000 more over 5 years, on average, compared to those without ADRD. The greatest cost disparity was in long‐term care waiver programs ($50,879). Cost‐effective interventions aimed at ADRD prevention and treatment among AI/ANs are greatly needed.

Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs.

The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood. To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions. Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs. Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively). Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.

Linguistic and cultural barriers to access and utilization of mental health care for Farsi-speaking newcomers in Quebec

Purpose In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations. Design/methodology/approach In this qualitative study, semi-structured individual interviews with Farsi-speaking health professionals and focus group interviews with participants from community organizations in Quebec were conducted. Findings Participants, both health-care professionals and community members, reported that mental health services are not readily accessible to Farsi-speaking immigrants and refugees. Structural barriers, language barriers, cultural safety and stigma were identified as obstacles to accessing care. Recommended strategies for improving access to mental health care are discussed. Originality/value Multiple studies have found that language and cultural barriers are associated with health inequalities and under-utilization of mental health services among linguistic and ethnic minorities. However, there are limited data on many groups and contexts, and a need to better understand how language barriers affect health outcomes, service utilization, patient satisfaction or overall costs to the health system or to society. In response to this gap, the present study explores how access to mental health services for Farsi-speaking newcomers may be limited by structural and linguistic barriers and cultural differences and as well as to identify strategies that can reduce the identified barriers.

Loneliness and its association with health service utilization in people with a psychotic disorder

BackgroundLoneliness is common in people with psychotic disorders and associated with reduced health and well-being. The relationship between loneliness in psychosis and health service use is unclear. This study examined whether loneliness predicts increased health care utilization in this population, independently of sociodemographics, health and functioning. MethodsWe used cross-sectional data from the Second Australian National Survey of Psychosis. Loneliness was assessed using a single-item question, rated on a 4-point scale (not lonely; lonely occasionally; some friends but lonely for company; socially isolated and lonely). Health service use (past 12-months) was measured by the number of general practitioner (GP), emergency department (ED) and outpatient visits, inpatient admissions, and home visits by mental health professionals. Frequent hospital users comprised those in the top 15% of users of at least two services. ResultsNegative binomial regression analysis showed that loneliness was associated with an increased number of GP visits, ED visits and inpatient admissions, only. Socially isolated and lonely survey participants were more than twice as likely (OR = 2.6) of being ‘frequent users’ compared to non-lonely responders. Following stringent adjustment for covariates, loneliness remained significantly associated with being a ‘frequent user’ and showed a non-significant trend to an increased number of GP visits and inpatient admissions. ConclusionsLoneliness is a complex social and personal problem for people with psychosis, related to greater use of some health services. Better strategies for identifying and responding to loneliness in this population have the potential to increase well-being and contain health service utilization costs.

Lifetime Costs of Surviving Cancer-A Queensland Study (COS-Q): Protocol of a Large Healthcare Data Linkage Study.

Australia-wide, there are currently more than one million cancer survivors. There are over 32 million world-wide. A trend of increasing cancer incidence, medical innovations and extended survival places growing pressure on healthcare systems to manage the ongoing and late effects of cancer treatment. There are no published studies of the long-term health service use and cost of cancer survivorship on a population basis in Australia. All residents of the state of Queensland, Australia, diagnosed with a first primary malignancy from 1997–2015 formed the cohort of interest. State and national healthcare databases are linked with cancer registry records to capture all health service utilization and healthcare costs for 20 years (or death, if this occurs first), starting from the date of cancer diagnosis, including hospital admissions, emergency presentations, healthcare costing data, Medicare services and pharmaceuticals. Data analyses include regression and economic modeling. We capture the whole journey of health service contact and estimate long-term costs of all cancer patients diagnosed and treated in Queensland by linking routinely collected state and national healthcare data. Our results may improve the understanding of lifetime health effects faced by cancer survivors and estimate related healthcare costs. Research outcomes may inform policy and facilitate future planning for the allocation of healthcare resources according to the burden of disease.

Association Between Work Absence and Health Services Utilization and Costs Among Employed Individuals With Arthritis.

To evaluate whether work absence is associated with increased health services utilization and health care costs among employed individuals with arthritis. This was a retrospective cross-sectional study using pooled data from the 2011 to 2015 Medical Expenditure Panel Survey (MEPS). Employed individuals with arthritis were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes and Clinical Classification code. Generalized linear models were used to analyze utilization and costs outcomes. Individuals with arthritis who reported work absences had greater odds of having a hospitalization event (odds ratio [OR]: 9.198, P < 0.001), higher number of ambulatory care visits (β = 0.549, P < 0.001), and had higher total health care costs (β = 0.40, P < 0.001) and arthritis-related costs (β = 0.035, P < 0.0002) compared with individuals without work absences. Among employed individuals with arthritis, self-reported work absence is associated with significantly higher health care utilization and health care costs.

Telerehabilitation services for stroke.

Background Telerehabilitation is an alternative way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face. Objectives To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self care and domestic life and improved mobility, health-related quality of life, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions. Search methods We searched the Cochrane Stroke Group Trials Register (November 2012), the Cochrane Effective Practice and Organization of Care Group Trials Register (November 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 11, 2012), MEDLINE (1950 to November 2012), EMBASE (1980 to November 2012) and eight additional databases. We searched trial registries, conference proceedings and reference lists. Selection criteria Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation. Data collection and analysis Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information. Main results We included in the review 10 trials involving a total of 933 participants. The studies were generally small, and reporting quality was often inadequate, particularly in relation to blinding of outcome assessors and concealment of allocation. Selective outcome reporting was apparent in several studies. Study interventions and comparisons varied, meaning that in most cases, it was inappropriate to pool studies. Intervention approaches included upper limb training, lower limb and mobility retraining, case management and caregiver support. Most studies were conducted with people in the chronic phase following stroke. Primary outcome: no statistically significant results for independence in activities of daily living (based on two studies with 661 participants) were noted when a case management intervention was evaluated. Secondary outcomes: no statistically significant results for upper limb function (based on two studies with 46 participants) were observed when a computer programme was used to remotely retrain upper limb function. Evidence was insufficient to draw conclusions on the effects of the intervention on mobility, health-related quality of life or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation. No studies reported on the occurrence of adverse events within the studies. Authors' conclusions We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach.

Protocol for a longitudinal study of melatonin therapy and cost effectiveness analysis in stimulant-treated children with ADHD and insomnia: An N-of-1 trial

BackgroundChildren with ADHD and sleep problems have more caregiver deficits and decreased school attendance than children with ADHD but without a sleep problem. We conducted an N-of-1 trial of melatonin for children with ADHD on stimulants. As a follow-up study, we aim to conduct a cost effectiveness analysis (CEA) of melatonin therapy by comparing costs of this condition (of using melatonin) to costs of the baseline condition (usual care with no N-of-1 trial). MethodsThe CEA will compare participants who remained on melatonin vs those who chose to cease melatonin. Costs will be determined by medication cost to the caregiver(s), school/work absences, other sleep remedy costs, and health service utilization costs, including incidentals like parking. These costs will be determined at baseline, end of 6-week trial, and 6 months post-trial. We will also calculate Quality-Adjusted Life-Years (QALY) based on responses to PedsQL or SF-12v2 for patients and caregiver(s) and assess differences between remaining on melatonin or not; and assess the intermediate-term effectiveness and adverse effects of melatonin at 6 months. DiscussionWe hypothesize that shorter sleep-onset-latency will be associated with improved QALYs for patients and caregivers. We also expect that targeting melatonin to positive responders will be cost effective both for individuals and society. Cost per QALY for positive responders to melatonin is useful for doctors when creating treatment plans since melatonin is not an over-the-counter pharmaceutical in Australia. Trial registration numberACTRN12614000542695.