Differences In Utilization Of Health Care Services Research Articles

Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

BackgroundPatients with polypharmacy suffer from complex medical conditions involving a large healthcare burden. This study aimed to describe the characteristics and utilization of primary care (PC) and hospital care (HC) and factors associated in chronic patients with polypharmacy, stratifying by adjusted morbidity groups (AMG) risk level, sex and age, and comparing with non-polypharmacy.MethodsCross-sectional study conducted in a Spanish basic healthcare area. Studied patients were those over 18 years with chronic diseases identified by the AMG tool from Madrid electronic clinical record, which was the data source. Sociodemographic, sociofunctional, clinical and healthcare utilization variables were described and compared by risk level, sex, age and having or not polypharmacy. Factors associated with healthcare utilization in polypharmacy patients were determined by a negative binomial regression model.ResultsIn the area studied, 61.3% patients had chronic diseases, of which 16.9% had polypharmacy vs. 83.1% without polypharmacy. Patients with polypharmacy (vs. non-polypharmacy) mean age was 82.7 (vs. 52.7), 68.9% (vs. 60.7%) were women, and 22.0% (vs. 1.2%) high risk. Their average number of chronic diseases was 4.8 (vs. 2.2), and 95.6% (vs. 56.9%) had multimorbidity. Their mean number of annual healthcare contacts was 30.3 (vs. 10.5), 25.9 (vs. 8.8) with PC and 4.4 (vs. 1.7) with HC. Factors associated with a greater PC utilization in patients with polypharmacy were elevated complexity, high risk level and dysrhythmia. Variables associated with a higher HC utilization were also increased complexity and high risk, in addition to male sex, being in palliative care, having a primary caregiver, suffering from neoplasia (specifically lymphoma or leukaemia) and arthritis, whereas older age and immobilization were negatively associated.ConclusionsPolypharmacy population compared to non-polypharmacy was characterized by a more advanced age, predominance of women, high-risk, complexity, numerous comorbidities, dependency and remarkable healthcare utilization. These findings could help healthcare policy makers to optimize the distribution of resources and professionals within PC and HC systems, aiming for the improvement of polypharmacy management and rational use of medicines while reducing costs attributed to healthcare utilization by these patients.

Differences in healthcare service utilization between older adults with and without dementia: a cross-sectional study in Shandong, China

Abstract Aim Dementia is characterized by a decline in cognitive functioning and is the main cause of disability, mortality, and care dependence among older adults. This study compared healthcare utilization in older adults with and without dementia and explored factors influencing service use in the former. Subject and methods A total of 8847 seniors (≥ 60 years) were chosen from the Health Service Survey of Shandong Province conducted in 2018. The chi-square test was used for baseline characteristics and healthcare utilization for older adults with and without dementia. Multivariate logistic regression analysed service utilization factors. Results Of the respondents, 261 (3.0%) had dementia. The proportions of respondents who used outpatient care and inpatient care were 40.6% and 76.9%, respectively. The rates of outpatient and inpatient care use among seniors with dementia were slightly higher than those among seniors without dementia (44.8% vs 40.5% and 80.8% vs 76.7%, respectively). Older adults with dementia who were married and had experienced non-communicable diseases within the past 6 months were less likely to use outpatient care. No factors associated with the utilization of inpatient care were found. Conclusion Health publicity and a combination of community care and medical assistance targeting older adults with dementia is essential to increase healthcare service utilization.

Age Cohort and Health Service Utilization Among Gay Men.

Gay men report unique health disparities and service utilization trends compared to their heterosexual peers including a lack of health-care participation which may lead to chronic health conditions. Limited research has been conducted analyzing group differences among gay men such as the influence of one’s age cohort on disparities. The aim of this study was to examine the association age cohort has on health service utilization among gay men. A sample of 383 self-identified gay men was collected by the San Francisco Department of Public Health. Older men were less likely to have visited a medical provider in the past 12 months compared to middle-aged men (OR = 0.10; 95% CI [2.47, 39.8]) and younger men (OR = 0.35; 95% CI [1.28, 10.42]). However, older men were more likely to have a usual source of medical care compared to younger men (OR = 4.0; 95% CI [.05, .84]). Age cohort differences in health-care service utilization appear to exist among gay men. This study highlights additional areas for exploration including the impact HIV and socioeconomic status have on health-seeking behavior and health service utilization.

Migrants´ Healthcare Utilization in Europe: A Comprehensive Review of Emergency Room Utilization and Hospitalization

There is an increasing number of migrants living in European. The increasing percentage of migrant population requires the assessment of their health needs and health service utilization to allow potential to guide appropriate programs and policies. This study aims to analyze the differences in healthcare service utilization, particularly regarding emergency room contacts and hospital admissions, by first-generation migrants compared to native residents in European countries in the last decade. Original publications in English language were identified by a systematic PubMed search. Their relevance was judged based on the abstracts, whereas further searches were guided by the references of the selected articles. We considered studies conducted in the EU countries and published in the last ten years, investigating emergency use and hospitalization rates in adult first-generation migrants. We excluded studies focusing on illegal migrants and asylum seekers or on a single gender. The final number of studies included was ten. The results of our study highlighted a lack of data regarding migrant healthcare utilization in Europe. Furthermore, our review underlines the yet unresolved problems of comparability between studies, due to discrepancies in terminology and registration between countries as well as over time. The studies considered in this review have found higher, equal and lower emergency room use and higher or equal hospitalization rates for migrants compared to non-migrants.

Healthcare utilization and costs in patients with benign prostatic hyperplasia: a population-based study.

This study aimed to investigate differences in healthcare service utilization between patients with and those without benign prostatic hyperplasia (BPH) using Taiwan's National Health Insurance population-based database. A total of 7413 patients with BPH and 7413 age-matched patients without BPH were included. The outcome variable was 1-year utilization of healthcare services including the number of outpatient visits, inpatient days, and the costs of outpatient and inpatient treatments. In addition, we separated healthcare services into urology services and nonurology services for analysis. We found that as to the utilization of outpatient urological services, patients with BPH had more outpatient services (7.84 vs 0.52, P < 0.001), higher outpatient costs (US$372 vs US$34, P < 0.001), a longer length of inpatient stay (0.55 vs 0.11, P < 0.001), higher in-patients costs (US$149 vs US$32, P < 0.001), and higher total costs (US$521 vs US$67, P < 0.001) than the comparison group. As for nonurological services, patients with BPH also had more outpatient services (49.11 vs 24.79, P < 0.001), higher outpatient costs (US$1794 vs US$1014, P < 0.001), a longer length of in-patient stay (3.72 vs 2.04, P < 0.001), higher inpatient costs (US$874 vs US$486, P < 0.001), and higher total costs (US$2668 vs US$1500, P < 0.001) compared to comparison patients. We also found that the average total cost was about 2-fold greater for patients with BPH than comparison patients. We concluded that patients with BPH had higher healthcare utilization than comparison patients without BPH.

Healthcare Service Utilization by Patients with Obstructive Sleep Apnea: A Population-Based Study.

ObjectiveAlthough obstructive sleep apnea (OSA) is not a life-threatening disease, very few studies have compared differences in healthcare service utilization between patients with and those without OSA in an Asian population according to different age groups. This study attempted to investigate differences in healthcare service utilization between patients with and those without OSA in different age groups in Taiwan.MethodsSampled subjects and data on their health service utilization were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included 568 patients with OSA and 2840 subjects without OSA. Each subject was followed for a 1-year period to evaluate their healthcare resource utilization. Wilcoxon-Mann-Whitney tests were performed to compare differences in healthcare utilization between patients with and those without OSA during the 1-year follow-up period.ResultsAs to all healthcare service utilization, patients with OSA had significantly more outpatient visits (30.3 vs. 18.6), outpatient costs (US$1231.2 vs. US$764.8), inpatient days (1.8 vs. 1.2), inpatient costs (US$563.6 vs. US$276.7), and total costs (US$1794.8 vs. US$1041.5) than comparison subjects during the 1-year follow-up period. Moreover, patients with OSA aged 40~49 and 50~59 years respectively incurred 2.11- and 2.02-fold higher total costs compared to patients without OSA. However, patients with OSA aged over 70 years did not have higher total costs compared to those without OSA.ConclusionsThis study found that patients with OSA had greater healthcare service utilization than those without OSA. Additionally, patients with OSA in the 40~49- and 50~59-year age groups had about 2-fold higher total costs of healthcare services than those without OSA.