Health Care Utilization Emergency Research Articles

Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes.

The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes. This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates. Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models. The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.

Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial

BackgroundHealth coaching services could help to reduce emergency healthcare utilisation for patients targeted proactively by a clinical prediction model (CPM) predicting patient likelihood of future hospitalisations. Such interventions are designed...

Sociodemographic disparities and healthcare utilization in pediatric obstructive sleep apnea management

ObjectivesWe examined (1) disparities in obstructive sleep apnea (OSA) care by insurance coverage, and by child race and ethnicity among Medicaid-insured children (MIC), and (2) healthcare utilization changes after OSA care. MethodsIBM MarketScan insurance claims were used to index OSA care 1-year before and after initial OSA diagnosis in 2017 among 2-17-year-old children (n = 31,787, MIC: 59%). OSA care and healthcare utilization analyses adjusted for child age, sex, obesity, and complex chronic conditions. ResultsWe identified 8 OSA care pathways, including no care, which occurred in 34.4% of the overall sample. MIC had 13% higher odds of no OSA care compared to commercially-insured children (CIC). MIC had 32–48% lower odds of any treatment pathway involving specialty care, but a 13–46% higher likelihood of receiving surgical care without polysomnogram (PSG) and PSG only. In MIC, non-Latinx Black/African American (Black) and Hispanic/Latinx children were 1.3–2.2 times more likely than White children to receive treatment involving specialty care and/or PSG, while Black children were 31% less likely than White youth to undergo surgery. In the full sample, surgical care was associated with less outpatient and emergency healthcare utilization compared to those untreated or not surgically treated. ConclusionsVaried OSA management by insurance coverage suggests disparities in access to and engagement in care and potentially greater disease burden among MIC. Surgical care is associated with reduced healthcare utilization. The lower odds of surgery in Black MIC should be further evaluated in the context of OSA severity, healthcare biases, and family preferences.

Electronic collection of cancer patient-reported outcomes using a novel digital oncology platform: A multi-site randomized controlled trial.

TPS1614 Background: Cancer is the leading contributor of disease burden worldwide, and incidence rates are estimated to rise 47% by 2040. With increasing numbers of people living with cancer, alongside healthcare workforce shortages, current models for cancer monitoring and surveillance are unsustainable. Within the UK’s National Health Service (NHS), this is exacerbated by a rising backlog following the COVID-19 pandemic. Furthermore, a 2020 Macmillan Cancer Support survey showed that current patient information and support is scattered, inaccessible, and poorly personalized. There is an urgent need for effective personalized tools to support cancer patient self-management and data collection to enable healthcare professional (HCP) monitoring and remote follow-up. Methods: A multi-site randomized controlled trial is underway within the NHS to evaluate the implementation of a novel digital oncology platform (Vinehealth) for personalized support. Vinehealth consists of a mobile patient application, integrated wearables data, and a clinician dashboard. The study aims to recruit 180 patients across 8 NHS Trusts diagnosed with (i) colorectal, breast, or lung cancer undergoing adjuvant systemic treatment (chemotherapy +/- targeted therapies) post surgery, or (ii) asymptomatic breast cancer undergoing neoadjuvant treatment. A power calculation was conducted relating to the primary objective demonstrating the efficacy in improvement of QoL in the interventional arm, providing 80% power and at a significance level of 0.05. Enrolled patients will be randomized (1:1) between standard of care (SoC) and interventional arms (SoC plus Vinehealth platform). The main objective is to assess if implementation of Vinehealth improves patients’ quality of life (QoL) compared to SoC based on EQ-5D-5L, EORTC QLQ-C30, and FACT-G (PWB) questionnaires. Secondary objectives include assessing patient compliance with electronic patient-reported outcome (ePRO) data collection and patient self-management of symptoms. The study will further evaluate whether Vinehealth improves the process of care (assessed through medication adherence) and reduces emergency healthcare utilization (including ED/GP visits/admissions and acute oncology hotline use). Questionnaires are completed by all patients at baseline, 6, 12, 18 and 24 weeks. Qualitative interviews will be conducted with a subset of interventional arm patients and HCPs from each NHS Trust to understand engagement with the Vinehealth platform. To our knowledge, this is the first multi-site RCT within the NHS to evaluate the impact of a digital oncology platform on cancer patients’ QoL, ePRO compliance, process of care, and healthcare utilization. The trial is expected to end by September 2023 with results being reported in January 2024. Clinical trial information: ISRCTN44293246 .

An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial

Perinatal anxiety is one of the most common conditions during pregnancy and is associated with adverse maternal and neonatal outcomes. Interventions that are focused on childbirth education and health literacy have been shown to help decrease pregnancy-related anxiety. These programs, however, have limitations. Transportation, childcare, and work conflicts pose barriers to patients. In addition, many of these programs have not been studied in high-risk patients, who are most at risk for pregnancy-related anxiety. Thus, it is uncertain whether an online childbirth education course can help to improve outcomes in a high-risk patient population. This study aimed to compare an interactive online platform for childbirth education (Birthly) with usual prenatal education on anxiety, emergency healthcare utilization, and delivery outcomes for high-risk pregnancies. We performed a randomized trial comparing an interactive online childbirth education platform combined with usual prenatal education (intervention) with usual prenatal education alone (usual care). Nulliparous, English-speaking patients with internet access and a high-risk pregnancy (medical or mental health disorders) were included. Patients in 2 urban clinics that serve underresourced patients were enrolled at <20 weeks of gestation. The intervention included 3 interactive courses (prenatal bootcamp, breastfeeding, newborn care) and access to a clinician-moderated online community. Pregnancy-related Anxiety Scale questionnaires were administered at randomization and at 34 to 40 weeks. The primary outcome was third-trimester Pregnancy-related Anxiety Scale score. Secondary outcomes included change in Pregnancy-related Anxiety Scale score, unscheduled emergency visits, delivery, and postpartum outcomes. To demonstrate a 15% decrease in Pregnancy-related Anxiety Scale score, 37 patients would be needed per group. Accounting for a 20% loss to follow-up rate, we planned to recruit 90 total patients or 45 per group. A total of 90 patients were randomized with no differences in demographics or baseline Pregnancy-related Anxiety Scale scores. Most patients self-identified as Black and were publicly insured. More than 60% of patients (62.2%) in the intervention arm completed at least 1 Birthly course. Patients in the intervention arm had significantly lower third-trimester Pregnancy-related Anxiety Scale scores (indicating lower anxiety) compared with those receiving usual care (44.6±7.3 vs 53.9±13.8; P<.01), with a decrease in score of 8.3 points vs 0.7 for usual care (P<.01). Patients in the intervention arm also had fewer emergency visits (1 [0-2] vs 2 [1-3]; P=.003). There were no differences in delivery outcomes. Patients in the intervention arm were more likely to breastfeed at delivery, although this was not different by the postpartum visit. Finally, patients who received the intervention were more likely to be satisfied with their childbirth education (94.6% vs 64.9%; P<.01). An interactive online childbirth education platform can reduce pregnancy-related anxiety and emergency healthcare utilization while improving satisfaction in a high-risk patient population.

Comparing Behavioral Health Outcomes and Treatment Utilization of Those With and Without Justice Involvement Within the Past Year Among American Indian and Alaska Native Adults.

Similar to other populations, worse health, increased emergency healthcare utilization, and heightened substance misuse are correlated with higher justice involvement among American Indian/Alaska Native (AI/AN) populations. The historical context and resulting contemporary injustices for AI/AN populations have directly contributed to higher rates of these health and behavioral health conditions among this population. As a result, AI/AN individuals have disproportionate rates of incarceration in the USA, with young AI/AN males having the highest odds of incarceration when compared to any other group. American Indian and Alaska Native populations are overrepresented in the criminal justice system across different touchpoints. However, there remains a scarcity of data and research on AI/AN peoples' involvement with the justice system, and what their lives look like prior to, during, and after justice involvement. The current study addresses this gap in the literature by exploring rates of substance use and mental health diagnoses and treatment utilization among justice-involved and non-justice-involved AI/AN samples. Further, we examined correlates associated with past-year service utilization. Data from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 adults aged 18+) was used. For this study, we examined a subsample of 3068 AI/AN adults. Quantitative data analyses using STATA 16 were run to test for differences on service utilization, mental health status, and substance misuse between AI/AN non-justice-involved and justice-involved samples. Among adults in the sample, 446 (15%) reported justice involvement in the past year. Justice-involved AI/AN individuals were significantly more likely to use the emergency department, utilize mental health treatment, and access substance use treatment in the past year. Additionally, justice-involved AI/AN individuals reported significantly higher rates of mental illness and past-year substance use disorder. In regression models, justice involvement was significantly associated with past-year substance use treatment and past-year mental health treatment. The findings from this work highlight the differences among substance use, mental illness, and treatment utilization between justice-involved and non-justice-involved AI/AN individuals. Findings suggest that justice-involved individuals fair worse in all areas and argue for the consideration of interventions that incorporate both culturally sensitive and justice-responsive models to improve the behavioral health outcomes of these populations. Lastly, while justice-involved AI/AN populations utilize treatment services at higher and disproportionate levels, there is reason to believe that there continues to be a mismatch of need and utilization and further exploration is warranted.

A randomized trial of an interactive childbirth education platform in a high-risk population

To compare an interactive online platform for childbirth education (Birthly), to usual prenatal education on anxiety, emergency healthcare utilization, and delivery outcomes for high-risk pregnancies. We performed a randomized trial comparing an interactive online childbirth education platform along with usual prenatal education (intervention) to usual prenatal education alone. Nulliparous, English-speaking patients with internet access and a high-risk pregnancy (medical or mental health disorders) were included. Patients in 2 urban clinics that serve under-resourced patients were enrolled at < 20 wks. The intervention included 3 interactive courses (prenatal bootcamp, breastfeeding, newborn care) and access to a clinician-moderated online community. Pregnancy-related Anxiety Scale (PrAS) questionnaires were administered at randomization and at 34-40 wks. The primary outcome was 3rd trimester PrAS score. Secondary outcomes included change in PrAS score, unscheduled emergency visits, delivery and postpartum outcomes 90 patients were randomized with no differences in demographics or baseline PrAS scores (Table 1). The majority of patients self-identified as Black and were publicly insured. Patients in the intervention arm had significantly lower third trimester PrAS scores (indicating lower anxiety) compared to usual care, 44.6 ± 7.3 vs. 53.9 ± 13.8, p< 0.01 (Table 2), with a decrease in PrAS score of 8.3 points (intervention) vs. 0.7 (usual care), p< 0.01. Patients in the intervention arm also had fewer emergency visits (1[0-2] vs. 2[1-3], p=0.003; Table 2). There were no differences in delivery outcomes. Patients in the intervention arm were more likely to breastfeed at delivery, though this was not different by the postpartum visit. Finally, patients who received the intervention were more likely to be satisfied with their childbirth education (94.6% vs. 64.9%, p< 0.01). An interactive online childbirth education platform can reduce pregnancy-related anxiety and emergency healthcare utilization while improving satisfaction in a high-risk patient population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

CLOSE ASSOCIATIONS AMONG WORK PRODUCTIVITY, EMERGENCY HEALTHCARE USE AND INDIVIDUAL FACTORS IN EMPLOYEES WITH CHRONIC DISEASES

Aim: The aim of this study was to evaluate the relationships among work productivity, emergency healthcare use and individual factors in employees with chronic diseases by using mediation analysis. &#x0D; Methods and Results: In this cross-sectional study, 143 employees with chronic diseases were included. Data were collected by a questionnaire including healthcare utilization (emergency care and hospitalization), daily medication use, Work Productivity and Activity Impairment (WPAI) scale, State-Trait Anxiety Inventory (STAI) and “Fear of inability to carry out duties” in the study. In Mediation analyses performed to clarify the relationship between causal and outcome variables, Presenteeism score as an outcome variable was identified with the emergency care service in the direct path (P=0.0000). Increases in T-STAI score was found to be a mediator for the Presenteeism score in the indirect path (P=0.0001). &#x0D; Conclusions: Emergency healthcare utilization and increases in Trait-STAI scores were predictive factors for Presenteeism in employees with chronic diseases within limits of the study.

Healthcare utilization and health-related quality of life of severe asthma patients in Singapore

Background Notwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilization, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not been appraised. Objectives To determine the burden of disease and extent of quality of life impairment in SA patients in Singapore. Methods A cross-sectional analysis of SA patients seen in Singapore General Hospital (2020–2021) to investigate emergency healthcare utilization, oral corticosteroid (OCS) burden and health-related quality of life (HRQoL) with primary endpoint EuroQoL-5 Dimension three-level (EQ-5D-3L) scores. The empirical measurement properties of the EQ-5D utility index in SA were comprehensively assessed through multivariate regression analyses. Results A total of 336 SA patients were recruited, 51.2% of SA patients had at least one acute healthcare resource utilization during the previous year, with 25.6% of patients having an emergency healthcare visit to the hospital. Overall mean (SD) EQ-5D-3L and EQ-5D-3L utility scores in SA patients were 6.22 (1.51) and 0.77 (0.30), respectively. EQ-5D utility scores were 0.14 lower in uncontrolled vs controlled asthma and 0.09 lower in the presence of severe exacerbation, whereas barely changed by maintenance OCS dose and airflow limitation. Conclusion SA patients were found to have high disease burden, high healthcare resource utilization and OCS use, low biologics usage, poor HRQoL and utility in comparison with other chronic diseases.

The Impact of COVID-19 on Pediatric Healthcare Utilization and Disease Dynamics: An Observational Study From Western Odisha.

IntroductionChildren were affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus during the first and second waves of the coronavirus disease 2019 (COVID-19 pandemic. Although the severity was less in children, the fear of contracting SARS-CoV-2 at the hospital might have led to a delayed health-seeking attitude. The objective of the study was tailored around emergency health care utilization affecting outcomes. The study was done to compare the trend concerning the utilization of pediatric healthcare and immunization services, changes in the profile of diseases, and the outcomes between the pre-COVID-19 period and the COVID-19 period in a tertiary care hospital.MethodsThis retrospective observational study was conducted in a tertiary care hospital in western Odisha. Data were collected retrospectively from different hospital registers (outpatient register, inpatient register, and immunization records) and analyzed between the pre-COVID-19 period (April 2019 to March 2020) and the COVID-19 period (April 2020 to March 2021) with appropriate statistical procedures.ResultsThere was a 60%, 49.8%, 51.1%, and 25.5% reduction in outpatient attendance, indoor pediatric admissions, nutritional rehabilitation centre admissions, and newborn admissions, respectively in COVID-19 period as compared to the pre-COVID-19 period. The pediatric bed occupancy rate was reduced by 54.5%. Unfavourable outcomes (death, left against medical advice, and referral) were significantly high in hospitalized children (24% vs. 18.1%, p < 0.001). The reduction in hospitalization due to common conditions like acute respiratory tract infections, bronchiolitis and asthma, and acute gastroenteritis during COVID-19 was 76.5%, 86.2%, and 39.5%, respectively. A higher percentage of low birth weight and preterm (<34 weeks) babies were admitted to special neonatal care unit (SNCU) during the pandemic (61.8% vs. 58%, p < 0.05; 18.9% vs. 15.8%; p < 0.05 respectively).ConclusionThe COVID-19 pandemic and the associated lockdown led to a significant decrease in pediatric and neonatal healthcare utilization. The impact of lower care-seeking and attendance resulting in poor patient-related outcomes (malnutrition, upsurge of vaccine-preventable diseases, disease-specific hospitalization, and mortality) post-pandemic is a real threat.

Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States

ABSTRACT Objective To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. Methods The most recently available (years 2016–2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes-related complications, and total days absent from school or work change from baseline. Results 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes-related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes-related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. Conclusion Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes-related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.

27. Emergency Care Utilization for Mental and Sexual Health Concerns Among Adolescents Following Sexual Assault: A Retrospective Cohort Study

Sexual assault (SA) is a prevalent public health issue that involves the violation of human rights and has various short-term and long-term impacts on health. Adolescents and young adults have the highest rates of SA victimization of any age group. Adolescent survivors of SA often present to the pediatric Emergency Department (ED), where the care they receive may impact their future mental and physical health trajectories. This study aimed to explore the health outcomes of adolescent survivors of SA, as measured by their subsequent emergency healthcare utilization for mental and sexual health concerns following an initial visit for SA.

Pediatric emergency healthcare utilization during the coronavirus disease 2019 pandemic in Tokyo.

BackgroundVarious public health interventions have been implemented against the coronavirus disease 2019 pandemic. We investigated changes in pediatric emergency healthcare utilization during the current pandemic.MethodsBased on data on outpatient healthcare visits to one pediatric emergency department in Tokyo, Japan, the descriptive, cross‐sectional study compared the number of emergency department visits in 2020 to the number in the previous 3 years. Data were extracted from the electronic triage reporting system. The primary outcome was the number of emergency department visits. The characteristics of patients by age group were also investigated.ResultsA 40.6% reduction in pediatric emergency healthcare utilization was observed during the study period, with the greatest decrease occurring in the number of visits for fever. However, while the number of patients with a complaint with an exogenous cause decreased, the proportion of these patients increased. Although social activities in the greater community have now almost normalized, and only a slight increase in the number of patients with fever has been reported, the number of emergency department visits remains lower than in previous years as of this writing.ConclusionsPublic health interventions led to a reduction in emergency department visits, thereby allowing time to redistribute health‐care resources.

Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data.

ContextAdrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients.ObjectiveWe aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada.MethodsThis study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records, and visit reasons.ResultsThe period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3 to 4 times as frequent as the average Albertan, and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medications only.ConclusionThe prevalence of AI in Alberta is higher than published data in other locations. The frequency of visits suggests a significant healthcare burden and emphasizes the need for a strong understanding of this condition across all clinical settings. Our most concerning finding is that 94.3% of visits were not labeled with AI, even though many of the top presenting complaints were consistent with adrenal crisis. Several data limitations were discovered that suggest improvements in the standardization of data submission and coding can expand the yield of future studies using this method.

Impact of the COVID-19 pandemic on emergency healthcare utilization: a cohort study

BackgroundEmergency department (ED) crowding is a burden on public health, so understanding the characteristics of frequent ED users is a key concern of the healthcare system and policy makers. This study aims to examine the characteristics and healthcare-seeking behaviors in frequent ED users before and during the COVID-19 pandemic.MethodsA retrospective observational study was conducted on ED users aged 18 years and over admitted to Taipei City Hospital in February 2019-January2020 (before pandemic) and February 2020-January2021 (during pandemic) (N = 120,011). Frequent and ED users were defined as patients with four or more ED visits in a year. Multivariate logistic regression was used to identify the predictors of frequent ED use before and during the COVID-19 pandemic.ResultsMonthly emergency department visits were significantly lower during the pandemic (by 10.1-26.8%). Frequent ED patients had shorter lengths of stay in the ED during the pandemic (212.5 vs.233.9 minutes; P < 0.0001). The proportion of ED patients receiving chest CT examination during the pandemic has increased by 0.5-0.6%. After adjusting for sociodemographic factors, triage status, mode of arrival, and copayment exemption, patients with a triage status of level 4-5 (AOR=1.60, 95% CI: 1.13-2.28), diagnosis of pneumonia (AOR=1.85, 95% CI: 1.07-3.17), giddiness (AOR=2.85, 95% CI: 1.82-4.45), dyspnea (AOR=1.85, 95% CI: 1.00-3.39), or chronic kidney disease (AOR=5.05, 95% CI: 2.66-9.59) were more likely to be frequent ED visitors during the pandemic.ConclusionsSince SAR-CoV-2 is highly contagious, it is imperative to educate non-emergent patients to utilize outpatient medical services rather than emergency medical services to reduce the risk of COVID-19 outbreaks at the ED.Key messages This study found that the utilization of emergent medical services during the COVID-19 pandemic significantly decreased by 10.1%–26.8% compared to before the COVID-19 pandemic.The lengths of stay in frequent ED users during the COVID-19 pandemic were significantly shorter than that in frequent ED users before the COVID-19 pandemic.

Lived Experience of Emergency Health Care Utilization during the COVID-19 Pandemic: A Qualitative Study.

As the understanding of health care worker lived experience during coronavirus disease 2019 (COVID-19) grows, the experiences of those utilizing emergency health care services (EHS) during the pandemic are yet to be fully appreciated. The objective of this research was to explore lived experience of EHS utilization in Victoria, Australia during the COVID-19 pandemic from March 2020 through March 2021. An explorative qualitative design underpinned by a phenomenological approach was applied. Data were collected through semi-structured, in-depth interviews, which were transcribed verbatim and analyzed using Colaizzi's approach. Qualitative data were collected from 67 participants aged from 32 to 78-years-of-age (average age of 52). Just over one-half of the research participants were male (54%) and three-quarters lived in metropolitan regions (75%). Four key themes emerged from data analysis: (1) Concerns regarding exposure and infection delayed EHS utilization among participants with chronic health conditions; (2) Participants with acute health conditions expressed concern regarding the impact of COVID-19 on their care, but continued to access services as required; (3) Participants caring for people with sensory and developmental disabilities identified unique communication needs during interactions with EHS during the COVID-19 pandemic; communicating with emergency health care workers wearing personal protective equipment (PPE) was identified as a key challenge, with face masks reported as especially problematic for people who are deaf or hard-of-hearing; and (4) Children and older people also experienced communication challenges associated with PPE, and the need for connection with emergency health care workers was important for positive lived experience during interactions with EHS throughout the pandemic. This research provides an important insight into the lived experience of EHS utilization during the COVID-19 pandemic, a perspective currently lacking in the published peer-reviewed literature.

COVID-19-Related Reduction in Emergency Health Care Utilization Among Febrile Pediatric Oncology Patients.

The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic has disrupted normal health care utilization patterns worldwide, including decreasing emergency department (ED) visits for various medical emergencies. We examined whether this pattern was present in febrile pediatric oncology patients. In this single-center cohort study, we conducted a retrospective chart review of ED visits of febrile pediatric oncology patients during the first 4 months of the global SARS-CoV-2 pandemic and compared those data to the same time periods in the previous 2 years. During the first 5 months of the pandemic, 25 pediatric oncology patients with fever visited our ED; 65 children visited during the same time period in 2018; and 60 visited in 2019. Compared with 2018 and 2019, encounters for 2020 were decreased by 62% and 58%, respectively. A significantly higher percentage of febrile pediatric oncology patients (84%) were admitted to our hospital during the pandemic compared the previous years (58%). Of concern is the possibility that fear of exposure to coronavirus disease-19 (COVID-19) at our health care facility prompted caregivers of pediatric oncology patients to avoid seeking care for their child with fever. Consistent communication with families about the life-threatening nature of fever should be prioritized among pediatric oncology providers.

The impact of the COVID-19 pandemic on child health and the provision of Care in Paediatric Emergency Departments: a qualitative study of frontline emergency care staff

BackgroundThe COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system.MethodsFifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians (n = 5), nursing managerial staff (n = 6), social workers (n = 2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes.ResultsThe pandemic and public health restrictions have had an adverse impact on children’s health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care.ConclusionsThe spread of COVID-19 and subsequent policies to address the pandemic has had wide-reaching implications for children’s health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.

Medication for Addiction Treatment and Postpartum Health Care Utilization Among Pregnant Persons With Opioid Use Disorder.

To estimate treatment and postpartum health care utilization among pregnant persons with opioid use disorder (OUD) in Vermont and Maine. Vermont's and Maine's All Payer Claims Databases were used to identify deliveries 2010 to 2018 that were paid for, in part, by Medicaid. OUD was identified among pregnant persons if they had any claim with an OUD-diagnosis code (ICD-9/10) or medication for addiction treatment (MAT) code during the 5 months before delivery event. Consistent and inconsistent MAT were compared to no MAT on the rate of hospitalizations and emergency department (ED) visits in the first 12 months' postpartum using negative binomial regression. From 2010 through 2018, 27,652 deliveries in Vermont and 43,480 deliveries in Maine were among persons insured by Medicaid. The prevalence of OUD among pregnant persons increased from 6.7% to 11.6% in Vermont and from 7.4% to 11.0% in Maine. Among pregnant persons with OUD in 2018, 57% had consistent MAT in Vermont and 50% had consistent MAT in Maine; approximately 32% and 27% were not in treatment in Vermont and Maine, respectively. In Maine, consistent MAT was associated with a 47% lower rate of hospitalization and 37% to 46% lower rates of ED visits when compared to those without MAT; in Vermont, those with consistent buprenorphine treatment had a 30% lower rate of ED visits. Medicaid data from Vermont and Maine suggests that medication for addiction treatment for opioid use disorder during pregnancy reduces emergency health care utilization in the first year postpartum.

Glucagon use by U.S. adults with type 1 and type 2 diabetes.

The American Diabetes Association recommends that all patients at risk for hypoglycemia be prescribed glucagon. Despite this recommendation, there is evidence that prescription rates are lower than expected for patients with type 1 and type 2 diabetes. This study investigated prescription patterns for glucagon among de-identified administrative claims from OptumLabs® Data Warehouse for prescriptions between January 1, 2014 and December 31, 2014 among pharmacologically treated type 1 and 2 diabetes patients. We find that glucagon was rarely filled by patients with type 1 and type 2 diabetes, including fewer than 5% of patients with prior hypoglycemia requiring emergency healthcare utilization. Among patients with type 1 diabetes, glucagon fills were unpredictable and not targeted to highest risk patients.