Utilization Of Health Care Services Research Articles

Community Hospital Interventions Addressing the Medical and Social Needs of Patients: Patient Perspectives From the CHART Investment Program.

High utilizers of acute care in nonurban settings are at risk for poor health outcomes. Much of Massachusetts is nonurban, with many residents experiencing limited access to health care providers, fragmented health care services, inadequate housing, and low health literacy. This study examines patient perspectives on the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program, a state-based grant program focused on advancing community hospitals toward value-based care. We found that CHART staff engaged patients in care coordination and patient advocacy, promoted patient agency and health literacy, and provided socioemotional support. These findings may help inform future program development around meeting the medical and social needs of high utilizers of health care services.

Five-year follow-up of the iBerry Study: screening in early adolescence to identify those at risk of psychopathology in emerging adulthood.

The iBerry Study, a Dutch population-based high-risk cohort (n = 1022) examines the transition from subclinical symptoms to psychiatric disorders in adolescents. Here, we present the first follow-up measurement, approximately 3years after baseline assessment and 5years after the screening based on self-reported emotional and behavioral problems (SDQ-Y). We give an update on the data collection, details on the (non)response, and the results on psychopathology outcomes. The first follow-up (2019-2022) had a response rate of 79% (n = 807). Our results at baseline (mean age 15.0years) have shown the effectiveness of using the SDQ-Y to select a cohort oversampled for the risk of psychopathology. At first follow-up (mean age 18.1years), the previously administered SDQ-Y remains predictive for selecting adolescents at risk. At follow-up, 47% of the high-risk adolescents showed significant mental health problems based on self- and parent reports and 46% of the high-risk adolescents met the criteria for multiple DSM-5 diagnoses.Compared to low-risk adolescents, high-risk adolescents had a sevenfold higher odds of significant emotional and behavioral problems at follow-up. Comprehensive assessment on psychopathology, substance abuse, psychotic symptoms, suicidality, nonsuicidal self-injury, addiction to social media and/or video gaming, and delinquency, as well as social development, and the utilization of healthcare and social services were conducted. This wave, as well as the ones to follow, track these adolescents into their young adulthood to identify risk factors, elucidate causal mechanisms, and discern pathways leading to both common and severe mental disorders. Results from the iBerry Study will provide leads for preventive interventions.

Exploring the path to optimal diabetes care by unravelling the contextual factors affecting access, utilisation, and quality of primary health care in West Africa: A scoping review protocol.

The prevalence of diabetes in West Africa is increasing, posing a major public health threat. An estimated 24 million Africans have diabetes, with rates in West Africa around 2-6% and projected to rise 129% by 2045 according to the WHO. Over 90% of cases are Type 2 diabetes (IDF, World Bank). As diabetes is ambulatory care sensitive, good primary care is crucial to reduce complications and mortality. However, research on factors influencing diabetes primary care access, utilisation and quality in West Africa remains limited despite growing disease burden. While research has emphasised diabetes prevalence and risk factors in West Africa, there remains limited evidence on contextual influences on primary care. This scoping review aims to address these evidence gaps. Using the established methodology by Arksey and O'Malley, this scoping review will undergo six stages. The review will adopt the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines to ensure methodological rigour. We will search four electronic databases and search through grey literature sources to thoroughly explore the topic. The identified articles will undergo thorough screening. We will collect data using a standardised data extraction form that covers study characteristics, population demographics, and study methods. The study will identify key themes and sub-themes related to primary healthcare access, utilisation, and quality. We will then analyse and summarise the data using a narrative synthesis approach. The findings and conclusive report will be finished and sent to a peer-reviewed publication within six months. This review protocol aims to systematically examine and assess the factors that impact the access, utilisation, and standard of primary healthcare services for diabetes in West Africa.

Spatial distribution and geographical heterogeneity factors associated with households' enrollment level in community-based health insurance

BackgroundHealthcare service utilization is unequal among different subpopulations in low-income countries. For healthcare access and utilization of healthcare services with partial or full support, households are recommended to be enrolled in a community-based health insurance system (CBHIS). However, many households in low-income countries incur catastrophic health expenditure. This study aimed to assess the spatial distribution and factors associated with households' enrollment level in CBHIS in Ethiopia.MethodsA cross-sectional study design with two-stage sampling techniques was used. The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. STATA 15 software and Microsoft Office Excel were used for data management. ArcMap 10.7 and SaTScan 9.5 software were used for geographically weighted regression analysis and mapping the results. A multilevel fixed-effect regression was used to assess the association of variables. A variable with a p < 0.05 was considered significant with a 95% confidence interval.ResultsNearly three out of 10 (28.6%) households were enrolled in a CBHIS. The spatial distribution of households' enrollment in the health insurance system was not random, and households in the Amhara and Tigray regions had good enrollment in community-based health insurance. A total of 126 significant clusters were detected, and households in the primary clusters were more likely to be enrolled in CBHIS. Primary education (AOR: 1.21, 95% CI: 1.05, 1.31), age of the head of the household >35 years (AOR: 2.47, 95% CI: 2.04, 3.02), poor wealth status (AOR: 0.31, 95% CI: 0.21, 1.31), media exposure (AOR: 1.35, 95% CI: 1.02, 2.27), and residing in Afar (AOR: 0.01, 95% CI: 0.003, 0.03), Gambela (AOR: 0.03, 95% CI: 0.01, 0.08), Harari (AOR: 0.06, 95% CI: 0.02, 0.18), and Dire Dawa (AOR: 0.02, 95% CI: 0.01, 0.06) regions were significant factors for households' enrollment in CBHIS. The secondary education status of household heads, poor wealth status, and media exposure had stationary significant positive and negative effects on the enrollment of households in CBHIS across the geographical areas of the country.ConclusionThe majority of households did not enroll in the CBHIS. Effective CBHIS frameworks and packages are required to improve the households' enrollment level. Financial support and subsidizing the premiums are also critical to enhancing households' enrollment in CBHIS.

Barriers to access and utilization of health services among marginalized communities in sub-Saharan African countries: Scoping review

Barriers to access and utilization of health services among marginalized communities in sub-Saharan African countries: Scoping review

Healthcare utilisation by diabetic patients in Denmark: the role of primary care in reducing emergency visits

Improving the management of diabetic patients is receiving increasing attention in the health policy agenda due to increasing prevalence in the population and raising pressure on healthcare resources. This paper examines the determinants of healthcare services utilisation in patients with type-2 diabetes, investigating the potential substitution effect of general practice visits on the utilisation of emergency department visits. By using rich longitudinal data from Denmark and a bivariate econometric model, our analysis highlights primary care services that are more effective in preventing emergency department visits and socioeconomic groups of patients with a weak substitution response. Our results suggest that empowering primary care services, such as preventive assessment visits, may contribute to reducing emergency department visits significantly. Moreover, special attention should be devoted to vulnerable groups, such as patients from low socioeconomic background and older patients, who may find more difficult achieving a large substitution response.

Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study

BackgroundDisparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia.MethodsData were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization.ResultsThis study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level.ConclusionThis study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.

"For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya.

The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.

Racial and ethnic disparities in healthcare utilization among children in U.S. foster care: Recommendations to challenge the status quo based on a scoping review

Prior work has examined racial and ethnic disparities in the access to and utilization of healthcare services. However, evidence across studies is mixed, making it challenging to precisely identify where the racial and ethnic disparities in healthcare utilization are amongst children in foster care, and which race and ethnicity groups are most impacted by such disparities. As such, the purpose of the current study was to conduct a scoping review to synthesize evidence on the topic of racial and ethnic disparities in the physical and mental or behavioral healthcare utilization for children in the U.S. foster care system (PROSPERO ID: CRD42021272072). Comprehensive literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 414 studies identified, 23 met inclusion criteria: peer-reviewed journal article, published between 1991 and 2023, written in English, examined healthcare access or utilization of children in the U.S. foster care system as outcomes, included and disaggregated results by children’s race and ethnicity, conducted quantitative analysis, and was observational in study design. In the physical healthcare utilization domain, Black children were less likely to utilize routine and preventative check-ups and more likely to utilize medical services for treating chronic illnesses such as asthma, compared to White children. In the mental or behavioral healthcare utilization domain, Black and Hispanic/Latinx children were less likely to utilize both inpatient and outpatient mental health services, compared to White children. Furthermore, notable variations were observed by specific service types and continuity of services over time. Implications include additional research and education about racial and ethnic disparities in healthcare utilization amongst children in foster care, as well as implementing regulations and oversights that mandate racial equity in the child welfare and healthcare service pathways.

Perceived Healthcare Priorities, Barriers, and Preferences When Selecting Private or Governmental Healthcare Services Among a Sample of University Affiliates from Saudi Arabia.

This study aims to measure the perceived healthcare priorities, barriers, and preferences when selecting private or governmental healthcare services among a sample of university affiliates from Saudi Arabia. This study utilized a cross-sectional design to reach targeted adults on the Jazan University campus. Data were collected during personal interviews. The questionnaires measured participant demographics, perceived healthcare priorities, barriers, and preferences when selecting private or governmental healthcare services. A chi-squared test was used to detect statistically significant differences between demographic and clinical characteristics according to preferences in their healthcare-seeking behavior. A total of 3083 university affiliates participated in this investigation. The mean age of the participants was 28 years, 49.6% of whom were males. Among the sample, 63% were students, and the remaining were university staff. The health condition perceived as most important was diabetes, and most of the sample viewed primary healthcare as the most vital service. The healthcare-seeking behavior of the sample indicated a higher preference for using governmental healthcare services. However, notable barriers related to the availability of appointments, long waiting times when visiting a healthcare facility, and healthcare costs were identified. Preference for private healthcare services was higher among females, expatriates, non-Arabic speaking affiliates, those with higher socioeconomic status, and health insurance owners (p-values < 0.05). Additionally, higher utilization of private healthcare services was noted among participants who frequently visit dentists and physicians and those performing consistent, routine medical checkups (p-values < 0.05). The findings indicate the importance of strengthening the role of primary healthcare to address the health needs required for preventing and managing chronic diseases, such as diabetes. Additionally, enhancing access to and effectiveness of primary healthcare may reduce the impact of healthcare barriers associated with limited appointments and prolonged waiting times.

Short- and mid-term morbidity and primary-care burden due to infant respiratory syncytial virus infection: A Spanish 6-year population-based longitudinal study.

The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is essential for evaluating any potential impact on short- to mid-term morbidity and the utilization of primary healthcare (PHC) and emergency services (ES). We established this reference data using a population-based cohort approach. Infants hospitalized for RSV from January 2016 to March 2023 were matched with non-hospitalized ones based on birthdate and sex. We defined the exposure as severe RSV hospitalization. The main study outcomes were as follows: (1) PHC and ES visits for RSV, categorized using the International Classification of Primary Care codes, (2) prescriptions for respiratory airway obstructive disease, and (3) antibacterial prescriptions. Participants were followed up from 30 days before hospitalization for severe RSV until the outcome occurrence or end of the study. Adjusted incidence rate ratios (IRRs) of the outcomes along with their 95% confidence intervals (CI) were estimated using Poisson regression models. Stratified analyses by type of PHC visit (nurse, pediatrician, or pharmacy) and follow-up period were undertaken. We defined mid-term outcomes as those taking place up to 24 months of follow-up period. The study included 6626 children (3313 RSV-hospitalized; 3313 non-hospitalized) with a median follow-up of 53.7 months (IQR = 27.9, 69.4). After a 3-month follow-up, severe RSV was associated with a considerable increase in PHC visits for wheezing/asthma (IRR = 4.31, 95% CI: 3.84-4.84), lower respiratory infections (IRR = 4.91, 95% CI: 4.34-5.58), and bronchiolitis (IRR = 4.68, 95% CI: 2.93-7.65). Severe RSV was also associated with more PHC visits for the pediatrician (IRR = 2.00, 95% CI: 1.96-2.05), nurse (IRR = 1.89, 95% CI: 1.75-1.92), hospital emergency (IRR = 2.39, 95% CI: 2.17-2.63), primary healthcare emergency (IRR: 1.54, 95% CI: 1.31-1.82), as well as with important increase in prescriptions for obstructive airway diseases (IRR = 5.98, 95% CI: 5.43-6.60) and antibacterials (IRR = 4.02, 95% CI: 3.38-4.81). All findings remained substantial until 2 years of post-infection. Severe RSV infection in infants significantly increases short- to mid-term respiratory morbidity leading to an escalation in healthcare utilization (PHC/ES attendance) and medication prescriptions for up to 2 years afterward. Our approach could be useful in assessing the impact and cost-effectiveness of RSV prevention programs.

Evaluation of medications used for opioid use disorder in emergency departments: A cross-sectional analysis of the 2020 National Hospital Ambulatory Medical Care Survey

IntroductionOpioid use disorder (OUD) is a significant health issue impacting millions in the United States (US). Medications used for OUD (MOUD) (e.g., buprenorphine, methadone, naltrexone) and medications for overdose and symptom management (e.g., naloxone, clonidine) have been shown to be safe and effective tools in clinical management. MOUD therapy in Emergency Departments (EDs) improves patient outcomes and enhances engagement with formal addiction treatment; however, provider factors and institutional barriers have created hurdles to ED-based MOUD treatment and heterogeneity in ED based OUD care. We used a nationally representative dataset, the National Hospital Ambulatory Medical Care Survey (NHAMCS) to characterize MOUD prescribing practices across patient demographics, geographic regions, payers, providers, and comorbidities in EDs. MethodsNHAMCS is a survey conducted by the US Census Bureau assessing utilization of ambulatory healthcare services nationally. Survey staff compile encounter records from a nationally representative sample of EDs. We conducted a cross-sectional study using this data to assess visits in 2020 among patients aged 18–64 presenting with an opioid overdose or OUD. We estimated the proportion of patients who had any MOUD, clonidine, or naloxone treatment and 95% confidence intervals (CI). We modeled the association between patient demographic, location, comorbidities, and provider characteristics with receipt of MOUD treatment as unadjusted odds ratios (OR) and 95% CI. ResultsThere was a weighted frequency of 469,434 patients who were discharged from EDs after being seen for OUD or overdose. Naloxone, clonidine, and buprenorphine were the most frequent treatments administered and/or prescribed for OUDs or overdose. Overall, 54,123 (11.5%, 95%CI 0–128,977) patients who were discharged from the ED for OUDs or overdose received at least one type of MOUD. Hispanic race, (OR 17.9, 95%CI 1.33–241.90) and Western region (OR43.77, 95%CI 2.97–645.27) were associated with increased odds of receiving MOUDs, while arrival by ambulance was associated with decreased odds of receiving MOUDs (OR0.01, 95%CI 0.001–0.19). Being seen by an APP or physician assistant was associated with MOUD treatment (OR 16.68, 95%CI: 1.41–152.33; OR: 13.84, 95%CI: 3.58–53.51, respectively). ConclusionOur study findings suggest that MOUD and other medications for opioid overdose are infrequently used in the ED setting. This finding was especially notable in race, geographic region, mode of arrival, and those seen by APP, underscoring the need for further study into the root causes of these disparities. Our study provides a foundational understanding of MOUD patterns, guiding future research as the landscape of OUD treatment continues to shift.

Perceptions of metabolic syndrome management utilization in relation to patient experience and health-related quality of life

BackgroundOne factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes. ObjectivesThe study explored the influence of PEwP and PMU on the HRQoL of people with MetS. MethodsData on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square and ordinal regression tests were used to predict the association between PMU, PEwP, and HRQoL. Also, mediation analysis through Haye's model 4 explored the direct and indirect relationship of PMU and PEwP on HRQoL. ResultsA total of 706 completed surveys were collected and used for analyses. On average, respondents reported three comorbidities. Of the respondents, 72.0% had good PEwP, while 32.6% had good PMU. Comparatively, 38.4% of those with good PEwP had good PMU, compared with 17.3% of those with poor PEwP. Also, 47.0% of those with good PMU had good HRQoL compared to 35.3% with poor PMU. The odds of having fair or good PMU were nearly triple (OR = 2.97, P < 0.001) among those with good PEwP compared to those with poor PEwP. Also, respondents with good PMU had 58% (OR = 1.58, P = 0.008) higher odds of having fair or good HRQoL. Analysis through bootstrap indicated a significant relationship (BootCI = −0.072, −0.022) between PEwP and HRQoL via respondents' PMU. ConclusionsMetS individuals with good experience and PMU were more likely to have good HRQoL. Prior experience with pharmacists influenced PMU and indirectly impacted HRQoL. Therefore, pharmacists must consider patients' experience and management utilization perceptions to promote health outcome among people with MetS, while implementing interventions.

Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20.

This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.

The Association between Daily Care, and Social Support, and Health Care Services Utilization and Depressive Symptoms Among Chinese Older Adults with Chronic Diseases

The Association between Daily Care, and Social Support, and Health Care Services Utilization and Depressive Symptoms Among Chinese Older Adults with Chronic Diseases

Mental Health Considerations in HIV Research Published in the South African Journal of Psychology, 2008–2018

In this study, we explore the themes related to mental health considerations in HIV/AIDS research published in the South African Journal of Psychology (SAJP) from January 2008 to December 2018. Utilising an exploratory research design, we purposively sampled 35 empirical articles from the SAJP to represent general trends. We conducted a thematic content analysis to identify recurring constructs and themes, following established guidelines. Key themes identified include the intersection between stigma, mental health and access to healthcare; the impact of HIV on cognitive functioning and performance; behavioural vulnerabilities and power dynamics; and challenges in healthcare service utilisation. The cumulative evidence from the SAJP highlights the need for targeted, culturally sensitive interventions that deal with systemic inefficiencies and stigma in the healthcare system. Interventions should also consider broader socio-economic factors and promote equitable relationships. In addition, it is vital to ensure that healthcare providers receive ongoing education on legal and ethical matters to aid in sound ethical decision-making. An all-encompassing, coordinated strategy is key to improving the lives of people living with HIV/AIDS in South Africa.

Artificial intelligence informing clinical decision making on the risk of hospital readmissions in multi-morbid patients: a systematic review

Abstract Introduction Multi-morbid patients have complex care needs and are more likely to utilise healthcare services, which represents a financial burden on healthcare organisations. 30-day readmission of patients is a method of measuring the quality of the services provided within healthcare.[1] Artificial intelligence (AI) models can flag multi-morbidity patients at increased risk of readmission.[2] However, it is unclear which common predictors have been used to develop these models. Aim To systematically review the medical literature to identify predictors that have been used to develop AI models that predicted unplanned 30-day hospital readmissions of multi-morbid patients, and whether these predictors were modifiable or non-modifiable. Methods Four large databases: Medline, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched on 15th November 2022. Only publications that developed a machine learning algorithm to predict unplanned 30-day hospital readmission for patients with multi-morbidity were included. Articles published in English language were eligible for inclusion. A narrative synthesis of all eligible studies was undertaken. Key findings were identified through inductive strategy, which includes simplifying raw data in the included articles into a comprehensive format. This systematic review was registered with the PROSPRO database (CRD42022373937) and followed PRISMA guidelines. Results There were 1,906 articles extracted from all databases, 18 of which met our inclusion criteria. A total of 669 predictors of hospital readmission were found, and were divided into 103 modifiable (i.e., action could be taken to change the outcome) and 566 non-modifiable (i.e. age, gender, number of previous emergency admissions. The average number of modifiable predictors per prediction model was six, with the most common being length of hospital stay, multi-morbidity, obesity, hypertension, diabetes, depression, and anaemia. The most commonly used AI algorithm was the gradient boosting algorithm. This algorithm generally showed a better performance than other models reported. The performance of all models in the included studies was compared; 13 studies showed an average sensitivity of 72%. The average specificity was calculated at 73% from 11 studies. The highest AUC reported was above 0.9, which demonstrates an excellent performing model, while five models did not report a value for the AUC. Conclusion We identified modifiable and non-modifiable predictors used in previously developed AI algorithms that predict 30-day hospital readmissions of multi-morbid patients. Modifiable predictors in particular can help guide clinical decision-making by allowing early actions to be taken in primary care to potentially reduce the risk of readmission. However, one limitation of this review is that some included studies used balanced (i.e. synthetic) data which could have introduced a level of bias.

Does Participating in New Rural Cooperative Medical Insurance Change Catastrophic Health Expenditure? Evidence from the China Household Income Project.

A primary goal of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection against health care costs and alleviate the financial burdens of rural residents in China. This article examines whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above). The analysis utilized data from the 2007 China Household Income Project survey in rural areas and an instrumental variable estimation method in Anhui and Sichuan provinces, which exhibited heterogeneity in the NRCMI implementation schedule. The results show that NRCMI participation was not associated with changes in the CHE incidence among families. The finding is consistent with the prior literature using quasi-experimental study designs. This study provides empirical evidence for policymakers, highlighting that the impact of NRCMI participation on financial protections is limited despite its extensive population coverage. The limited effects are probably due to the low reimbursement rate and increased utilization of expensive health care services.

The effectiveness of cell salvage in extracorporeal circulation surgeries in relation to use of health resources after use: A systematic review and meta-analysis

BackgroundAlternatives to allogeneic blood transfusions are sought for resource management reasons and it is necessary to investigate the efficiency and efficacy on Cell Salvage use. The objective of this study is to analyze the effectiveness of the Cell Salvage system in addressing factors related to healthcare service utilization that may lead to increased healthcare expenditure. MethodsA systematic review with meta-analysis was conducted through literature search in Medline, CINAHL, Scopus, Web of Science, and Cochrane Library. Inclusion criteria were studies in English/Spanish, without year restriction and Randomized Controlled Trials design, conducted in adults. ResultsTwenty-six studies were included in the systematic review, involving a total of 4781 patients (nexperimental group = 2365; ncontrol group = 2416). Significant differences favored the Cell Salvage system in units of transfused Red Blood Cells, in terms of units (p = 0.04; SMD = −0.42 95 % CI = −0.83 to −0.02) and individuals (p = 0.001; RR = 0.71, 95 % CI = 0.60 to 0.84) transfused. No significant differences were found in ICU (p = 0.93) and hospital stay duration (p = 0.21), number of reoperations (p = 0.68), and number of units and individuals transfused in terms of platelets (p > 0.05). ConclusionsCell Salvage use holds high potential for reducing healthcare costs and indirectly contributing to improving blood and blood product reserves within blood banks. Results obtained thus far do not provide definitive evidence regarding the duration of hospital stay, ICU stay, need for reoperation, or the quantity of transfused platelets. Therefore, it is recommended to increase the number of studies to assess the impact on the economic models of the Cell Salvage system.

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study

BackgroundThe COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia.MethodsWe employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges.ResultsThe number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public’s fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic.ConclusionsThe COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.