Healthcare Utilization In Adults Research Articles

Impact of the COVID-19 pandemic and lockdown restrictions on psychosocial and behavioural outcomes among Australian adults with type 2 diabetes: Findings from the PREDICT cohort study.

AimTo examine psychosocial and behavioural impacts of the novel coronavirus disease 2019 (COVID‐19) pandemic and lockdown restrictions among adults with type 2 diabetes.MethodsParticipants enrolled in the PRogrEssion of DIabetic ComplicaTions (PREDICT) cohort study in Melbourne, Australia (n = 489 with a baseline assessment pre‐2020) were invited to complete a phone/online follow‐up assessment in mid‐2020 (i.e., amidst COVID‐19 lockdown restrictions). Repeated assessments that were compared with pre‐COVID‐19 baseline levels included anxiety symptoms (7‐item Generalised Anxiety Disorder scale [GAD‐7]), depressive symptoms (8‐item Patient Health Questionnaire [PHQ‐8]), diabetes distress (Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, alcohol consumption and diabetes self‐management behaviours. Additional once‐off measures at follow‐up included COVID‐19‐specific worry, quality of life (QoL), and healthcare appointment changes (telehealth engagement and appointment cancellations/avoidance).ResultsAmong 470 respondents (96%; aged 66 ± 9 years, 69% men), at least ‘moderate’ worry about COVID‐19 infection was reported by 31%, and 29%–73% reported negative impacts on QoL dimensions (greatest for: leisure activities, feelings about the future, emotional well‐being). Younger participants reported more negative impacts (p < 0.05). Overall, anxiety/depressive symptoms were similar at follow‐up compared with pre‐COVID‐19, but diabetes distress reduced (p < 0.001). Worse trajectories of anxiety/depressive symptoms were observed among those who reported COVID‐19‐specific worry or negative QoL impacts (p < 0.05). Physical activity trended lower (~10%), but sitting time, alcohol consumption and glucose‐monitoring frequency remained unchanged. 73% of participants used telehealth, but 43% cancelled a healthcare appointment and 39% avoided new appointments despite perceived need.ConclusionsCOVID‐19 lockdown restrictions negatively impacted QoL, some behavioural risk factors and healthcare utilisation in adults with type 2 diabetes. However, generalised anxiety and depressive symptoms remained relatively stable.

Clinical and utilization outcomes associated with tumor mutational burden in a real-world pan-tumor population.

Aim & methods: This real-world study examined the association of tumor mutational burden (TMB) with clinical and healthcare utilization in adults diagnosed with advanced solid tumor 1 January2015- 31 January2019. Results: There were 170 patients in low-TMB group (TMB<10mut/Mb) and 32 in high-TMB group (TMB ≥10mut/Mb). Median overall survival was 18.8 (95% CI: 17.3-28.8) and 15.9months (95% CI: 11.3-18.0) whereas median progression-free survival was 9.9 (95% CI: 8.6-11.4) and 7.8months (95% CI: 3.8-12.5) for the low- and high-TMB groups, respectively. Hospitalization (49.4 vs 37.5%), emergency visit (25.3 vs 21.9%), and median overall cost of care (US$135,403 vs 87,570) were all lower in low-TMB group. Conclusion: Despite the limited sample, these data provide a historical perspective for examining real-world outcomes associated with TMB.

National Estimates of Financial Hardship From Medical Bills and Cost-related Medication Nonadherence in Patients With Inflammatory Bowel Diseases in the United States

Inflammatory bowel diseases (IBDs) are associated with substantial health care needs. We estimated the national burden and patterns of financial toxicity and its association with unplanned health care utilization in adults with IBD in the United States. Using the National Health Interview survey (2015), we identified individuals with self-reported IBD and assessed national estimates of financial toxicity across domains of financial hardship due to medical bills, cost-related medication nonadherence (CRN) and adoption of cost-reducing strategies, personal and health-related financial distress (worry about expenses), and health care affordability. We also evaluated the association of financial toxicity with emergency department (ED) utilization. Of the estimated 3.1 million adults with IBD in the United States, 23% reported financial hardships due to medical bills, 16% of patients reported CRN, and 31% reported cost-reducing behaviors. Approximately 62% of patients reported personal and/or health-related financial distress, and 10% of patients deemed health care unaffordable. Prevalence of financial toxicity was substantial even in participants with higher education, with private insurance, and belonging to middle/high-income families, highlighting underinsurance. Inflammatory bowel disease was associated with 1.6 to 2.6 times higher odds of financial toxicity across domains compared with patients without IBD. Presence of any marker of financial toxicity was associated with higher ED utilization. One in 4 adults with IBD experiences financial hardship due to medical bills, and 1 in 6 adults reports cost-related medication nonadherence. These financial determinates of health-especially underinsurance-have important implications in the context of value-based care.

An Apple A Day?

In this study, we document the effect of food stamp access on adult health-care utilization. While the Food Stamp Program is one of the largest safety net programs in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this issue, we use variation in documented immigrants’ eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in physician visits due to food stamps may offset some of the program’s impact on the overall government budget because of the existence of government-provided health insurance programs such as Medicaid.

Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma

BackgroundAsthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. ObjectiveTo examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. MethodsCross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. ResultsOf the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). ConclusionCompared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.

Health related quality of life and healthcare utilization among adults with diabetes and kidney and eye complications in the United States

BackgroundOne-third of adults with diabetes in the United States have chronic kidney disease (CKD), and 19% of them have eye complications (ECs). However, little is known about the Health-related Quality of Life (HRQoL) of adults with both of these diabetes-related complications. Therefore, the purpose of this study is to examine differences in the HRQoL, mental health, and healthcare utilization of adults with diabetes who have CKD, ECs, both or neither.MethodsA cross-sectional study design was implemented using data from multiple panels (2009–2015) of the Medical Expenditure Panel Survey. HRQoL was measured using the SF-12 Physical and Mental Component Summary (PCS & MCS) scores. The HRQoL, mental health, and healthcare utilization of four mutually exclusive groups: 1) diabetes with both CKD and ECs; 2) diabetes with CKD only; 3) diabetes with ECs only, and 4) diabetes with neither CKD nor ECs were compared. In all analyses, adults with neither CKD nor ECs were the reference group.ResultsThere were 8415 adults with diabetes who met the inclusion criteria. Approximately, 75% of the study sample had neither CKD nor ECs, 13.3% had ECs only, 5.7% had CKD only, and 5.5% had both CKD and ECs. In the adjusted analyses, adults with both CKD and/or ECs complications exhibited significantly lower HRQoL compared to those with neither CKD nor ECs. Mental illness and psychological distress were higher among adults with both CKD and ECs compared to those with neither CKD nor ECs. Furthermore, adults with CKD and/or ECs had higher polypharmacy, inpatient and emergency services use compared to those with neither CKD nor ECs.ConclusionsThe results indicate that the presence of both CKD and/or ECs was negatively associated with poor HRQoL, poor mental health, higher psychological distress and healthcare utilization in adults with diabetes. The findings emphasize the need for routine assessment and treatment for diabetes-related CKD and/or ECs complications to improve the quality of care for individuals with diabetes.

Case Management Featuring Community Health Workers Reduces Inpatient Health Care Utilization in Adults with Sickle Cell Disease

Background: Hospital readmission rates and acute care utilization among adults with sickle cell disease (SCD) are almost twice the rates of children. Adult patients may have complex medical and psychosocial needs that are not adequately addressed in fragmented healthcare systems. Few systems have implemented evidence-based, comprehensive care for SCD adults, shown to improve both medical and psychosocial outcomes in chronic diseases. Case management (CM) and community health workers (CHWs) are two evidence-based health management strategies that can help reduce health risks, reduce readmission rates, and improve patient-provider relationships. Methods: After years of attempting adult SCD CM with two MDs and one advanced practice provider (APP), Virginia Commonwealth University Medical Center (VCU) built upon a pilot study of CM and CHWs and implemented a multi-disciplinary Adult Sickle Cell Medical Home that assigned one of two CHWs for CM of the 50 highest SCD adult utilizers ranked by calendar year (CY) 2017 VCU charges, then by CY 2017 inpatient days. CHWs followed patients in and out of the hospital, and met with them at home. They were joined by a social worker who provided CM and behavioral therapy, an additional APP, and a project manager. This team met weekly. Medical Home leaders and quality improvement (QI) specialists enlisted other periodic caregivers to form QI teams with Medical Home workers focusing on behavioral health, ambulatory management, inpatient management, and emergency department (ED) management. A prior authorization specialist handled administrative access to opioids. Evaluation compared utilization during CY 2017 (pre-intervention) versus CY 2018 (intervention). For all patients we compared the average 30-day readmission rate, the average length of stay (ALOS), the average 3-Day ED return rate, the number of ED discharges, the numbers of inpatient days, inpatient discharges, and outpatient visits, the number of patients who used the ED, and total VCU charges. For the 50 highest utilizers, we compared the 30-day readmission rate, ALOS, total inpatient days and total VCU charges. VCU had no ambulatory SCD infusion unit, and the VCU ED did not have a special SCD rapid triage protocol. There was no control group. Analysis consisted of chi square and paired and unpaired t-tests. Results: Among 567 SCD adults (Table), including 231 males and 336 females, ages 18 - 80, comparing pre-intervention to intervention, average utilization and VCU charges were either numerically or statistically significantly reduced, with the exception of outpatient visits, which remained flat. For the 50 highest utilizers, mean 30-day readmission rates were flat (45.98% vs 44.35%, p=0.7257), ALOS was significantly reduced (6.1 days vs 4.8 days, p&lt;0.0001), inpatient days were reduced (206 days vs 106 days), and total charges were significantly reduced (25.43%, $5,297,323.73 vs $3,950,267.26, p=0.0037). Conclusions: At VCU, a multi-disciplinary Adult Sickle Cell Medical Home that featured intensive CM and CHWs, but no infusion center or rapid ED triage, reduced annual utilization for adult SCD patients. CM program elements that were most effective should be studied in the future. A randomized controlled trial of CM and CHWs would strengthen evidence of their efficacy in improving utilization. Table. Disclosures Smith: Novartis: Consultancy, Honoraria. Lipato:Novartis: Honoraria. Roberts:Truven Health Analytics: Consultancy; Community Health Network of Connecticut: Consultancy.

Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes?

ObjectiveTo assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. Research design and methods1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions. ResultsIn analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08–1.86) and 64% (RR: 1.64; 95% CI: 1.08–2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02–1.42) and 42% (RR:1.42; 95% 1.09–1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): −0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): −0.23% (1.59%)). ConclusionIn an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.

Disparities in Healthcare Utilization Among Adults with Obesity in the United States, Findings from the NHIS: 2006–2015

Few studies of disparities consider logistical hurdles faced by adults with obesity in obtaining needed healthcare. This study compared adults with obesity to adults without obesity on self-reported practical aspects of receiving healthcare including ease of seeing a doctor and wait times for appointments. Serious psychological distress and chronic health conditions are prevalent in adults with obesity. Because serious psychological distress and number of chronic health conditions can act as confounders in any observed differences between the adults with and without obesity in their use of healthcare, we have examined these differences independent of serious psychological distress and chronic health conditions. Adults 18 to 64 years sampled from the 2006–2015 National Health Interview Survey (NHIS) (n = 74,598) were examined on five self-reported indicators: does not need a doctor, waited too long in the doctor’s office, and to get an appointment, year since having seen a doctor, and saw a doctor ten times or more in the last 12 months. Multivariable models adjusted for serious psychological distress, chronic health conditions, gender, age, race/ethnicity, income, health coverage, and survey year demonstrated that adults with obesity were more likely to wait too long to get an appointment, and in the waiting room. Adults with obesity report not needing doctors despite seeing doctors frequently. Greater attention is needed to understand barriers to health care utilization in adults with obesity.

Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population.

To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population. Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed. The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend&lt;.001) with rising ACE score. Odds ratios (CIs) for those with four or more vs. zero ACEs were 1.37 (95% CI 1.27-1.47) for 1-10 times and 1.80 (95% CI 1.29-2.52) for more than 10 times ER visits, 1.37 (95% CI 1.18-1.59) for over 10 doctor's visits, and 2.29 (95% CI 2.06-2.54) for three or more chronic diseases. High ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood. Long-lasting effects from ACE on the health care of underserved populations are indicated. There is an urgent need to train health care providers, patients, and their families on ACE effects and treatments for better health care outcomes.

An Apple a Day? Adult Food Stamp Eligibility and Health Care Utilization among Immigrants

In this study, we document the effect of Food Stamp access on adult health care utilization. While Food Stamps is one of the largest safety net programs in the U.S. today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this, we use variation in documented immigrants' eligibility for Food Stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to Food Stamps reduced the likelihood of an adult visiting a physician more than twice in one year, but had no significant effect on the likelihood of having any physician visits.This result does not appear to be due to changes in physical or mental health, or due to individuals with common chronic health conditions, leaving open the possibility that changes in nutrition or resources may reduce the need for physician visits. Additionally, we find that for single women, Food Stamps increased the affordability of specialty health care, which may have further reduced the need for physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp program, as reductions in health care utilization due to Food Stamps may offset some of the program's impact on the overall government budget due to the existence of government-provided health insurance programs such as Medicaid.

Relating Activity, Participation, and High Health Care Utilization in Adults With Type 2 Diabetes Mellitus: Occupational Therapy Intervention Targets

Abstract Date Presented 4/20/2018 Lower activity and participation levels in daily occupations contribute to overly high health care utilization (HCU) in adults with Type 2 diabetes mellitus (T2DM). Adults with T2DM who are younger, are a member of a minority group, and have many comorbidities are also at increased risk for higher HCU. Primary Author and Speaker: Matt P. Malcolm Additional Authors and Speakers: Arlene A. Schmid, Laura A. Grimm, Tara C. Klinedinst, Karen E. Atler

Estimated prevalence and incidence of diagnosed ADHD and health care utilization in adults in Sweden &amp;ndash; a longitudinal population-based register study

BackgroundAlthough the worldwide prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults is estimated to be between 2% and 5%, it is considered to be underdiagnosed. This register study explored the prevalence of diagnosed ADHD and incidence of newly diagnosed ADHD in Swedish adults over time, and assessed comorbidities and pharmacologic treatment.MethodsNational Patient Register data were used to estimate the overall prevalence of adults (≥18 years) with a registered ADHD diagnosis from 2006 to 2011, and the incidence of newly registered diagnoses from 2007 to 2011. Data from the Prescribed Drug Register were used to estimate the mean dose of the most frequently prescribed ADHD medication.ResultsThe estimated annual prevalence (N=44,364) of diagnosed ADHD increased from 0.58 per 1,000 persons in 2006 to 3.54 per 1,000 persons in 2011. The estimated annual incidence of newly diagnosed ADHD (N=24,921) increased from 0.39 per 1,000 persons to 0.90 per 1,000 persons between 2007 and 2011. At least one comorbidity was diagnosed in 52.6% of adults with ADHD (54.0% of newly diagnosed adults), with anxiety, substance use disorders, and depression being the most common. Among all adults with ADHD, 78.9% (65.7% of newly diagnosed adults) were prescribed ADHD medication and one-third were prescribed more than one add-on medication. Osmotic release oral system methylphenidate was the most commonly used medication. The mean daily dose was 51.5 mg, and was significantly higher in males, patients with substance use disorders, patients with drug holidays, and patients with at least one add-on medication. The most frequent concomitant medications were anxiolytics and hypnotics.ConclusionIn Sweden, the number of adults diagnosed with ADHD increased between 2006 and 2011, and the majority of patients were prescribed ADHD-specific medication. Over one-half of patients had psychiatric comorbidities; one-third were prescribed more than one add-on medication. Consumption of pharmacologic ADHD medication was high in specific patient subpopulations.

Disparities in Health Care Utilization of Adults With Traumatic Brain Injuries Are Related to Insurance, Race, and Ethnicity: A Systematic Review.

To characterize racial/ethnic and insurance disparities in the utilization of healthcare services among US adults with traumatic brain injury (TBI). The PubMed database was used to search for articles that directly examined the association between race/ethnicity and insurance disparities and healthcare utilization among patients with TBI. Eleven articles that met the criteria and were published between June 2011 and June 2016 were finally included in the review. Lack of insurance was significantly associated with decreased use of inhospital and posthospital healthcare services among patients with TBI. However, mixed results were reported for the associations between insurance types and healthcare utilization. The majority of studies reported that racial/ethnic minorities were less likely to use inhospital and posthospital healthcare services, while some studies did not indicate any significant relation between race/ethnicity and healthcare utilization among patients with TBI. This review provides evidence of a relation between insurance status and healthcare utilization among US adults with TBI. Insurance status may also account for some portion of the relation between race/ethnicity and healthcare utilization.

Health conditions, functional status and health care utilization in adults with cerebral palsy.

Health conditions in children with cerebral palsy (CP) are well described, yet health is less defined with advancing age. We examined health conditions, functional status and health care utilization in adults with CP across age groups. We collected cross-sectional data on health conditions, functional status and utilization from the medical records of adults with CP across a large university-affiliated primary care network using the Rochester Health Status Survey IV (RHSS-IV), a 58-item validated survey. Data from the National Health and Nutrition Examination Survey and National Health Interview Survey provided prevalence estimates for the general population as comparison. Compared to the general population, adults with CP had higher rates of seizure disorder, obesity and asthma across all ages. Adults with CP under 30 years of age had higher rates of hypertension (16.7 versus 5.6%; P = 0.04), urinary incontinence (41.7 versus 10.5%; P < 0.001) and depression (16.7 versus 6.9%; P = 0.07). Conversely, there were lower rates of alcohol misuse, tobacco/nicotine and sexually transmitted illnesses. Independence with all activities of daily living decreased from 37.5% at 18-29 years of age to 22.5% in those 60 and over. Seizure disorders, urinary incontinence and gastroesophageal reflux disease were all independently associated with lower functional status. As expected, health care utilization increased with advancing age. Adults with CP should be monitored for conditions occurring at higher prevalence in CP, as well as common conditions occurring with advancing age. Age-related functional decline should be anticipated, especially with coexisting seizure disorders and urinary incontinence.

An Apple a Day? Adult Food Stamp Eligibility and Health Care Utilization Among Immigrants

In this study, we document the effect of Food Stamp access on adult health care utilization. While Food Stamps is one of the largest safety net programs in the U.S. today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this, we use variation in documented immigrants' eligibility for Food Stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to Food Stamps reduced the likelihood of an adult visiting a physician more than twice in one year, but had no significant effect on the likelihood of having any physician visits. This result does not appear to be due to changes in physical or mental health, or due to individuals with common chronic health conditions, leaving open the possibility that changes in nutrition or resources may reduce the need for physician visits. Additionally, we find that for single women, Food Stamps increased the affordability of specialty health care, which may have further reduced the need for physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp program, as reductions in health care utilization due to Food Stamps may offset some of the program's impact on the overall government budget due to the existence of government-provided health insurance programs such as Medicaid.

Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual

BackgroundOpioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. MethodsThis retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. ResultsOf the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63–1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32–2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30–1.00, p=0.05) during the course of the entire study. ConclusionsXR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.

Relationships between adult emotional states and indicators of health care utilization: Findings from the National Health Interview Survey 2006–2014

ObjectiveAdults with serious psychological distress have a high likelihood of mental health problems severe enough to cause serious impairment in social and occupational functioning requiring treatment. These adults visit doctors frequently yet have poor health compared to adults without serious psychological distress. This study examined associations between emotional states of serious psychological distress in relationship to healthcare utilization indicators. A guiding hypothesis was that somatization underlying emotional states contributes to excessive healthcare seeking among adults with serious psychological distress. MethodsUsing 2006–2014 National Health Interview Survey, in adults with serious psychological distress (n=9271), the six states: unable to make efforts, nervousness, hopelessness, sadness, worthlessness and restlessness were assessed in multivariate models in relation to four healthcare utilization indicators: change in the usual place of healthcare, change due to insurance, having seen a healthcare provider in the last 6months and having 10 or more doctor visits in the last 12months. Models were adjusted for sociodemographic variables, having seen a mental health provider, and health conditions. ResultsAdults feeling unable to make efforts were more likely to seek healthcare in the last 6months and at least ten times in the last twelve months. Adults feeling hopeless were less likely to be heavy healthcare utilizers. ConclusionsPredisposing medical conditions do not fully explain healthcare utilization in adults with serious psychological distress. Educating healthcare providers about the emotional states motivating healthcare seeking, and integrating mental healthcare into primary care, may improve the health of adults with serious psychological distress.

First outpatient follow-up after psychiatric hospitalization: does one size fit all?

Claims-based indicators of follow-up within seven and 30 days after psychiatric discharge have face validity as quality measures: early follow-up may improve disease management and guide appropriate service use. Yet these indicators are rarely examined empirically. This study assessed their association with subsequent health care utilization for adults with comorbid conditions. Postdischarge follow-up and subsequent utilization were examined among adults enrolled in North Carolina Medicaid who were discharged with claims-based diagnoses of depression or schizophrenia and not readmitted within 30 days. A total of 24,934 discharges (18,341 individuals) in fiscal years 2008-2010 were analyzed. Follow-up was categorized as occurring within 0-7 days, 8-30 days, or none in 30 days. Outcomes in the subsequent six months included psychotropic medication claims, adherence (proportion of days covered), number of hospital admissions, emergency department visits, and outpatient visits. Follow-up within seven days was associated with greater medication adherence and outpatient utilization, compared with no follow-up in 30 days. This was observed for both follow-up with a mental health provider and with any provider. Adults receiving mental health follow-up within seven days had equivalent, or lower, subsequent inpatient and emergency department utilization as those without follow-up within 30 days. However, adults receiving follow-up with any provider within seven days were more likely than those with no follow-up to have an inpatient admission or emergency department visit in the subsequent six months. Few differences in subsequent utilization were observed between mental health follow-up within seven days versus eight to 30 days. For patients not readmitted within 30 days, follow-up within 30 days appeared to be beneficial on the basis of subsequent service utilization.

Provincially Funded Insulin Pump Therapy and Health Care Utilization In Adults with Type 1 Diabetes

Provincially Funded Insulin Pump Therapy and Health Care Utilization In Adults with Type 1 Diabetes