Levels Of Health Care Utilization Research Articles

Unexpected Journeys: Investigating Urgent and Emergency Care Trends of Patients Attending a Community Specialist Team for Older Adults

Abstract Background Transitions of care for older people via ICPOP and Urgent and Emergency Care (UEC) pathways are becoming more complex. Demand for unscheduled care for older adults with complex care needs will increase with an ageing society, requiring proactive case management and practical realisation of integrated care pathways. Methods Retrospective analysis of UEC presentations of older patients attending a community specialist team (CST) who underwent Comprehensive Geriatric Assessment (CGA) between January-July 2023. Demographics and functional status [Clinical Frailty Score (CFS), Barthel Index (BI), Lawton-Brody Score (IADL), Montreal Cognitive Assessment (MOCA)] were extracted, along with UEC presentations post-CGA until March 2024. Results 356 patients underwent CGA and 42% (n=148) had subsequent unscheduled care attendance(s). Of those with an UEC attendance 36% (n=54) lived alone. Median functional scores were: CFS 5, BI 17, IADL 3, MOCA 17. Median time to UEC presentation was 100 days since CGA. There were 283 UEC interactions in total. 39% (n=58) had >1 interaction. 73% (n=206) of interactions resulted in acute hospital admissions, 21% (n=58) were ED visits, and 6% (n=19) were Pathfinder interactions. Falls (31%) and infection (19%) were the leading causes for presentation. Of 206 admissions, 61% were admitted under medical specialties, 26% under Geriatric Medicine, and 13% under Surgery. Average hospital stay was 13 days. 65% (n=134), were discharged home, 11% (n=22) to transitional care beds, 7% (n=15) to rehabilitation, 7% (n=14) to nursing home, 3% (n=5) transferred to other hospitals, 7%(n=15) died. Conclusion Over half of patients attending a CST had an UEC presentation, reflecting the complexity of this cohort and their level of healthcare utilisation. Case management roles that complement and pull together existing elements of the older persons pathway are lacking across healthcare settings and are fundamental to successful implementation of a patient-centred age friendly health system.

The impact of adenotonsillectomy on healthcare utilization in children with obstructive sleep apnea: Experience of an integrated medical model

Background and objectivesStudies suggest that children with obstructive sleep apnea (OSA) have increased healthcare utilization patterns in comparison to matched controls. However, the effect of adenotonsillectomy (AT) on utilization patterns in these children is poorly understood. Additionally, no previous studies have compared the effect of AT on healthcare utilization patterns across different OSA severity groups. The aim of this retrospective cohort study is to assess the effects of surgical treatment on the level of healthcare utilization among children with OSA at a large integrated multicenter healthcare system. MethodsRetrospective analysis was performed of children aged 3–12 diagnosed with OSA via an attended polysomnogram (PSG) between December 2016 and February 2019. Demographic variables including age (at time of PSG), body mass index (BMI), race, and ethnicity were obtained. Variables for healthcare utilization were assessed for 12 months prior to PSG, and for 12 months after PSG (or after AT, delayed for the first 30 days after surgery to account for surgery-related visits). Healthcare utilization variables assessed included the total number of outpatient visits, inpatient, and emergency department (ED) visits, visits involving diagnostic codes associated with upper respiratory infection (URI), otitis media (OM), and allergic rhinitis (AR), prescription data involving intranasal steroids or leukotriene receptor antagonists (LTRA), and communication data such as secure message load and specialty referrals. Repeated measure linear difference-in-difference (D-I-D) models were used to assess the causal impact of AT on healthcare utilization outcomes. Sensitivity analyses were performed using modeling with a Poisson distribution and as an unadjusted model, with statistical significance set to p < 0.05. ResultsAnalysis elicited 577 children identified with OSA. Of these, 336 (58.2 %) underwent observation while 241 (41.8 %) underwent AT. The mean age was 6.4 years, with a slight male predominance (60.5 %). Analysis of baseline healthcare utilization patterns revealed that the treatment group had a significantly higher number of baseline inpatient/ED visits and OM visits in comparison to the observation group, but no differences in regards to baseline outpatient visits, or in visits involving URI or AR.Analysis of the entire OSA cohort via D-I-D modelling showed a significantly larger reduction in outpatient visits, secure messages, specialty referrals, and the use of intranasal steroid and LTRA in the treatment group compared to the observation group. Stratification of children based on OSA severity showed that the significant differences in healthcare utilization attributed to surgical treatment were primarily driven by the severe OSA group. Children with severe OSA who underwent AT showed significant reductions in most variables including outpatient visits, inpatient/ED visits, and OM visits. Alternatively, the only significant reductions in healthcare utilization among children with mild OSA treated with AT were in AR visits, intranasal steroid use, and LTRA use. Pattern changes among children with moderate OSA compared similarly to those with mild OSA. ConclusionTo the authors’ knowledge this study represents the largest available study assessing the impact of AT on healthcare utilization in children with OSA that also considers the effect of OSA severity on utilization patterns. AT appears to decrease healthcare utilization patterns, particularly in children with severe OSA. Alternatively, children with mild or moderate OSA treated with AT had only modest reductions in healthcare utilization patterns.

High dimensional predictions of suicide risk in 4.2 million US Veterans using ensemble transfer learning

We present an ensemble transfer learning method to predict suicide from Veterans Affairs (VA) electronic medical records (EMR). A diverse set of base models was trained to predict a binary outcome constructed from reported suicide, suicide attempt, and overdose diagnoses with varying choices of study design and prediction methodology. Each model used twenty cross-sectional and 190 longitudinal variables observed in eight time intervals covering 7.5 years prior to the time of prediction. Ensembles of seven base models were created and fine-tuned with ten variables expected to change with study design and outcome definition in order to predict suicide and combined outcome in a prospective cohort. The ensemble models achieved c-statistics of 0.73 on 2-year suicide risk and 0.83 on the combined outcome when predicting on a prospective cohort of ∼\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\sim$$\\end{document} 4.2 M veterans. The ensembles rely on nonlinear base models trained using a matched retrospective nested case-control (Rcc) study cohort and show good calibration across a diversity of subgroups, including risk strata, age, sex, race, and level of healthcare utilization. In addition, a linear Rcc base model provided a rich set of biological predictors, including indicators of suicide, substance use disorder, mental health diagnoses and treatments, hypoxia and vascular damage, and demographics.

Choice of high-deductible health plans among enrollees with a substance use disorder

IntroductionHigh-deductible health plans (HDHPs) expose enrollees to increased out-of-pocket costs for their medical care, which can exacerbate the undertreatment of substance use disorders (SUDs). However, the factors that influence whether an enrollee with SUD chooses an HDHP are not well understood. In this study, we examine the factors associated with an individual with an SUD’s decision to enroll in an HDHP. MethodsUsing de-identified administrative commercial claims and enrollment data from OptumLabs (2007–2017), we identified individuals at employers offering at least one HDHP and one non-HDHP plan. We modeled whether an enrollee chose an HDHP using linear regression on plan and enrollee demographic characteristics. Key plan characteristics included whether a plan had a health savings account (HSA) or a health reimbursement arrangement (HRA). Key demographic variables included age, race/ethnicity, census block income range, census block highest educational attainment, and sex. We separately investigate new enrollment decisions (i.e., not previously enrolled in an HDHP) and re-enrollment decisions, as well as decisions among single enrollees and families of differing sizes. The study also adjusted models for additional plan characteristics, employer and year fixed effects, and census division. Robust standard errors were clustered at the employer level. ResultsThe sample comprised 30,832 plans and 318,334 enrollees. Among enrollees with new enrollment decisions, 24.6 % chose an HDHP; 93.8 % of HDHP enrollees chose to re-enroll in an HDHP. The study found the presence of a plan HRA to be associated with a higher probability of new and re-enrollment in an HDHP. We found that older enrollees with SUD were less likely to newly enroll in an HDHP, while enrollees who were non-White, living in lower-income census blocks, and living in lower educational attainment census blocks were more likely to newly enroll in an HDHP. Higher levels of health care utilization in the prior year were associated with a lower probability of newly enrolling in an HDHP but associated with a higher probability of re-enrolling. ConclusionGiven the emerging evidence that HDHPs may discourage SUD treatment, greater HDHP enrollment could exacerbate health disparities.

Caregivers' willingness to use integrated medical care in regional hospital in northern Taiwan

&lt;p&gt;目的：探討北部某區域醫院附設居家護理所之個案，影響參加居家醫療服務的相關因素。方法：橫斷性研究設計，使用Andersen所提出醫療利用性模式為架構，於2021年9至10月對居家護理個案主要決策之照顧者共91位進行結構式問卷，內容為：被照顧者及照顧者基本資料、居家醫療整合照護認知、照顧者知覺量表、照顧者負荷量表。統計方法為描述性統計、t檢定、Anova檢定、卡方檢定、皮爾森積差相關分析與多元邏輯斯迴歸分析。結果：不同的固定就醫場所與參加居家醫療呈統計上顯著差異。照顧者壓力生理負荷對壓力心理與社會負荷有高度正相關，壓力財務負荷對壓力生理、心理與社會負荷有中度正相關，壓力心理負荷與壓力社會負荷有高度正相關。影響居家醫療整合照護之預測因子為固定就醫場所。結論：本研究結果促使因素中個案有固定就醫場所，參加居家醫療整合照護服務達顯著相關。有無固定的就醫場所是消費者對組織易接近或熟悉的地方，常被用來預測醫療服務利用度的高低，有固定就醫地點、醫師，能有連續性及協調性的照護。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Objective: To investigate a case of a home care center attached to regional hos-pital in northern Taiwan, and to explore the relevant factors affecting participation in home medical integrated care. Methods: Using cross-sectional study design, a struc-tured questionnaire was administered to 91 caregivers who were the primary decision makers in home care cases from September 2021 to October 2021 using the model proposed by Andersen as a framework, with the following content: basic information about the care recipient and caregiver, home health integrated care perception, care-giver perception scale, caregiver burden scale. The statistical methods were descriptive statistics, t-test, ANOVA, chi-square, Pearson’s product correlation analysis, and multivariate logistic regression analysis. Results: Statistically significant differences were found between different fixed health care settings and participation in integrated home health care. Caregivers stress physiological load was highly positively correlated with stress psychological and social load, stress economic load was moderately positively correlated with stress physiological, psychological and social load, and stress psychological load was highly positively correlated with stress social load. The predictor of integrated home medical care is the fixed location. Conclusion: The re-sults of this study showed that there was a significant correlation between the pres-ence of a fixed medical site and the participation of home medical integrated care. The availability of a fixed health care site is a site that is familiar to consumers and is often used to predict the level of health care utilization. The presence of a regular home medical integrated care.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review

IntroductionParticipation in lung cancer screening (LCS) is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of health care utilization (through structurally inaccessible care) leading to a widening of health inequities. MethodsWe conducted a scoping review using the Arksey and O’Malley methodological framework to inform equitable access to LCS by illuminating knowledge and implementation gaps in interventions designed to increase the uptake of LCS. We comprehensively searched for LCS interventions (Ovid Medline, Excerpta Medica database, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus from 2000 to June 22, 2021) and included peer-reviewed articles and gray literature published in the English language that describe an intervention designed to increase the uptake of LCS, charted data using our previously published tool and conduced a health equity analysis to determine the intended-unintended and positive-negative outcomes of the interventions for populations experiencing the greatest inequities. ResultsOur search yielded 3572 peer-reviewed articles and 54,292 pieces of gray literature. Ultimately, we included 35 peer-reviewed articles and one gray literature. The interventions occurred in the United States, United Kingdom, Japan, and Italy, focusing on shared decision-making, the use of electronic health records as reminders, patient navigation, community-based campaigns, and mobile computed tomography scanners. We developed an equity-oriented LCS framework and mapped the dimensions and outcomes of the interventions on access to LCS on the basis of approachability, acceptability, availability, affordability, and appropriateness of the intervention. No intervention was mapped across all five dimensions. Most notably, knowledge and implementation gaps were identified in dimensions of acceptability, availability, and affordability. ConclusionsInterventions that were most effective in improving access to LCS targeted priority populations, raised community-level awareness, tailored materials for sociocultural acceptability, did not depend on prior patient engagement/registration with the health care system, proactively considered costs related to participation, and enhanced utilization through informed decision-making.

Impact of the Introduction of a Public Taxi Ride in Rural South Korea on Levels of Healthcare Utilization among Elderly Patients with Diabetes

Introduction: A nine-cent public taxi ride service was introduced to improve public transportation in the rural county of Seocheon, which has an ageing population. This study investigated the effect of this policy on the levels of healthcare utilization in individuals with diabetes aged 65 years or above. Methods: The Korea National Health Insurance System claims data from January 2006 to May 2013 (pre-intervention) and June 2013 to December 2014 (post-intervention) were used. The treatment group consisted of patients residing in Seocheon, and the control group consisted of patients residing in neighbouring areas with a similar demographic composition. The difference-in-difference approach was used to estimate differences in levels of healthcare utilization between the treatment and control groups before and after the intervention period. Results: The introduction of public taxi transportation service was associated with an increase in outpatient visits. Specifically, the number of outpatient visits to public health centres increased, whereas those to tertiary hospitals decreased. The number of inpatient visits to general hospitals also increased. Conclusion: The results of this study confirm a relationship between the introduction of public taxi transportation services and increased healthcare utilization in older patients with diabetes in rural areas. These findings are noteworthy considering the importance of continuous care in managing chronic diseases.

State Immigration Policy Contexts and Racialized Legal Status Disparities in Health Care Utilization Among U.S. Agricultural Workers.

Research links restrictive immigration policies to immigrant health and health care outcomes. Yet most studies in this area focus on the impact of single policies in particular years, with few assessing how broader state-level immigration policy contexts affect groups by nativity, race/ethnicity, and legal status. Linking data from the National Agricultural Workers Survey (2005-2012) with information on state immigration policies, we use an intersectional approach to examine the links between policy contexts and health care utilization by nativity, race/ethnicity, and legal status. We also assess the associations between two specific types of state immigration policies-those governing immigrant access to Medicaid and driver's licenses-and health care utilization disparities. We find that state-level immigration policy contexts are associated with health care utilization among U.S.-born and naturalized U.S. citizen non-White Latinx agricultural workers, who report lower levels of health care utilization and greater barriers to care-seeking in more restrictive policy contexts. By contrast, we find little evidence that state policies shaped health care utilization among undocumented workers. These findings advance understanding of the impact of "policies of exclusion" on the lives of marginalized groups and underscore the importance of racialized legal status in considering the links between sociopolitical contexts and health and health care disparities.

Vital Signs: Use of Recommended Health Care Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents - Selected U.S. States, 2019.

IntroductionSickle cell disease (SCD), a group of inherited blood cell disorders that primarily affects Black or African American persons, is associated with severe complications and a >20-year reduction in life expectancy. In 2014, an expert panel convened by the National Heart, Lung, and Blood Institute issued recommendations to prevent or reduce complications in children and adolescents with the most severe SCD subtypes, known as sickle cell anemia (SCA); recommendations included 1) annual screening of children and adolescents aged 2–16 years with transcranial Doppler (TCD) ultrasound to identify those at risk for stroke and 2) offering hydroxyurea therapy to children and adolescents aged ≥9 months to reduce the risk for several life-threatening complications.MethodsData from the IBM MarketScan Multi-State Medicaid Database were analyzed. TCD screening and hydroxyurea use were examined for 3,352 children and adolescents with SCA aged 2–16 years and continuously enrolled in Medicaid during 2019. Percentage change during 2014–2019 and variation by health subgroups were assessed. Analyses were stratified by age.ResultsDuring 2014–2019, TCD screening increased 27% among children and adolescents aged 10–16 years; hydroxyurea use increased 27% among children aged 2–9 years and 23% among children and adolescents aged 10–16 years. However, in 2019, only 47% and 38% of children and adolescents aged 2–9 and 10–16 years, respectively, had received TCD screening and 38% and 53% of children and adolescents aged 2–9 years and 10–16 years, respectively, used hydroxyurea. For both prevention strategies, usage was highest among children and adolescents with high levels of health care utilization and evidence of previous complications indicative of severe disease.Conclusion and Implications for Public Health PracticeDespite increases since 2014, TCD screening and hydroxyurea use remain low among children and adolescents with SCA. Health care providers should implement quality care strategies within their clinics and partner with patients, families, and community-based organizations to address barriers to delivering and receiving recommended care.

Childhood Obesity and Health Care Utilization: Empirical Evidence from Austrian Administrative Data.

Background: Increases in pediatric obesity have been associated with higher levels of health care utilization. There is currently a lack of knowledge on the therapeutic drivers of increased health care use. Objective: To examine the association between different measures of health care utilization and BMI among children. Methods: We linked cross-sectional administrative data from a regional health insurance fund in Austria with objectively measured BMI from routine school health examinations in 6-15-year-old children (n = 13,493). Differences in probabilities of annual health care utilization (drug prescriptions by therapeutic classification, physician visits by medical specialty, and hospitalizations) were compared between children with normal weight, overweight, or obesity using Probit regressions. Results: Children with obesity had a 1.6 and 8.6 percentage points (pp) higher probability of outpatient doctor visits and prescribed medication, respectively (all p < 0.05). Children with overweight were intermediate. There was a higher probability of consulting a general practitioner, pediatrician, or orthopedist, and higher levels of prescribing for children with obesity across most common drug groups. Children with obesity were ∼40% more likely to receive medication for musculoskeletal and for mental health problems. This was reflected in orthopedic clinic appointments but not in psychology clinics. There were no major differences by gender or age, or parental socioeconomic status. Conclusions: Our data show clear and objective evidence of higher health care utilization by children with obesity. This highlights the importance of policy interventions to curb obesity in children and young people.

The COVID-19 Pandemic and Ophthalmic Care: A Qualitative Study of Patients with Neovascular Age-Related Macular Degeneration (nAMD).

Concerns have been expressed about the relationship between reduced levels of health care utilisation and the COVID-19 pandemic. This study aimed to elicit and explore the views of patients with neovascular age-related macular degeneration (nAMD) regarding the COVID-19 pandemic and their ophthalmic care. Semi-structured telephone interviews were conducted with thirty-five patients with nAMD taking part in a larger diagnostic accuracy study of home-monitoring tests. Participants were recruited using maximum variation sampling to capture a range of key characteristics including age, gender and time since initial treatment. Transcribed interview data were analysed using a deductive and inductive thematic approach. Three themes emerged from the analysis: i. access to eye clinic care. ii. COVID-19-mitigating factors and care delivery and iii. social and personal circumstances. Participants reported anxieties about cancelled or delayed appointments, limited communication from clinic-based services about appointments, and the impact of this on their ongoing care. Despite these concerns, there was apprehension about attending appointments due to infection risk and a perception that nAMD patients are a ‘high risk’ group. Views of those who attended clinics during the study period were, however, positive, with social distancing and infection control measures providing reassurance. These findings contribute to our understanding about experiences of patients with nAMD during the COVID-19 pandemic and may have potential implications for future planning of care services in similar circumstances. Innovative approaches may be required to address issues related to access to care, including concerns about delayed or cancelled appointments.

The association of cancer diagnosis with frailty status in high need, high risk veterans.

e24024 Background: Frailty, a common geriatric condition, is characterized by a vulnerability to stressors caused by multisystem dysfunction associated with poor clinical outcomes. Patients with frailty are often High-Need High-Risk (HNHR), a group with higher levels of healthcare utilization. Cancer diagnosis could increase the incidence of frailty in this group by several mechanisms: immunosenescence, chronic inflammation, potentially harmful effects of therapies and associated comorbidities. The study aim was to determine the cross-sectional association of cancer with frailty status in High Need, High Risk veterans. Methods: This was a cross-sectional study of HNHR Veterans in the Veterans Integrated Service Network 8 identified through quarterly reports run by VA predictive analytic models. We compared Veterans with and without cancer in terms of frailty status, sociodemographic characteristics, substance or alcohol abuse and number of medications. Frailty was defined using a 30-item VA Frailty Index (VA-FI, excluding cancer) generated as a proportion based on the number of items present. We compared non-frail (robust = 0–0.1, and pre-frail = 0.11–0.20), and frail (mild = 0.21–0.30, moderate = 0.31–0.40, and severe = &gt; 0.4). After adjusting for gender, age, alcohol abuse, tobacco abuse and number of medications, we performed a multinomial logistic regression using odds ratios (OR) with 95% confidence intervals (CI) with cancer as the independent variable and frailty status as the dependent variable. Results: A total of 10916 Veterans were included in the analysis, mean age 68.5 (SD = 11.8) years, 93.4% male, 74.7% Caucasian, 18.0% Black, 7.4% Hispanic, 8710 (79.8%) frail and 3641 (36.1%) had Cancer. Of those with cancer, frail = 3358 (85.2%) vs. non-frail = 583 (14.8%) (p &lt; .0001). After multivariate multinomial logistic regression, the presence of cancer was associated with being severely frail as compared to robust, adjusted OR:2.3(95%C.I.:1.8-2.9), p &lt; 0.0001. Conclusions: In this HNHR veteran population, cancer had a positive, cross-sectional association with frailty. Identifying HNHR patients with cancer may assist clinicians in the implementation of targeted clinical interventions that may prevent or reverse frailty status and associated poor clinical outcomes. More research is needed to better determine the impact of cancer on frailty diagnosis.

Abstract PO-262: Interventions designed to increase the uptake of lung cancer screening and implications for populations experiencing the greatest burden of lung cancer disparities: A scoping study

Abstract Background: Lung cancer screening (LCS) with low-dose CT can reduce mortality due to lung cancer by detecting early-stage tumours that are amenable to treatment. Participation in LCS programs however has not been equally distributed among at-risk groups, such that populations with the highest burden of lung cancer risk (through the social patterning of smoking behaviour) and lowest levels of healthcare utilization (through care which is structurally inaccessible) can experience a widening in healthcare disparities as a result of LCS interventions. Approach: We sought to inform equitable access to LCS by illuminating knowledge and implementation gaps in current interventions designed to increase the uptake of LCS. To do this, we conducted a scoping study using the Arksey and O'Malley methodological framework. We conducted comprehensive searches for lung cancer screening promotion interventions (Ovid Medline, Embase, the Cochrane Library, CINAHL and Scopus) and included published English language peer-reviewed and grey literature published between January 2000 and 2020 that describe an intervention designed to increase the uptake of LDCT lung cancer screening in the Organization for Economic Cooperation and Development (OECD) countries. We extracted data onto a chart modified from the Template for Intervention Description and Republication (TIDieR) checklist and the Consolidated Standards of Reporting Trials. We used the Health Equity Impact Assessment (HEIA) tool to analyse the intended/unintended and positive/negative outcomes of the interventions for populations experiencing the greatest disparities. Results: Our search yielded 2681 articles. We included 22 peer review articles dated from January 2000 to January 2020. Interventions occured primarily in the USA, Europe and Canada. We used the ‘Patient Centered Access to Healthcare' conceptual framework by Khanassov et al 2016 to synthesize our findings. Three main themes summarise current interventions designed to increase the uptake of LCS: (i) a focus on individuals and their ability to engage with the healthcare system; (ii) inadequate targeting of populations experiencing greatest disparities and (iii) a lack of conceptual underpinning in the design of interventions so that the social patterning of lung cancer risk and ability to access care is ignored. Conclusion: LCS interventions must take into consideration the disproportionate burden of lung cancer risk in populations experiencing social disadvantage. Designing interventions that are cognisant of the social distribution of risk and targeted to support the uptake in high-risk populations can prevent an inadvertent widening of health disparities. Citation Format: Ambreen Sayani, Muhanad Ahmed Ali, Pooja Dey, Ann Marie Corrado, Carolyn Ziegler, Alex Sadler, Christina Williams, Aisha Lofters. Interventions designed to increase the uptake of lung cancer screening and implications for populations experiencing the greatest burden of lung cancer disparities: A scoping study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-262.

OUD Overdose, Suicide Risk in Veterans Four Times Higher Without Buprenorphine

Back to table of contents Previous article Next article Clinical & ResearchFull AccessOUD Overdose, Suicide Risk in Veterans Four Times Higher Without BuprenorphineTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:24 Aug 2021https://doi.org/10.1176/appi.pn.2021.8.23AbstractMost suicide/overdose deaths among veterans with opioid use disorder who do not take buprenorphine involve prescription or illicit opioids.Veterans with opioid use disorder (OUD) who do not receive treatment with buprenorphine are more than four times as likely to die by suicide or overdose than those who do take the medication, a study in the American Journal of Preventive Medicine has found.If patients with OUD stop buprenorphine treatment because of a relapse or other unplanned discontinuation, the care team should work toward re-engaging them, says Priyanka Vakkalanka, Ph.D.University of Iowa/Thomas LangdonPriyanka Vakkalanka, Ph.D., an assistant research scientist in the Department of Emergency Medicine at University of Iowa Hospitals and Clinics in Iowa City, and colleagues analyzed the records of more than 29,000 veterans who were diagnosed with OUD and treated with buprenorphine in the Veterans Health Administration (VHA) system between January 1, 2008, and December 31, 2017. The researchers measured a combined outcome of death by suicide and overdose, noting that they grouped suicide and overdose together because it is not always clear whether an overdose is intentional. They were able to determine from the veterans’ records whether those who died had been actively taking buprenorphine at the time of death.Over five years of follow-up, 964 of the veterans in the study died of suicide/overdose. Among these deaths, 89.9% involved overdose (some of the deaths were documented as suicide but not overdose), and 71% of overdose deaths involved a prescription or illicit opioid. On any given day during follow-up, the risk of suicide/overdose death was 4.33 times greater in veterans with OUD who were not taking buprenorphine compared with those who were, even after accounting for those who might have been taking other medication treatment such as methadone.“Perhaps one explanation [for this result] is that the medication works, and this work supports the growing body of literature out there about the long-term benefits of medications for OUD management,” Vakkalanka told Psychiatric News. “Additionally, maybe those who were getting pharmacotherapy treatment for OUD were also accessing other mental health services such as counseling or even primary care appointments for preventive health measures. While that was not something we investigated in this work, it might be of interest to explore how there might be different levels of health care utilization that could also be impacting long-term survival outcomes.”The risk of suicide/overdose appeared to be greatest 8 to 14 days after treatment with buprenorphine was discontinued, but Vakkalanka said that this result should be interpreted with caution.“It may be that the longer half-life of buprenorphine helps and that there is a sustained protective effect in the first few days,” she said.Comorbid psychiatric conditions were common among the entire study population. More than 73% of veterans were diagnosed with depression, more than 60% were diagnosed with anxiety disorders, and more than 50% were diagnosed as having more than one substance use disorder.“Like with the general population, OUD [among veterans] is not an isolated issue. There may be additional mental health conditions that may also need to be managed or treated along with OUD,” Vakkalanka said. “Veterans in particular may represent a unique population that has some additional challenges, including physical and mental trauma, chronic pain and injury, and higher rates of homelessness.”Vakkalanka noted several ways of helping veterans who take buprenorphine for OUD.“It might be important to offer counseling services, increase access and availability of treatment, and reduce any stigma associated with care management,” she said. “If a discontinuation of medication occurs, there should be good communication, support, and follow-up between the care team and the veteran. If [patients] stop treatment because of a relapse or other unplanned discontinuation, the care team should work toward re-engaging them or helping them.”This study was supported by the National Institute on Drug Abuse, the Centers for Disease Control and Prevention/National Institute of Occupational Health and Safety, the Heartland Center for Occupational Health and Safety, and the Department of Veterans Affairs Health Care System. ■“Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk” is posted here. ISSUES NewArchived

Children's education and level of health care utilization among parents: a pooled cross-sectional study from national population-based survey in India.

The study of upward spill over on parents of their offspring's education is vital for understanding the family dynamics and role of adult children in the decisions of parents. Such association has widespread implication and application on ageing policies. We use pooled data frompopulation-based cross-sectional health consumption surveys conducted by the National Sample Survey Organization in 2014 and 2018 (rounds 71 and 75, respectively) in this study. The analysis is restricted to individuals aged 60 and above, who are head of the household or their spouse and have children aged 25years or above. The analysis is carried out for inpatient and outpatient cases separately. For inpatient analysis, the dependent variable is designed as a rank variable representing an increasing level of health care utilization. For the same partial proportional odds are calculated. For outpatient cases, the dependent variable is binary that takes the value 0 if the parents use public facilities and 1 if private facilities are used. Here, binary logistic regression is used for analysis. The odds of parents using a higher level of inpatient as well as outpatient health care are higher for those with better-educated children (inpatient: OR are 2.6 (p < 0.001, CI: 2.0-3.5); outpatient: OR are 1.5 (p < 0.001, CI: 1.1-2.2)). Education of children does influence the level of health care utilization among parents. Therefore, policy interventions can target offspring of working age group, who can assimilate information better and transfer it to their parents.

Health profiles of adults with autism spectrum disorder: Differences between women and men.

The purpose of the present study was to investigate the hypothesis that women with autism have poorer health compared with men with autism, and compared with women without autism. Utilizing electronic health records drawn from a single health care system serving over 2 million individuals, 2119 adults with diagnosed autism spectrum disorders were compared with age- and sex-matched controls. When considering health care utilization, we found evidence of multiplicative risk for conditions within some domains (i.e., nutrition conditions, neurologic disease, psychiatric conditions, and sleep disorders) such that women with autism spectrum disorder (ASD) experienced double jeopardy-meaning they had greater rates of health care utilization within a domain than what would separately be expected by virtue of being a woman and having ASD. For other domains (i.e., endocrine disorders, gastrointestinal disorders), the risk was additive such that being a female and having ASD were both associated with higher health care utilization, but there were no significant interaction effects. It was only with respect to one domain (cardiovascular) that rates of health care utilization were reflective of neither ASD diagnosis nor sex. Overall, our findings suggest that women with ASD are a vulnerable subgroup with high levels of health care utilization. LAY SUMMARY: This study asked whether women with autism have poorer health compared with men with autism, and compared with women without autism. To answer this question, we used data from electronic health records. We found that women with autism spectrum disorder (ASD) were at the greatest risk for health problems such as nutrition conditions, neurologic disease, psychiatric conditions, and sleep disorders. More research on health of women with ASD is needed.

Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

BackgroundMultimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE).MethodsWe conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE.ResultsOverall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07–0.14 for outpatient care and coefficient 0.09 (95% CI 0.02–0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4–42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5–1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9–46.2).ConclusionMultimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation.

Preoperative Heart Failure Treatment Prevents Postoperative Cardiac Complications in Patients With Lower Risk: A Retrospective Cohort Study.

The objective of this study was to identify undertreated subgroups of patients with heart failure who would benefit from better perioperative optimization. Patients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery. In this analysis of hospital registry data of 130,677 patients undergoing noncardiac surgery, the exposure was preoperative history of heart failure. The outcome, cardiac complications, was defined as a composite of myocardial infarction, cardiac arrest, acute heart failure, and mortality within 30 postoperative days. History of heart failure (n = 10,256; 7.9%) was associated with increased risk of cardiac complications [8.1% vs 1.1%; adjusted odds ratio, 2.28 (95% CI, 2.02-2.56); P < 0.001). Patients with heart failure and who carried a lower risk profile had increased risks of postoperative cardiac complications secondary to heart failure [adjusted absolute risk difference, 1.7% (95% CI, 1.4%-2.0%, lower risk); P < 0.001 vs 0.5% (95% CI, -0.6% to 1.6%, higher risk); P = 0.38]. Patients with heart failure and lower risk received a lower level of health care utilization preoperatively, and less frequently received anti-heart failure medications (59% vs 72% and 61% vs 82%; both P < 0.001). These preventive therapies significantly decreased the risk of cardiac complications in patients with heart failure. In patients with heart failure who have a lower preoperative risk profile, clinicians often make insufficient attempts to optimize their clinical condition preoperatively. Preoperative preventive treatment reduces the risk of postoperative cardiac complications in these lower-risk patients with heart failure.

Geriatric syndromes and subsequent health-care utilization among older community dwellers in Stockholm

Little is known about the long-term effect of geriatric syndromes on health-care utilization. This study aims to determine the association between geriatric syndromes and health-care utilization during a four-year period among older community dwellers. Based on the Stockholm Public Health Cohort study, a total number of 6700 community dwellers aged ≥65 years were included. From a baseline survey in 2006, geriatric syndromes were defined as having at least one of the following: insomnia, functional decline, urinary incontinence, depressive symptoms and vision impairment. Health-care utilization was identified by linkages at individual level with register data with a four-year follow-up. Cox regression was performed to estimate the associations. Compared to those without geriatric syndromes, participants with any geriatric syndromes had a higher prevalence of frequent hospitalizations, long hospital stays, frequent outpatient visits and polypharmacy in each of the follow-up years. After controlling for covariates, having any geriatric syndromes was associated with higher levels of utilization of inpatient and outpatient care as well as polypharmacy. The association was stable over time, and the fully adjusted hazard ratio (95% confidence interval) remained stable in frequent hospitalizations (from 1.89 [1.31, 2.73] in year 1 to 1.70 [1.23, 2.35] in year 4), long hospital stay (from 1.75 [1.41, 2.16] to 1.49 [1.24, 1.78]), frequent outpatient visits (from 1.40 [1.26, 1.54] to 1.33 [1.22, 1.46]) and polypharmacy (from 1.63 [1.46, 1.83] to 1.53 [1.37, 1.71]). Having any geriatric syndromes is associated with higher levels of health-care utilization among older community dwellers, and the impact of geriatric syndromes is stable over a four-year period.

The Covid Impact to Public Healthcare Utilization Among Urban Low-Income Subsidized Community in Klang Valley Malaysia.

Background:Appropriate level of healthcare utilization is one of the aims in translating health system inputs into improving the outcome of population health. Healthcare utilization services in Malaysia remains relatively low as compared to the rate in most high-income countries and some gaps exist across socioeconomic status. After the financial handouts deemed Household Living Aid (HLA) to low-income earners, Malaysia has recently implemented a financial health protection scheme toward for low-income group known as PeKa B40 to improve their access for healthcare services. This study aims to determine the healthcare utilization among the low-income population living in urban Klang Valley, and to explore the relationship between healthcare utilization with the demographic characteristics of this population.Material and Methods:A cross-sectional study using face to face structured questionnaire. All 447 respondents included were low-income earners enrolled in the HLA. Chi-square analysis and multiple logistic regression were used to examine association between the risk factors and healthcare utilization.Results:The response rate was 93.5%. The healthcare utilization among the respondents during the partial lockdown period was 19.5% and 33.1% during the recovery lockdown period. Enrollment in the PeKa B40 scheme among the 7.6% respondents was not associated with healthcare utilization. After controlling for the variables, those aged 60 years and above [AOR: 1.87; 95% (CI): (1.07; 3.27)], self-rated poor health status [AOR: 2.16; 95% (CI): (1.07; 4.34)], having NCDs [AOR: 4.21; 95% (CI): (2.23; 7.94)], and being hospitalized in the past 12 months [AOR: 3.54; 95% (CI): (1.46; 8.62)], were more likely to utilize healthcare services as compared to their counterparts.Conclusion:The results from this study is valuable for policy recommendations to improve on the coverage of the PeKa B40 scheme and healthcare access for the low-income population especially during the pandemic.