Health-related Resource Use Research Articles

Association between physical activity and costs in very mild to moderately frail community-dwelling older adults: a cross-sectional study.

Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.

Meaningful benefit of disease-modifying treatment: Evaluating changes in health-related resource use.

Are reductions in the rate of decline from the new disease-modifying treatments (DMTs) in early Alzheimer's disease (AD) meaningful? We examined whether such reductions may be reflected in changes in health-related resource use. Patients with Clinical Dementia Rating (CDR) = 0.5 or 1 with a clinical diagnosis of mild cognitive impairment or AD, reflecting clinical trial populations. Health-related resource use was reported using the Resource Use Inventory (RUI) including direct medical care, non-medical care, unpaid informal care, and time use. Faster decline in CDR-Sum of Boxes (CDR-SB) from baseline was independently associated with higher likelihood and hours of informal care received, and lower likelihood of employment/volunteer work, but not with direct medical care. Reductions in the rate of decline in CDR-SB seen from DMTs significantly affect patients' work capacity and need for informal care, indicators of economic impact meaningful to patients, families, and health systems. These measures are not readily captured in administrative data sets. Following a cohort of participants with MCI or mild dementia due to AD that mimics participants targeted for AD trials, this study showed slower decline in CDR-SB have significant effects on patients' work capacity and need for informal care, but not on their direct medical care utilization such as hospitalizations, ED use, and doctors' visits.Capturing potential benefits in health-related resource use may require direct measures of informal care and work/volunteer effort which are meaningful outcomes to patients, families and health systems.Caution is needed in our effort to assess benefits of recently developed disease modifying treatment in AD using electronic health records and administrative data from which utilization of direct medical care are routinely collected as these data sources may not capture the most apparent changes in resource utilization during early disease stages.

Costs associated with insufficient physical activity in Germany: cross-sectional results from the baseline examination of the German national cohort (NAKO).

Insufficient physical activity (PA) is a leading risk factor for non-communicable diseases posing a significant economic burden to healthcare systems and societies. The study aimed to examine the differences in healthcare and indirect costs between sufficient and insufficient PA and the cost differences between PA intensity groups. The cross-sectional analysis was based on data from 157,648 participants in the baseline examination of the German National Cohort (NAKO) study. Healthcare and indirect costs were calculated based on self-reported information on health-related resource use and productivity losses. PA in the domains leisure, transport, and work was assessed by the Global Physical Activity Questionnaire and categorized into sufficient/insufficient and intensity levels (very low/low/medium/high) based on PA recommendations of the World Health Organization. Two-part models adjusted for relevant covariates were used to estimate mean costs for PA groups. Insufficiently active people had higher average annual healthcare costs (Δ €188, 95% CI [64, 311]) and healthcare plus indirect costs (Δ €482, 95% CI [262, 702]) compared to sufficiently active people. The difference was especially evident in the population aged 60 + years and when considering only leisure PA. An inverse association was observed between leisure PA and costs, whereas a direct association was found between PA at work and costs. Adjusting for the number of comorbidities reduced the differences between activity groups, but the trend persisted. The association between PA and costs differed in direction between PA domains. Future research may provide further insight into the temporal relationship between PA and costs.

Patterns of follow-up care in adult blood cancer survivors-Prospective evaluation of health-related outcomes, resource use, and quality of life.

Information about follow-up care in blood cancer survivors is limited. The questionnaire-based "Aftercare in Blood Cancer Survivors" (ABC) study aimed to identify patterns of follow-up care in Germany and compare different types of follow-up institutions. The study's 18-month prospective part compared the follow-up institutions identified in the preceding retrospective part (academic oncologists, community oncologists, primary care physicians). The questionnaires were completed by the follow-up physicians. Of 1070 physicians named by 1479 blood-cancer survivors, 478 (44.7%) consented to participate. For provision of care, most oncologists relied on published guidelines, while most primary care physicians depended on information from other physicians. Survivors with a history of allogeneic transplantation or indolent lymphoma were mainly seen by academic oncologists, whereas survivors with monoclonal gammopathy, multiple myeloma, or myeloproliferative disorders were often seen by community oncologists, and survivors with a history of aggressive lymphoma or acute leukemia by primary care physicians. Detection of relapse and secondary diseases was consistently viewed as the most important follow-up goal. Follow-up visits were most extensively documented by academic oncologists (574 of 1045 survivors cared for, 54.9%), followed by community oncologists (90/231, 39.0%) and primary care physicians (51/203, 25.1%). Relapse and secondary disease detection rates and the patients' quality of life were similar at the three institutions. Laboratory tests were most often ordered by academic oncologists, and imaging by primary care physicians. Psychosocial issues and preventive care were more often addressed by primary care physicians than by oncologists. Patients at high risk of relapse or late complications were preferentially treated by academic oncologists, while patients in stable condition requiring continuous monitoring were also seen by community oncologists, and patients with curable diseases in long-term remission by primary care physicians. For the latter, transfer of follow-up care from oncologists to well-informed primary care providers appears feasible.

Updating standardized unit costs from a societal perspective for health economic evaluation

The aim of this work was to update the 2015 unit costs (UC) for the monetary valuation of health-related resource use from a societal perspective for the years 2019 and 2020 in Germany. The update follows the methodology of Bock et al. 2015. Based on the newly established care levels, UC for care degree 1 to 5 are now provided. To account for change in price trends during the Covid-19 pandemic, average growth rates in UC are shown from 2011-2019 and compared to 2019-2020. Updates of UC for the outpatient medical sector, remedies and aids, hospitals, (in)formal care services, and rehabilitation for 2019 and 2020 are provided. The updated UC can be used as reference values for the monetary valuation of individual resource use in health economic evaluations in Germany.

CycLing and EducATion (CLEAT): protocol for a single centre randomised controlled trial of a cycling and education intervention versus standard physiotherapy care for the treatment of hip osteoarthritis

BackgroundOsteoarthritis (OA) is a chronic degenerative joint disorder for which there is no known cure. Non-surgical management for people with mild-to-moderate hip OA focuses mainly on alleviating pain and maximising function via the National Institute for Health and Care Excellence (NICE) recommended combination of education and advice, exercise, and, where appropriate, weight loss. The CHAIN (Cycling against Hip pAIN) intervention is a group cycling and education intervention conceived as a way of implementing the NICE guidance.MethodsCycLing and EducATion (CLEAT) is a pragmatic, two parallel arm, randomised controlled trial comparing CHAIN with standard physiotherapy care for the treatment of mild-to-moderate hip OA. We will recruit 256 participants referred to the local NHS physiotherapy department over a 24-month recruitment period. Participants diagnosed with hip OA according to NICE guidance and meeting the criteria for GP exercise referral will be eligible to participate. Primary outcome is the difference in Hip Disability and Osteoarthritis Outcome Score (HOOS) function, daily living subscale between those receiving CHAIN and standard physiotherapy care. Secondary outcomes include performance-based functional measures (40 m walking, 30s chair stand and stair climb tests), ability for patient to self-care (patient activation measure) and self-reported health-related resource use including primary and secondary care contacts. The primary economic endpoint is the number of quality adjusted life years (QALYs) at 24 weeks follow-up. The study is funded by the National Institute for Health Research, Research for Patient Benefit PB-PG-0816-20033.DiscussionThe literature identifies a lack of high-quality trials which inform on the content and design of education and exercise in the treatment of patients with hip OA and explore cost-effectiveness. CLEAT is a pragmatic trial which seeks to build further evidence of the clinical benefits of the CHAIN intervention compared to standard physiotherapy care within a randomised, controlled trial setting, and examine its cost-effectiveness.Trial registration numberISRCTN19778222. Protocol v4.1, 24th October 2022.

Protocol for the effectiveness evaluation of an antenatal, universally offered, and remotely delivered parenting programme ‘Baby Steps’ on maternal outcomes: a Born in Bradford’s Better Start (BiBBS) study

BackgroundPoor perinatal mental health and maternal sensitivity towards a child in the early years can carry a long-term cost to individuals and to society, and result in negative child outcomes such as poor mental health and social emotional issues. Despite the recognition of early intervention and prevention, there is mixed evidence regarding antenatal parenting interventions that aim to enhance perinatal mental health and maternal sensitivity to prevent negative child outcomes. ‘Baby Steps’ is a relationship-based antenatal and postnatal parenting programme. The service evaluated in this study is delivered in a low-income and ethnically diverse community via Better Start Bradford.This study aims to assess whether the universally, and remotely delivered Baby Steps programme is effective in improving postnatal maternal sensitivity (primary outcome) and postnatal maternal mental health (secondary outcome) when compared to services as usual 6–10 weeks post-birth. It will also assess differences in birth outcomes, and differences in the prevalence of poor perinatal mental ill health through routine data. The feasibility of collecting cost and health related resource use data for a future economic evaluation will be explored.MethodsThe study is a quasi-experimental evaluation in a single centre. All participants are drawn from Born in Bradford’s Better Start (BiBBS) interventional family cohort study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. The required minimum sample is n = 130 (ratio 1:1) to detect a medium effect (± 2.35, d = .50) on the primary outcome—maternal-child sensitivity, using the Mothers Object Relations Scale Short Form (MORS-SF). Secondary outcomes include the Patient Health Questionnaire (PHQ-8), Generalised Anxiety Disorder assessment 7 (GAD-7), identification of poor perinatal mental health through routine data, and birth outcomes (delivery method, gestation period, low birth weight). Service delivery costs and health resource use will be gathered from routine data.DiscussionThis study will evaluate the effectiveness of Baby Steps for enhancing maternal-child sensitivity and maternal mental health when delivered universally and remotely. The findings regarding programme effectiveness, process, and costs will be relevant for researchers, service commissioners, and service staff.Trial registrationThis study was prospectively registered with ISRCTN (22/04/2022, ISRCTN12196131).

Development of an Instrument for the Assessment of Health-Related Multi-sectoral Resource Use in Europe: The PECUNIA RUM.

Measuring objective resource-use quantities is important for generating valid cost estimates in economic evaluations. In the absence of acknowledged guidelines, measurement methods are often chosen based on practicality rather than methodological evidence. Furthermore, few resource-use measurement (RUM) instruments focus on the measurement of resource use in multiple societal sectors and their development process is rarely described. Thorn and colleagues proposed a stepwise approach to the development of RUM instruments, which has been used for developing cost questionnaires for specific trials. However, it remains unclear how this approach can be translated into practice and whether it is applicable to the development of generic self-reported RUM instruments and instruments measuring resource use in multiple sectors. This study provides a detailed description of the practical application of this stepwise approach to the development of a multi-sectoral RUM instrument developed within the ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) project. For the development of the PECUNIA RUM, the methodological approach was based on best practice guidelines. The process included six steps, including the definition of the instrument attributes, identification of cost-driving elements in each sector, review of methodological literature and development of a harmonized cross-sectorial approach, development of questionnaire modules and their subsequent harmonization. The selected development approach was, overall, applicable to the development of the PECUNIA RUM. However, due to the complexity of the development of a multi-sectoral RUM instrument, additional steps such as establishing a uniform methodological basis, harmonization of questionnaire modules and involvement of a broader range of stakeholders (healthcare professionals, sector-specific experts, health economists) were needed. This is the first study that transparently describes the development process of a generic multi-sectoral RUM instrument in health economics and provides insights into the methodological aspects and overall validity of its development process.

What Patients Find on the Internet When Looking for Information About Percutaneous Coronary Intervention: Multilanguage Cross-sectional Assessment.

The internet provides general users with wide access to medical information. However, regulating and controlling the quality and reliability of the considerable volume of available data is challenging, thus generating concerns about the consequences of inaccurate health care-related documentation. Several tools have been proposed to increase the transparency and overall trustworthiness of medical information present on the web. We aimed to analyze and compare the quality and reliability of information about percutaneous coronary intervention on English, German, Hungarian, Romanian, and Russian language websites. Following a rigorous protocol, 125 websites were selected, 25 for each language sub-sample. The websites were assessed concerning their general characteristics, compliance with a set of eEurope 2002 credibility criteria, and quality of the informational content (namely completeness and accuracy), based on a topic-specific benchmark. Completeness and accuracy were graded independently by 2 evaluators. Scores were reported on a scale from 0 to 10. The 5 language subsamples were compared regarding credibility, completeness, and accuracy. Correlations between credibility scores on the one hand, and completeness and accuracy scores, on the other hand, were tested within each language subsample. The websites' compliance with credibility criteria was average at best with scores between 3.0 and 6.0. In terms of completeness and accuracy, the website subsets qualified as poor or average, with scores ranging from 2.4 to 4.6 and 3.6 to 5.3, respectively. English language websites scored significantly higher in all 3 aspects, followed by German and Hungarian language websites. Only German language websites showed a significant correlation between credibility and information quality. The quality of websites in English, German, Hungarian, Romanian, and Russian languages about percutaneous coronary intervention was rather inadequate and may raise concerns regarding their impact on informed decision-making. Using credibility criteria as indicators of information quality may not be warranted, as credibility scores were only exceptionally correlated with content quality. The study brings valuable descriptive data on the quality of web-based information regarding percutaneous coronary intervention in multiple languages and raises awareness about the need for responsible use of health-related web resources.

Comparing the quality of care for long-term ventilated individuals at home versus in shared living communities: a convergent parallel mixed-methods study

BackgroundPeople on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC?MethodsThis study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care.ResultsThe quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs (n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL (n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers (n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18).ConclusionThis study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting.

Can Personalization or Creativity Reduce Banner Blindness?

<h3>Introduction</h3> Loneliness and social isolation have been identified as significant public health concerns, but improving relationships and increasing social participation may improve health outcomes and quality of life. The aim of the Project About Loneliness and Social networks (PALS) study is to assess the effectiveness and cost-effectiveness of a guided social network intervention within a community setting among individuals experiencing loneliness and isolation and to understand implementation of Generating Engagement in Network Involvement (Genie) in the context of different organisations. <h3>Methods and analysis</h3> The PALS trial will be a pragmatic, randomised controlled trial comparing participants receiving the Genie intervention to a wait-list control group. Eligible participants will be recruited from organisations working within a community setting: any adult identified as socially isolated or at-risk of loneliness and living in the community will be eligible. Genie will be delivered by trained facilitators recruited from community organisations. The primary outcome will be the difference in the SF-12 Mental Health composite scale score at 6-month follow-up between the intervention and control group using a mixed effects model (accounting for clustering within facilitators and organisation). Secondary outcomes will be loneliness, social isolation, well-being, physical health and engagement with new activities. The economic evaluation will use a cost-utility approach, and adopt a public sector perspective to include health-related resource use and costs incurred by other public services. Exploratory analysis will use a societal perspective, and explore broader measures of benefit (capability well-being). A qualitative process evaluation will explore organisational and environmental arrangements, as well as stakeholder and participant experiences of the study to understand the factors likely to influence future sustainability, implementation and scalability of using a social network intervention within this context. <h3>Ethics and dissemination</h3> This study has received NHS ethical approval (REC reference: 18/SC/0245). The findings from PALS will be disseminated widely through peer-reviewed publications, conferences and workshops in collaboration with our community partners. <h3>Trial registration number</h3> ISRCTN19193075

Establishing a comprehensive list of mental health-related services and resource use items in Austria: A national-level, cross-sectoral country report for the PECUNIA project.

BackgroundA comprehensive, comparable assessment of the economic disease burden and the value of relevant care forms a major challenge in the case of mental diseases. This study aimed to inform the development of a resource use measurement (RUM) instrument and harmonized reference unit costs valid for multi-sectoral and multi-national cost assessments for mental health diseases as part of the European PECUNIA project.MethodsAn iterative, multi-methods approach was applied. Systematic literature reviews appended with national grey literature searches in six European countries were conducted to generate preliminary, literature-based, international, mental health-related service and resource use lists for all investigated sectors in 2018. As part of a multi-national expert survey, these lists were reviewed by 18 Austrian sector-specific experts regarding the clarity, relevance, comprehensiveness and availability in the Austrian context.ResultsOut of 295 items included in the preliminary, international, sector-specific lists (health and social care—201 items, criminal justice—35 items, education—39 items; patient, family and informal care—20 items), a total of 261 items and descriptions (88%) were considered clear by all experts. 42 items (14%) were considered not existing in Austria, and 111 items (38%) were prioritized regarding their relevance in the national context. Thirteen additional items (4%) were suggested to be added to accommodate for Austria-specific features of the individual sectors. Major typological difficulties based on item names were observed.ConclusionsThe identified country-specific variations and general typological bias and their potential contributions to service and resource use cost variations across countries and sectors call for further systematic investigation. Next, PECUNIA will develop internationally harmonized and comparable definitions of the listed items and their units of analysis based on a new conceptual multi-sectoral costing framework. The developed lists will require consolidation and further prioritization for the development of a patient-reported RUM instrument and consequent reference unit cost valuation.

Health-related information resource use: an exploratory study of expectant mothers

ABSTRACT Expectant mothers use various information resources when making health decisions. Resources include health professionals, eHealth resources, printed materials, family and friends. Pregnancy and parenting are times of constant change, driving information needs and are considered a context-rich area in which to study information behaviour. This exploratory research study examines what health-related information resources expectant mothers seek, how they process and utilise them. One key contribution of this research is a classification of Information Use, which includes three types: 1) Information Use as Access, 2) Information Use as Processing, and 3) Information Use as Outcomes. Leveraging this classification, we design and distribute an exploratory questionnaire. The results highlight that health professionals and eHealth resources are the most used and influential information resources for expectant mothers. The article also presents a list of criteria used to evaluate eHealth resources. Finally, we highlight the cognitive, affective, and behavioural information use outcomes experienced by expectant mothers.

Validation of the FIMA Questionnaire for Health-Related Resource Use Against Medical Claims Data: The Role Played by Length of Recall Period

Self-reported health care use of 1,552 participants was validated against medical claims data. Reliability was measured by intraclass correlation coefficient (ICC), sensitivity, specificity, and Cohen's Kappa. Linear regression models were used to investigate the association between validity and individual characteristics, health state, recall period (3, 6, or 12 months), or frequency of resource use. On average, participants were 74 years old; 95% rated the questionnaire as easy. The number of physician contacts was underestimated depending on recall period by 9 to 28% and the ICC was moderate (3/6/12 months, ICC 0.46/0.48/0.55), whereas contacts with physiotherapists were remembered quite well (ICC>0.75). Remembering the number of days in rehabilitation and hospital differed by recall periods (3/6/12 months); rehabilitation ICC=0.88/0.51/0.87; hospital ICC=0.69/0.88/0.66. Very good reliability of self-reported long-term care insurance benefits was found for all recall periods (Kappa>0.90) while agreement in self-reported medical aid was poor (Kappa<0.30); agreement in intake of medication was good (Kappa>0.40). The chance of agreement between self-reports and claims data significantly decreased with the number of contacts. Individuals with better health had a significantly higher chance of reporting contacts with physiotherapists accurately. The FIMA largely demonstrated good reliability. The FIMA is a coherent and valid instrument to collect health-related resource use in health economic studies in an elderly population.

Needs and health care costs in old age: a longitudinal perspective: results from the AgeMooDe study

Background: The current study aimed to identify whether needs are associated with health care costs in late life longitudinally.Methods: Data were gathered from two waves (at baseline, n = 1199; at follow-up, n = 958) of a multicenter prospective cohort study (‘Late-life depression in primary care: needs, health care utilization and costs’, AgeMooDe) in Germany. Individuals aged 75 years and above were recruited via general practitioners. The ‘Camberwell Assessment of Need for the Elderly’ (CANE) was used to assess needs. Based on a questionnaire, the health-related resource use was assessed retrospectively from a societal perspective. The assessment covered outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Random effects regressions were used.Results: Regressions showed that the number of ‘no needs’ is inversely associated with total health care costs from a societal perspective (β = –584.0, p < .001). When a health care perspective was adopted, this association was also significant (β = –298.8, p < .001). The association between needs and health care costs persisted in all health care sectors considered in this study.Limitations: It might be difficult to generalize our findings to individuals residing in institutional settings.Conclusion: Adjusting for several potential confounders (e.g. sociodemographic and health-related factors), our study showed that needs – quantified using the CANE – are important for health care costs. Interventions should be developed to reduce needs in late life. These interventions may be beneficial for the health care system.

Study protocol for ‘The Project About Loneliness and Social networks (PALS)’: a pragmatic, randomised trial comparing a facilitated social network intervention (Genie) with a wait-list control for lonely and socially isolated people

IntroductionLoneliness and social isolation have been identified as significant public health concerns, but improving relationships and increasing social participation may improve health outcomes and quality of life. The aim of...

Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study

BackgroundDepression often remains undiagnosed or treated inadequately. Web-based interventions for depression may improve accessibility of treatment and reduce disease-related costs. This study aimed to examine the potential of the web-based cognitive behavioral intervention “deprexis” in reducing disease-related costs.MethodsParticipants with mild to moderate depressive symptoms were recruited and randomized to either a 12-week web-based intervention (deprexis) in addition to care as usual (intervention group) or care as usual (control group). Outcome measures were health-related resource use, use of medication and incapacity to work as well as relating direct health care costs. Outcomes were assessed on patients’ self-report at baseline, three months and six months.ResultsA total of 1013 participants were randomized. In both groups total direct health care costs decreased during the study period, but changes from baseline did not significantly differ between study groups. Numeric differences between study groups existed in outpatient treatment costs. They could be attributed to differences in changes of costs for psychotherapeutic treatment from baseline. Whereas costs for psychotherapeutic treatment decreased in the intervention group, costs increased in the control group (− 16.8% (€80) vs. + 14.7% (€60)) (tdf = 685 = 2.57; p = 0.008).ConclusionThe study indicates the health economic potential of innovative e-mental-health programs. There is evidence to suggest that the use of deprexis over a period of 12 weeks leads to a decrease in outpatient treatment cost, especially in those related to different types of psychotherapeutic treatment.

Asset Mapping and Focus Group Usage: An Exploration of the Russian-Ukrainian Population’s Need For and Use of Health-Related Community Resources

Community resources are an important aspect of preventive medicine and can also provide support to individuals with existing medical conditions. However, resources may not address all population groups within the community equally, and immigrants, who frequently face cultural and language barriers, are often unable to access the full range of healthcare resources available in the community. The purpose of this study was to gain insight on healthcare needs, attitudes, and access of a Ukrainian immigrant population in a large town in northern Indiana. Focus groups were conducted as a first step to creating connections upon which a community-based participatory research project could be built. Findings revealed cultural barriers (lack of understanding of health insurance options or value, belief that similar services were less expensive in the Ukraine) and language issues (lack of translation services or resources written in languages other than English or Spanish) were key barriers to accessing healthcare resources in the community. Concerns about dental care and its expense were also voiced. Future efforts might build on these findings by exploring policies and practices that affect various immigrant groups’ access to community healthcare resources. Recommendations for such efforts are also discussed.

FIMA, the questionnaire for health-related resource use in the elderly population: validity, reliability, and usage of the Polish version in clinical practice.

PurposeThe purpose of this study was to determine the validity and reliability of the Polish version of the Questionnaire for Health-Related Resource Use in an Elderly Population [Fragebogen zur Inanspruchnahme medizinischer und nicht-medizinischer Versorgungsleistungen im Alter (FIMA)].Patients and methodsThis was a cross-sectional study conducted in a rehabilitation care unit in Poland between January and June of 2017. Sixty-one patients aged ≥65 years who had been admitted to the unit were enrolled into the study. Each participant was evaluated twice: once within 48 hours of admission (T1) and once after 2 weeks (T2).ResultsThe translated instrument was understood by most respondents in a selected population and it maintained a reading and comprehension level that was accessible by most respondents, even of a low education level. With the aid of the prevalence-adjusted bias-adjusted kappa (PABAK) and intraclass correlation coefficient (ICC), 100% test–retest reliability for 10 out of the 12 questions that were subjected to analysis was indicated. The most frequent health-related resource uses were appointments at the general practitioner (90.2%) and orthopedist (54.1%), medication (93.4%), and the necessity to have glasses as supportive equipment (70.5%).ConclusionThe Polish FIMA demonstrated very good test–retest reliability, good validity, and ease of use for elderly people. Further investigation is required. In the future, the routine use of this instrument could be encouraged to assess the use and demand for medical and nonmedical services among the elderly.

The Impact of Depressive Symptoms on Healthcare Costs in Late Life: Longitudinal Findings From the AgeMooDe Study

To examine whether depressive symptoms affect healthcare costs in old age longitudinally. Multicenter prospective observational cohort study (two waves with nt1 = 1,195 and nt2 = 951) in Germany. Community. Participants aged 75 years and older recruited via general practitioners. Depressive symptoms were assessed by the Geriatric Depression Scale (GDS). The health-related resource use was measured retrospectively from a societal perspective based on a questionnaire, covering outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Hybrid regression models were used to determine the between- and within-effect of depressive symptoms on healthcare costs, adjusting for important covariates. Six-month total cost increased from €3,090 (t1) to €3,748 (t2). The hybrid random effects models showed that individuals with more depressive symptoms had higher healthcare costs compared with individuals with less depressive symptoms (between-effect). Moreover, an intra-individual increase in depressive symptoms increased healthcare costs by €539.60 (within-effect) per symptom on GDS. Our findings emphasize the economic importance of depressive symptoms in old age. Appropriate interventions to treat depressive symptoms in old age might also be a promising strategy to reduce healthcare costs.