Utilization Of Health Care Services Research Articles

Health Care Service Utilization Among People with HIV, Chronic Pain, and Depression: Utilization and Cost Outcomes from the HIV-PASS Study.

In the United States (U.S.), 90% of annual health care expenditures are devoted to people with chronic physical and mental health conditions. For people with HIV (PWH), two common, chronic comorbidities are pain and depression. This report assesses the impact of a brief psychotherapy intervention for PWH and comorbid chronic pain and depression on health care service utilization. Data from the HIV Pain and Sadness Study (HIV-PASS) randomized trial were used. Electronic health records were reviewed to tabulate use of the following services: (a) outpatient rehabilitation; (b) outpatient psychiatric; and (c) hospital-based (e.g., emergency department). Estimated average marginal effects were analyzed to determine how many times a participant accessed the service and the charge at each event. The sample consisted of 187 adults recruited from three U.S. sites. Individuals randomized to the three-month, seven session HIV-PASS intervention had average charges for hospital-based services that were significantly less during the post-treatment phase (months 4-12; 95%CI: -$16,612, -$131; p =.046) than those randomized to the comparison condition. On average, comparison condition participants were charged $8,371 more for hospital services in the 8-month period following intervention. No significant differences between treatment conditions were observed in use of outpatient rehabilitation, outpatient psychiatric services, or hospital-based care. Consistent with predictions, lower health care charges among those randomized to the HIV-PASS behavioral intervention were incurred for hospital services, indicating that a brief behavioral intervention could lead to decreased use of more emergent and expensive care services among persons with HIV, depression, and chronic pain.

Factors associated with access and utilization of sexual abuse emergency healthcare services among street children in Zomba, Malawi: a qualitative study.

Sexual abuse among street children is a problem that renders a burden of sexually transmitted diseases, HIV infection, and early pregnancy. Literature shows that globally 95 million children experience sexual abuse with 1 in 5 girls and 1 in 7 boys exposed to sexual abuse before 18years of age in Malawi. Malawi adopted the World Health Organization guidelines for providing emergency health services for victims of sexual abuse, which include HIV Post Exposure Prophylaxis (PEP) and Emergency Contraceptive Pills (ECP) within 72h of exposure, Sexually Transmitted Infections (STI) treatment, and psychosocial services. However, there are challenges associated with the services that limit access and utilization among street children. This study explored the factors associated with access and utilization of sexual abuse emergency healthcare services among street children in Zomba. This was a cross-sectional phenomenological qualitative study conducted in Zomba City from 2022 to 2023 using in-depth and key informant interviews. We purposively selected street children between 10 to 17years who have been exposed to sexual abuse on the streets and social actors working with street children. The study employed a thematic analysis approach. The study found that street children did not utilize sexual abuse emergency health services. The major factors associated with utilization included the knowledge of sexual abuse, its associated health risks and sexual abuse emergency health services, and perceptions of utilizing sexual abuse emergency health services. The barriers to utilization of sexual abuse emergency health services included perceived shame, fear, discrimination, prolonged treatment process, and attitude of the health service providers. Sexual abuse and its health risks continue to be a challenge among street children. The absence of adequate connections and secure environments for street children to report sexual abuse and seek help without facing judgment has created significant obstacles for them in accessing sexual abuse emergency health services. To curb this challenge it is crucial for successful interventions to specifically address the health needs of street children and involve them in the decision-making processes related to their interventions.

Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Gynecological health care services utilization and violence among female sex workers in Togo in 2021.

Female Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo. A cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence. A total of 447 FSW with a median age of 30 [IQR: (24-38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22-0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19-2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16-2.73); a history of abortion (aOR = 1.53; 95%CI 1.03-2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99-11.94), were more likely to experience violence. There is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

End-of-Life Health Care Service Use and Cost Among Medicare Decedents With Neurodegenerative Diseases.

Although neurodegenerative diseases are a leading cause of death, little is known about health care utilization and cost during the end-of-life (EoL) period or how it compares with that of other life-limiting conditions. We aimed to describe and compare resource utilization among US Medicare decedents with neurodegenerative diseases with decedents with cancer. We conducted a retrospective study of Medicare Part A and B beneficiaries with Alzheimer disease (AD), Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Decedents diagnosed with malignant brain tumors or pancreatic cancer served as non-neurodegenerative comparators. Descriptive analyses examined demographic and clinical characteristics in the last year of life. The probabilities and associated costs of emergency department (ED), inpatient, skilled nursing facility (SNF), and hospice utilization during the last 12 and 6 months of life were also compared between persons with neurodegenerative diseases and cancer, adjusting for sociodemographic factors and comorbidity burden. A total of 1,126,799 Medicare beneficiaries died in 2018, of which 357,926 had a qualifying diagnosis. Persons with neurodegenerative diseases were older and more frequently received Medicaid assistance than persons with brain or pancreatic cancer. In all groups, health care service utilization increased over the last year of life, and total costs were predominantly attributable to inpatient care. In the last 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Persons with neurodegenerative diseases as compared to persons with malignant brain tumors also had greater odds of ED use (AD: adjusted odds ratio [aOR] 1.17, 95% CI 1.11-1.23; PD: aOR 1.18, 95% CI 1.11-1.25; ALS: aOR 1.11, 95% CI 1.01-1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60-0.68; PD: aOR 0.65, 95% CI 0.61-0.69; ALS: aOR 0.33, 95% CI 0.30-0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31-0.36; PD: aOR 0.33, 95% CI 0.31-0.36; ALS: aOR 0.41, 95% CI 0.36-0.46). The findings were similar in pancreatic cancer. Persons with neurodegenerative diseases in the United States are more likely to visit the ED and less likely to use inpatient and hospice services at EoL than persons with brain or pancreatic cancer. These group differences may stem from prognostic uncertainty and reflect inadequate EoL care practices, requiring further investigation to ensure more timely palliative care and hospice referrals.

Impact of Family Mutual Aid System for Personal Medical Insurance Accounts on Paediatric Patients' Outpatient Utilisation Patterns and Costs: a difference-in-differences analysis.

This study explores the effect of the transformation of paediatric healthcare through the implementation of the Family Mutual Aid System (FMAS) for personal medical insurance accounts, among paediatric patients at a children's hospital (Hospital A in Shanghai, China). We conducted a cohort study in the endocrinology department of Hospital A from August 2021 to July 2023 to assess the impact of the FMAS enrolment on patients' annual outpatient visits, annual outpatient expenditures, and the allocation of these costs among the Basic Medical Insurance Pooling Fund and patients' out-of-pocket (OOP) expenses, with a further subdivision into online and offline consultations. Analysis employed a weighted Difference-in-Differences approach within a fixed-effects model following Propensity Score Matching. The study encompassed 10,975 paediatric patients, divided into those enrolled in the FMAS (observation group) and those not (control group). Enrolment in FMAS was associated with a statistically significant increase in annual outpatient visits by an average of 1.107, predominantly attributed to an uptick in offline consultations. Additionally, there was a substantial 38.9% rise in annual outpatient costs. Detailed analysis revealed a 52.5% increase in costs covered by the medical insurance pooling fund, while patients' OOP expenses decreased by an average of 69.2%. These findings highlight the beneficial effects of FMAS enrolment on healthcare service utilization and risk-sharing mechanisms of medical insurance.

Disparities in end-of-life care and place of death in people with malignant brain tumors – a Swedish registry study

Abstract Background Malignant brain tumors often lead to death. While improving future treatments is essential, end-of-life care must also be addressed. To ensure equitable palliative care, understanding place of death is crucial, as disparities may lead to inequity of care. This study aims to identify place of death in adults with malignant brain tumors in Sweden, and the potential associations with official palliative care status by the ICD-10 code Z-51.5, sociodemographic factors, health service characteristics, and healthcare service utilization. Methods A population-level registry study examined the place of death among adults who died of malignant brain tumors in Sweden from 2013-2019. Descriptive statistics, univariable and multivariable binary logistic regression analyses were performed. Results We identified 3 888 adults who died from malignant brain tumors. Of these, 64.4% did not receive an official palliative care status. Specialized palliative care was not utilized in 57.2% at the place of death, and in 80.0% of nursing home deaths. In the last month of life, 53.5% of hospital deaths involved one transfer, while 41.8% had two or more transfers. The odds ratio of dying in hospital versus at home was higher, with two or more transfers (OR 0.63(0.40,0.99)). The odds ratio of dying in hospital versus at home showed significant regional differences. Conclusions Despite the severity of their diagnosis, only a minority of patients utilized specialized palliative services at death, and this varied by the place of death. Significant regional disparities were found between hospital and home deaths, indicating unequal end-of-life palliative care in this patient group.

Protocol for a randomized controlled trial with a stepped care approach, utilizing PrEP navigation with and without contingency management, for transgender women and sexual minority men with a substance use disorder: Assistance Services Knowledge-PrEP (A.S.K.-PrEP)

BackgroundIn the United States, most (~ 70%) annual newly diagnosed HIV infections are among substance-using sexual minority men (SMM) and gender minority transgender women (trans women). Trans women and SMM are more likely to report or be diagnosed with a substance use disorder (SUD) than their cisgender or heterosexual counterparts and the presence of an SUD substantially increases the risk of HIV infection in both groups. Although Pre-Exposure Prophylaxis (PrEP) is highly effective, initiation, adherence, and persistence are exclusively behavioral outcomes; thus, the biomedical benefits of PrEP are abrogated by substance use. SUD is also associated with reduced quality-of-life, and increased overdose deaths, utilization of high-cost healthcare services, engagement in a street economy, and cycles of incarceration.ObjectiveTo determine the optimal (considering efficacy and cost-effectiveness) strategy for advancement along the PrEP Care Continuum among trans women and SMM with an SUD.MethodsThis study will implement a randomized controlled trial, evaluating two Stepped Care approaches involving A.S.K.-PrEP vs. standard of care (SOC) to determine optimal intervention strategies for trans women and SMM with an SUD (N = 250; n = 83 trans women; n = 167 SMM) for advancement along the PrEP Care Continuum. Participants will be randomized (3:1) to Stepped Care (n = 187) or SOC (n = 63). Participants in the Stepped Care arm will be assessed at 3-months for intervention response; responders will be maintained in A.S.K.-PrEP, while non-responders will receive added attention to their SUD via Contingency Management (CM). Non-responders will be re-randomized (1:1) to either (a) receive A.S.K.-PrEP + CM, or (b) shift the primary focus to their SUD (CM alone).ResultsRecruitment and enrollment began in May 2023. Recruitment will span approximately 36 months. Data collection, including all follow-up assessments, is expected to be completed in April 2027.DiscussionTrans women and SMM with an SUD have the two highest HIV prevalence rates in the United States, which underscores the urgent need for effective measures to develop scalable behavioral interventions that can encourage advancement along the PrEP Care Continuum. To improve public health, researchers must identify scalable and cost-effective behavioral interventions to promote PrEP initiation, adherence, and persistence among trans women and SMM who use substances.Trial registrationThis trial has been registered at ClinicalTrials.gov under the number NCT05934877.

The impact of COVID-19 on private healthcare service utilisation: time series analysis in the capital region of Finland during 2020–2022

BackgroundMost current studies on COVID-19 have focused on the first weeks or months of the pandemic or have addressed specific diseases. The long-term effects of the COVID-19 pandemic on healthcare services are insufficiently understood. We analysed the long-term effects of the COVID-19 pandemic on outpatient healthcare utilisation in the full spectrum of diseases in Uusimaa, the capital region of Finland.MethodsOur data included 632 466 individual patients between the ages of 18 and 65 and 6 521 394 visits to healthcare personnel from electronic health records. We fitted an autoregressive integrated moving average (ARIMA) model to pre-2020 data to predict the expected quantity of diagnoses for the period between 1 January 2020 and 16 June 2022. Expected and observed quantities of diagnoses were compared.ResultsThe overall quantity of diagnoses declined by one-fourth immediately following the onset of the pandemic and remained around 15% below predicted values for most of the pandemic. After the pandemic-related restrictions were lifted, the total diagnostic activity started to recover to pre-pandemic projection levels. However, this recovery has been mainly driven by upper respiratory system-related activity. The number of diagnoses for many diagnosis groups has remained below the predicted levels, even after the concurrent removal of mobility restrictions and increased coverage of vaccinations in this population.ConclusionsThe pandemic resulted in an overall reduction in outpatient healthcare utilisation which persisted for 30 months. While the overall diagnostic activity has eventually recovered to predicted levels, many classes of diagnoses display reduced levels in the study population over the follow-up period. Some diseases that may have long-lasting effects when left untreated seem to remain underdiagnosed, potentially increasing pressure on the healthcare system in the future.

Factors Influencing Professional Help-Seeking Intentions for Sexual and Gender-Based Violence Among Female University Students in Eswatini.

To investigate the prevalence of sexual and gender-based violence (SGBV) among female college students, identify factors influencing intention to seek professional help among SGBV survivors, and compare help-seeking determinants among survivors based on their prior utilization of healthcare services. A cross-sectional online survey was employed among female students aged 18-24 years from two universities in Eswatini. A total of 271 female college students were recruited to assess SGBV experience, attitudes, social norms, perceived control, help-seeking intention, and other factors not originally included in the theory of planned behavior. Data analyses utilized descriptive statistics, comparative analyses, and multiple regression methods. Among the participants, 73.1% reported experiencing one or more forms of SGBV, while only 43.4% sought professional help through health services. Help-seeking intentions of survivors were significantly associated with positive attitudes, subjective norms, and marital status, collectively explaining 66% of the variance. In subgroup analyses, the subjective norm and attitude emerged as the most robust predictors of help-seeking intentions. The results revealed a high prevalence of SGBV and a concerning trend of low help-seeking behavior, with attitudes and subjective norms emerging as the most influential factors shaping intention. These results provide valuable insights for designing theory-driven and culturally sensitive public health nursing interventions and educational programs aimed at effectively supporting SGBV survivors.

Effect of exercise referral schemes and self-management strategies on healthcare service utilisation among community-dwelling older adults: secondary analyses of two randomised controlled trials.

The objective of this study is to explore whether offering an integrated self-management strategy and exercise referral scheme intervention (ERS+SMS) or a stand-alone ERS intervention is more effective in reducing healthcare service utilisation among community-dwelling older adults over time compared with a stand-alone SMS/control intervention. Secondary analyses of two randomised controlled trials (RCTs) with linkage to Danish national health registries. Three Danish municipalities: Esbjerg, Slagelse and Odense. Danish community-dwelling older adults, aged 65 years or older, were included in the study. Participants originated from two completed RCTs: the Welfare Innovation in Primary Prevention (WIPP, n=115) and the SITLESS project (SITLESS, n=333). Participants in the two trials were randomly assigned to one of three intervention groups: ERS in combination with SMS (ERS+SMS), ERS alone or an SMS/control intervention. Annual number of days with contact to general practice (GP) and days hospitalised for all causes. No statistically significant between-group difference was observed in the annual number of days with contact with GP between participants randomised to ERS+SMS (p=0.759) or ERS only (p=0.156) compared with those randomised to the SMS/control group. In addition, no statistically significant between-group differences in days hospitalised were observed when comparing the ERS+SMS (p=0.222) or ERS only (p=0.060) group to the SMS/control group. Neither the integrated intervention (ERS+SMS) nor the ERS alone intervention was more effective in reducing healthcare service utilisation during a 2-year follow-up period compared with a stand-alone SMS/control intervention. A potential stabilising effect of ERS and/or SMS interventions on the general age-related increase in healthcare service utilisation cannot be ruled out but needs further exploration in future studies along with the exploration of the effects of long-term interventions. NCT04531852 : and : NCT02629666 : .

Prevalence of economic violence among the geriatric population and their knowledge and utilization of social security schemes in Chengalpattu district, Tamil Nadu

ABSTRACT Context: Economic independence is an important factor in the prevention of violence among the elderly. Optimal utilization of various social security schemes in India helps them in achieving financial independence and proper utilization of health care services. However, there is a knowledge and service utilization gap among the elderly in our population. Aim and Objectives: To assess the prevalence of economic violence and awareness and utilization of social security schemes among the geriatric population. Settings and Design: Community-based cross-sectional study conducted in rural and urban field practice areas of the tertiary care center. Methods and Material: A simple random sampling method was adopted. The data were collected using a pilot-tested semistructured questionnaire among 406 participants from three selected villages and wards of Venmalagaram and Maduranthakam during January to July 2023. Statistical Analysis Used: Frequencies and proportions were used for categorical variables, and Chi-square test was applied to test the level of significance. P <0.05 was considered statistically significant. Results: The prevalence of economic violence was found to be 12.1%. Among them, neglect was seen in a major proportion (61.2%). Awareness about the old age pension was seen in 70.7%, followed by Annapurna scheme (17%) and PMVVY (4.9%). The utilization of these schemes was found to be 34.0%, 11.6%, and 2.7%, respectively. Conclusions: The prevalence of economic violence among the geriatric population was in the form of neglect and property misuse. The knowledge and utilization of social security schemes were poor among the elderly.

Post-COVID in healthcare workers and its consequences on quality of life, activities, participation, need for rehabilitation and care experiences: protocol of a cohort study

IntroductionHealthcare workers (HCWs) have been of particular relevance for overcoming the SARS-CoV-2 pandemic. At the same time they have been affected by SARS-CoV-2 infections with above average probability. Around 6.5% of the overall infected persons are likely to develop persistent symptoms resulting from the infection, known as long-COVID or post-COVID syndrome (PCS). The aim of this study is (1) to investigate the prevalence, course and characteristics of PCS in German HCWs, (2) to examine its effects on psychosocial variables, (3) to identify rehabilitation and healthcare needs and (4) to analyse treatment experiences.Methods and analysisIn a cohort study with a randomised selection of participants (N=20 000) from the Employer’s Liability Insurance Association for Health and Welfare Care, the health status of HCWs, who had COVID-19 in their professional context will be examined. There will be two measurement points: baseline (T1) and a 12-month follow-up (T2). The outcome measures are the health status with a particular focus on persistent or newly occurring symptoms after a SARS-CoV-2 infection, health-related quality of life, functional capacity, the subjective need for and utilisation of healthcare services. Pre-existing conditions, the course of the acute infection and sociodemographic factors are considered as predictors. An advisory board made up of affected HCWs supports the study by contributing to the surveys’ contents.Ethics and disseminationThe study has been approved by the Local Ethics Committee of the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf (LPEK-0518). For dissemination, the results will be published in peer-reviewed journals, presented at conferences and communicated to relevant stakeholders in general and rehabilitation medicine.Trail registration numberhttps://drks.de/search/de/trial/DRKS00029314

Healthcare Service Utilization and Related Costs. A Comparison of the Situation of Persons With Spinal Cord Injury to the General Population.

The aim of the study is to investigate healthcare utilization and related costs in spinal cord injury compared to the Swiss population, addressing gaps in understanding this vulnerable group's needs. We analyzed healthcare utilization across age groups using data from the Swiss Health Survey and the Swiss Community Survey. Employing count models, Zero-Inflated Negative Binomial, and Poisson regressions, we estimated the adjusted healthcare visits across different age groups in the sample. Persons with spinal cord injury use 11 times more healthcare services than the healthy population and 4 times more than persons with other chronic health conditions. Notably, service providers for persons with spinal cord injury include physiotherapists, nursing services, general practitioners, and specialists. The high frequency of usage of persons with spinal cord injury translates into high costs, which is 3 times higher than in the general healthy population. These patterns become more evident as persons with spinal cord injury age, where nursing care and rehabilitation services become the most demanded services. Our findings show the multiple healthcare needs of people with spinal cord injury, which makes them a high-needs, high-cost group. This characteristic underscores the importance of preventive measures to reduce the incidence of spinal cord injury in older adults.

Provision and utilization of basic maternal healthcare during the pandemic in Ecuador: The health workers’ perspective

ABSTRACT Context: Ecuador was one of the most affected counties in Latin America during coronavirus disease 2019 (COVID-19). Its health system already faced financing and organizational problems before the pandemic. Aims: To analyze the effects of the pandemic on the provision and utilization of maternal health services in units of the Public Health of Ecuador as perceived by the health personnel. Material and Methods: This is a mixed methods study with two rapid evaluation cycles. The first cycle collected information during January–March and the second one during April–June, 2021. An online questionnaire and semistructured interviews were applied to professionals involved in the management and provision of maternal health programs. Both instruments explored provision and utilization of maternal health services. Questionnaires were processed using SPSS and descriptive statistics. Interviews were exported to Atlas-Ti and were codified using the explored categories. Results: A total of 207 health workers participated in the first cycle, and 200 in the second one. They recognized that during the pandemic, healthcare personnel were reduced by more than 30% due to the presence of risk factors among them as well as the lack of budget for new contracts. The availability of materials and supplies was also reduced by nearly 50%, mainly due to the lack of budget. The demand for maternal healthcare in public health units was reduced because people feared being infected by COVID-19 and nearly 25% goes to the private sector. Conclusions: The pandemic has had a negative effect on the provision as well as utilization of maternal healthcare services. Nevertheless, health professionals implemented diverse strategies to reduce this negative effect on maternal care.

Impact of discontinuing disease-modifying therapies on health care utilization among midlife patients with multiple sclerosis in the United States.

Multiple sclerosis (MS) is a lifelong progressive neurological disease treated primarily with disease-modifying therapies (DMTs). Disease activity tends to decline as patients age. Midlife represents a crossroads where the risks of DMT may outweigh the benefits, prompting providers to consider DMT discontinuation to reduce treatment burden. However, real-world evidence on the impact of DMT discontinuation among midlife patients is lacking. To evaluate the association between DMT discontinuation and health care utilization among midlife patients with MS. Midlife patients with MS who received an injectable or oral DMT between 2001 and 2018 were identified from the MarketScan commercial claims database. DMT discontinuation, defined as a treatment gap exceeding 90 days in days supply, was the independent variable. Patients who discontinued DMTs had their index date set as the last gap day, whereas index dates for those who continued DMTs were matched based on the time distribution of index dates of discontinuers. Inpatient hospitalizations (all-cause, MS-related, and non-MS-related), emergency department (ED) visits (all-cause, MS-related, and non-MS-related), and relapse-related hospitalizations and outpatient visits were independently evaluated during the 365-day follow-up. Patients were observed until the occurrence of an event (depending on the model), deviation from the treatment group, disenrollment, death, end of follow-up, or data unavailability. Stabilized inverse probability of treatment weighting (sIPTW) was employed to balance the 2 groups. The associations between DMT discontinuation and each utilization outcome were estimated using Cox proportional hazard regression models with sIPTW. Of 149,721 midlife patients with MS, 22.8% discontinued DMTs and 77.2% continued DMTs. Patients who discontinued DMTs had a higher cumulative incidence for all utilization outcomes during the 365-day follow-up than those who continued DMTs. Cox regression showed that DMT discontinuation was associated with a 10.3% and 24.9% higher rate of all-cause and non-MS-related inpatient hospitalizations, respectively, with no significant association found for MS-related hospitalizations. Patients discontinuing DMTs exhibited higher utilization rates for ED visits, with an increase of 21.3% for all-cause, 23.0% for MS-related, and 20.9% for non-MS-related visits compared with those who continued DMTs. We also observed a 15.9% and 52.1% higher rate of relapse-related hospitalizations and outpatient visits associated with DMT discontinuation, respectively. This study revealed that DMT discontinuation was associated with higher health care services utilization among midlife patients with MS, especially relapse-related outpatient visits. DMT discontinuation during midlife may be premature, and DMTs may still be necessary to reduce health care utilization.

Advancing preventive health care for men across the lifespan.

Historically, cisgender men have been found to be reluctant to utilize healthcare services, particularly preventive care services. NPs can bridge this gap to address health disparities among men, who are more likely to develop life-threatening conditions and who generally face higher mortality at younger ages than women. Focusing on advancing preventive care among men strengthens family, community, and societal health, and the NP is crucial in fostering a culture of preventive care in this population. To help drive this change, use of a life-stage approach that incorporates a preventive care mindset is critical. The NP should tailor health strategies to each life phase to ensure that men receive the best preventive care possible across the lifespan.

Male partners’ involvement in antenatal care and its associated factors in West-central Ethiopia

BackgroundMale partner involvement in antenatal care is a key factor that cannot be ignored in the quest for improvement in maternal health and is recommended as an essential intervention to improve maternal and neonatal health outcomes. However, little attention has been given to male partners’ involvement in maternity care, particularly in developing countries.ObjectiveThis study aimed to assess male partners’ involvement in antenatal care and its associated factors among male partners whose wives gave birth within the last one-year in Bichena town, Westcentral, Ethiopia, 2019.MethodsA community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019, in Bichena town, among 406 male partners. The data was collected by a simple random sampling technique and analyzed using the Statistical Package of the Social Science 23.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant.ResultsIn this study, 53.4% [95% CI: 48.3- 58.1%] of male partners had high involvement in antenatal care. The age group of 20–29 years [AOR = 2.14, 95% CI = 1.04–4.38], having primary, secondary, and diploma and above educational level [AOR = 2.04, 95% CI = 1.02–4.07], [AOR = 3.02, 95% CI = 1.49–6.11] and [AOR = 4.03, 95% CI = 2.06–7.89] respectively, ≤ 10 years marriage length [AOR = 2.92, 95% CI = 1.46–5.87], good knowledge of the services provided in antenatal care [AOR = 2.68, 95%, CI = 1.62–4.42], good awareness of the danger signs of pregnancy [AOR = 1.77, 95 CI = 1.10–2.85], favorable attitude towards antenatal care [AOR = 2.62, 95% CI = 1.64–4.19], travel less than 15 min to reach a nearby health facility [AOR = 3.43, 95% CI = 1.54–7.65] and making decision together to seek care in health facility [AOR = 2.44, 95% CI = 1.19–5.03] were associated with male partners involvement in antenatal care.ConclusionsMale partners' involvement in antenatal care was encouraging in the study area compared to previous studies done in Ethiopia. We suggest strengthening awareness among male partners about their shared responsibility during pregnancy. Male partners should be invited to attend the antenatal care. Policymakers and healthcare planners should design programs and plans that will encourage male partners’ involvement in maternal healthcare services utilization.

Treatment patterns and characteristics of patients with Post-Traumatic Stress Disorder (PTSD): A retrospective claims analysis among commercially insured population.

This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity. The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD). The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent. PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence.

Health-related quality of life among refugees from Nagorno Karabagh resided in Kotayk, Armenia

Abstract Background In September 2023, more than 100,000 ethnic Armenians were displaced from Nagorno Karabakh (NK). This study assessed the health-related quality of life (HRQoL) and associated factors among NK refugees who settled in Kotayk province of Armenia. Methods We surveyed 197 refugees using a structured interviewer-administered questionnaire, which collected information about socio-demographics, chronic diseases, smoking status, HRQoL, utilization of healthcare services, living conditions and food access. The SF-36 Health Survey assessed HRQoL. Ophthalmic examination was conducted. Eyeglasses and medications were provided at no cost to those requiring them. Results The participants’ mean age was 64.8 years and 59.4% were retired. The most commonly reported chronic diseases were bone/joint diseases (67.5%), hypertension (55.3%) and heart diseases (24.9%). Around 48.7% of participants experienced sleeping disorders often/ very often. The mean total SF-36 score was 57.42±23.12; the mean physical (PHC) and mental health component (MHC) scores were 63.57±26.28 and 59.37±20.04, respectively. Only 28% of the participants utilized healthcare services after displacement. Most participants had consistent access to an adequate food supply. In the adjusted analysis age (B/PHC=-0.94, p &amp;lt; 0.001; B/MHC=-0.61, p &amp;lt; 0.001), sleeping disorder (B/PHC=-21.86, p = 0.011; B/MHC=-17.44, p = 0.001), use of medical service (B/PHC=-8.63, p = 0.022; B/MHC=-6.95; p = 0.015) and having more than one chronic disease (B/PHC=-17.35, p &amp;lt; 0.001; B/MHC=-10.90, p = 0.001) were associated with both PHC and MHC. Conclusions This study marks the first assessment of HRQoL among NK refugees. Governmental support and interventions targeting individuals with ophthalmic, sleeping, and chronic diseases might be beneficial. Follow-up assessments should track changes in both physical and mental health scores in this population, as they may fluctuate over time in response to displacement challenges. Key messages • Age, sleeping disorder, use of medical service, and the number of chronic diseases were significantly associated with decreased PHC and MHC of HRQoL • Interventions targeting individuals with restricted access to healthcare services, as well as those affected by eye diseases and chronic health issues might be beneficial.