High Users Of Healthcare Services Research Articles

Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men

AimsWhen patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and...

Prevalence of medically unexplained symptoms in adults who are high users of healthcare services and magnitude of associated costs: a systematic review

IntroductionMedically unexplained symptoms (MUS) is a common clinical syndrome in primary and secondary healthcare service. Outcomes for patients with persistent MUS include increased disability, poorer quality of life and higher...

Prioritizing the healthcare access concerns of Canadians with MS.

BackgroundCanadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS.ObjectiveTo identify and prioritize the healthcare access concerns of Canadians with MS.MethodsA cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants.Results324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness.ConclusionThese findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals.

Healthcare access experiences of persons with MS explored through the Candidacy Framework.

Canada has one of the highest rates of multiple sclerosis (MS) in the world, affecting 1 in every 385 individuals. This neurodegenerative condition is unpredictable and variable in symptom profile and disease course making it difficult to manage. Canadians with MS are high users of healthcare services; however, they report multiple unmet needs, high disease burden, and low satisfaction with healthcare. Access to healthcare is vital to health maintenance and may explain these poor experiences. Access is often measured using utilisation as a proxy, which may fail to capture the complexities of access experiences that this population faces. The Candidacy Framework offers an alternative to utilisation measures, by examining the process of accessing care, while considering the impact of social patterning and health system environments on this process. The aim of the current study is to align the experiences of persons with MS in accessing healthcare services with the stages of the Candidacy Framework. Forty-eight individuals with MS living across Ontario were recruited to participate in one of five focus groups or ten individual interviews. Analysis included a first inductive phase, using constant comparative methods, followed by a deductive phase, using content analysis. The Candidacy Framework was not able to capture all experiences shared by persons with MS, including patient-centred care, past experiences and outcome expectation, and care outcomes. We propose these concepts be included as refinements to the current Framework, providing a more thorough explanation of the experiences of persons with MS in accessing care to manage their condition.

High Users of Healthcare Services: Development and Alpha Testing of a Patient Decision Aid for Case Management.

Some patients with complex healthcare needs become high users of healthcare services. Case management allows these patients and their interprofessional team to work together to evaluate their needs, priorities and available resources. High-user patients must make an informed decision when choosing whether to engage in case management and currently there is no tool to support them. The objective of this study was to develop and conduct a pilot alpha testing of a patient decision aid that supports high-user patients with complex needs and the teams who guide those patients in shared decision making when engaging in case management. We chose a user-centered design to co-develop a patient decision aid with stakeholders informed by the Ottawa Research Institute and International Patient Decision Aid Standards frameworks. Perceptions and preferences for the patient decision aid's content and format were assessed with patients and clinicians and were iteratively collected through interviews and focus groups. We developed a prototype and assessed its acceptability by using a think-aloud method and a questionnaire with three patient-partners, six clinicians and seven high-user patients with complex needs. The three rounds of evaluation to assess the decision aid's acceptability highlighted comments related to simplicity, readability and visual aspect. A section presenting clinical vignettes including story telling was identified as the most helpful. We created and evaluated a patient decision aid. Considering the positive comments, we believe that this aid has the potential to help high-user patients with complex care needs make better choices concerning case management.

Perspectives of Ontarians with Multiple Sclerosis on Accessing Healthcare Services for Managing their Condition

Multiple sclerosis (MS) requires complex care throughout life. Current Canadian literature demonstrates that persons with MS are high users of healthcare services, yet still have multiple unmet health care needs and low satisfaction with healthcare services received. This study investigated access to healthcare from the perspective of Ontarians with MS, using interpretive description methodology. Participants were 48 Persons with MS living across seven communities in Ontario recruited primarily through the MS Society of Canada. Data collection involved five focus groups plus ten individual semi-structured telephone interviews. Participants described access to healthcare services as a process of cost-benefit analysis that involved weighing out the likelihood of getting useful assistance against the range of expected barriers. Expected barriers were based on past experience and included a lack of patient-centered care, limited MS-related knowledge of generalists, and lack of affordability of preferred source of care. Ongoing experiences with these barriers led participants to believe that seeking care was not worth it. The result was that participants tended to avoid seeking healthcare services until they felt threatened by their health state, which then led to use of emergency services. Many participants also described completely disengaging from traditional healthcare services in favour of alternative treatments. Ontarians with MS report negative experiences with traditional healthcare services that fail to meet their complex care needs. Findings suggest that a patient-centered approach could reduce healthcare avoidance which may, in turn, reduce secondary complications and avoidable hospitalizations. (MS) requires complex care throughout life. Current Canadian literature demonstrates that persons with MS are high users of healthcare services, yet still have multiple unmet health care needs and low satisfaction with healthcare services received. This study investigated access to healthcare from the perspective of Ontarians with MS, using interpretive description methodology. Participants were 48 Persons with MS living across seven communities in Ontario recruited primarily through the MS Society of Canada. Data collection involved five focus groups plus ten individual semi-structured telephone interviews. Participants described access to healthcare services as a process of cost-benefit analysis that involved weighing out the likelihood of getting useful assistance against the range of expected barriers. Expected barriers were based on past experience and included a lack of patient-centered care, limited MS-related knowledge of generalists, and lack of affordability of preferred source of care. Ongoing experiences with these barriers led participants to believe that seeking care was not worth it. The result was that participants tended to avoid seeking healthcare services until they felt threatened by their health state, which then led to use of emergency services. Many participants also described completely disengaging from traditional healthcare services in favour of alternative treatments. Ontarians with MS report negative experiences with traditional healthcare services that fail to meet their complex care needs. Findings suggest that a patient-centered approach could reduce healthcare avoidance which may, in turn, reduce secondary complications and avoidable hospitalizations.

Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial.

Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.

Effectiveness of a Housing Support Team Intervention with a Recovery-Oriented Approach on Hospital and Emergency Department Use by Homeless People with Severe Mental Illness: A Randomized Controlled Trial

Background: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether an independent housing with mental health support teams with a recovery-oriented approach (Housing First program) in people who are homeless with severe mental disorders improves hospital and emergency department use. Methods: We did a randomized controlled trial in 4 French cities: Lille, Marseille, Paris, and Toulouse, including a cost effectiveness analysis. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD), and were required to have a high level of needs (moderate-to-severe disability and past hospitalizations over the last 5 years or comorbid alcohol or substance use disorder. Using computer-generated random numbers, participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist, and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalization admissions, and inpatient days at 24 months. Secondary outcomes were recovery (RAS), quality of life (SQOL and SF36), mental health symptoms (MCSI), addiction issues, stably housed days and cost savings from a societal perspective. Findings: Between August 2011and April 2014, 703 eligible patients were randomly assigned to the HF group (n=353) or TAU group (n=350). No differences were found in the number of hospital admissions (success rate difference [95% CI], -0.03 [-0.12 to 0.05]) or ED visits (-0.05 [-0.14 to 0.3]). Significant less inpatient days were found for HF versus TAU (-0.16 [-0.23 to -0.08]). HF group exhibited higher housing stability (standardized Beta, 20.2 [18 to 22.3]) and higher scores for some sub-dimensions of the SQOL scale (psychological well-being and autonomy). No differences were found for SF36, mental health symptoms, rates of alcohol or substance dependence. HF was associated with cost savings in healthcare costs (-0.21[-0.29 to -0.13]) and residential costs (-0.81[-0.85 to -0.77]). Interpretation: An immediate access to independent housing and support from an Assertive Community Treatment team resulted in decreased inpatient days and cost savings in people who are homeless with SCZ or BP disorders. Trial Registration: This study is registered with ClinicalTrials.gov, number NCT01570712. Funding Statement: French institutional grant from the Programme Hospitalier de Recherche Clinique National (DGOS), Janssen Pharmaceutical Company, and the Fondation de France. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at http://www.thelancet.com/forauthors/forms#icmje-coi, and stated that no conflicts of interest exist. Ethics Approval Statement: The local ethics committee (Comite de Protection des Personnes Sud-Mediterranee V, France: trial number 11.050) and the French Drug and Device Regulation Agency (trial number 2011-A00668-33) approved this study.

The electronic frailty index as an indicator of community healthcare service utilisation in the older population.

older people with frailty are particularly high users of healthcare services, however a lack of standardised recording of frailty in different healthcare electronic datasets has limited investigations into healthcare service usage and demand of the older frail population. to investigate the community service demand of frail patients using the electronic frailty index (eFI) as a measure of frailty. a retrospective cohort study using anonymised linked healthcare patient data from primary care, community services and acute hospitals in Norfolk. patients aged 65 and over who had an eFI assessment score established in their primary care electronic patient record in Norwich based General Practices. we include data from 22,859 patients with an eFI score. Frailty severity increased with age and was associated with increased acute hospital admission within a 6-month window. Patients with a frail eFI score were also more likely to have a community service referral within a 6-month window of frailty assessment, with a RR of 1.84 (1.76-1.93) for mild frailty, 1.96 (1.83-2.09) for moderate frailty and 2.95 (2.76-3.14) for severe frailty scores. We also found that frail patients had more community referrals per patient then those classified as fit and required more care plans per community referral. eFI score was an indicator of community service use, with increasing severity of frailty being associated with higher community healthcare requirements. The eFI may help planning of community services for the frail population.

Screening tools to identify patients with complex health needs at risk of high use of health care services: A scoping review.

BackgroundMany people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early.ObjectiveThe aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics. Our purpose was to find a short, valid screening tool to identify adult patients of all ages.MethodsA scoping review was performed on articles published between 1985 and July 2016, retrieved through a comprehensive search of the Scopus and CINAHL databases, following the methodological framework developed by Arksey and O’Malley (2005), and completed by Levac et al. (2010).ResultsOf the 3,818 articles identified, 30 were included, presenting 14 different screening tools. Seven tools were self-reported. Five targeted adult patients, and nine geriatric patients. Two tools were designed for specific populations. Four can be completed in 15 minutes or less. Most screening tools target elderly persons. The INTERMED self-assessment (IM-SA) targets adults of all ages and can be completed in less than 15 minutes.ConclusionFuture research could evaluate its usefulness as a screening tool for identifying patients with complex needs at risk of becoming high users of healthcare services.

Conserving Quality of Life through Community Paramedics.

The Economic Value of Community Paramedicine Programs Study was a randomized controlled trial in two Eastern Ontario communities ߝ one urban and one rural ߝ to determine whether community paramedicine services (the intervention through home visits) would have a positive economic impact through influencing self-perceived quality of life and determining a monetized value. A total of 200 clients who were high-users of healthcare services and had one or more of five chronic diseases (congestive heart failure, chronic obstructive pulmonary disease, hypertension, stroke and diabetes) were recruited in early 2015. These participants were randomly assigned to either the intervention group (receiving community paramedicine services for 12 months) or the control group (receiving conventional treatment). Study results suggest that although quality of life scores decreased for all groups, those receiving community paramedicine services demonstrated significantly less reduction in their scores. Suggestions to further increase cost efficiency of this novel service are given.

Evidence of sustained benefit: Use of teleconsultation to support people living in residential care settings

Introduction: An increasing proportion of the population require long term supported care in nursing or residential care home settings. As high users of healthcare services, interventions that can be delivered in their place of residence offer substantial benefit to the patient, their carers and to the wider health system. Teleconsultation using 2 way video links has been used to deliver such interventions and its use appeared in early results to reduce the need for hospital admission and Emergency Department (ED) attendance. Aims: To evaluate, using 2nd year activity and outcome data, whether the impact a dedicated 24/7 teleconsultation service (the Hub) has on admissions, ED attendance and total hospital bed days used by the residents of a cohort of local nursing and residential care homes is sustained beyond the initial “honeymoon” period following introduction of a novel service. Results: From a population comprising the residents of the nursing and residential care homes in the locality served by a single acute hospital, hospital admissions, ED attendances and total bed days used were measured using routinely collected hospital statistics. Hub activity statistics were initially collected using manual audit. Data were recorded for the year before and the year after each care home began using teleconsultation. Initial findings, from 17 care homes supporting a population of just over 1000 people, showed that there appeared to be a 45% reduction in admissions and a 60% reduction in total bed days used by residents from these locations in the 12 months following introduction of the service. As the numbers of locations supported has risen and data collection methods have been automated, these figures have settled at a reduction in acute admissions of 35% (n=654 to 437), a reduction in ED attendance of 53% (n=798 to 379) and of total bed days used by 59% (n=8247 to 3435). These reductions equate to a fall in the number of hospital beds required to service this level of in-patient activity from 22.6 to 9.4 (-59%). Service user satisfaction remains high at >9/10 across a range of measures using a questionnaire-based International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116540– http://www.ijic.org/ approach. The service continues to grow, with 100 care homes now receiving support across a wide geographical area. Conclusions: Use of teleconsultation, delivered on a 24/7 basis, appears to be supporting sustained reductions in the need for in-patient and ED hospital services and service user satisfaction with the approach remains very high. These reductions equate to substantial falls in the number of hospital beds required by this frail and difficult to move population. At scale deployment of this approach could offer real benefit to patients and both commissioning and provider organisations.

Self-reported use of diabetes healthcare services in a Quebec community-based sample: impact of depression status

ObjectivesTo ascertain the impact of minor and major depression on self-reported use of and access to diabetes healthcare services, and the care components received in a community-based Quebec sample with type 2 diabetes. Study designAdults with type 2 diabetes who took part in baseline and 1-year follow-up telephone interviews for the Diabetes Health Study were assessed (n = 1175). MethodsInformation was collected regarding depression status (i.e. minor or major depression), use of and access to diabetes healthcare services, sociodemographic and diabetes characteristics, treatment, diabetes complications, disability, body mass index, residential area and depression. ResultsPeople with major depression were more likely to be high users or non-users of diabetes healthcare services. The high users reported more diabetes complications. People with major depression also reported more problems with accessing diabetes healthcare services, specifically having to wait too long between making their appointment and their visit, specialist care not being available in their area, general health deterioration, being unable to leave their house due to their health and problems with transportation. People with major depression were less likely to report having their feet checked by their doctor, and were more likely to report problems with getting advice from their doctor. ConclusionsPeople with diabetes need to use healthcare services in order to receive recommended care components. People with major depression and no complications are less likely to report using healthcare services; conversely, people with major depression and complications are more likely to be high users of healthcare services. People with major depression perceive more problems with the health care they receive.

The Vulnerable Child Syndrome

The Vulnerable Child Syndrome