High Utilization Of Health Care Services Research Articles

Association between gastrointestinal symptoms and specialty care utilization among colon cancer survivors: a cohort study

PurposePersistent gastrointestinal (GI) symptoms are frequently experienced by colon cancer survivors and may help identify patients with higher utilization of healthcare services. To assess the relationship between GI symptoms and specialty care utilization among colon cancer survivors.MethodsA prospective longitudinal cohort study at an academic medical center of 126 adults surgically treated for stage I–IV colon cancer between February 2017 and June 2022. Participants reported GI symptoms through the EORTC QLQ-C30 and QLQ-CR29 at enrollment and as frequently as every 6 months for 5 years. Main outcome measures were visits, telephone encounters, and secure messages with a medical provider within specialty oncology clinics within 6 months after each survey completion. Generalized linear mixed regression model for repeated measurements with random trajectory for each participant was performed to estimate the associations between symptoms and healthcare use. Models were adjusted for demographics, clinical and surgical factors, and timing in relation to onset of the COVID-19 pandemic.ResultsIn the 6 months after each survey time point, patients averaged 1.2 visits, 0.5 telephone encounters, and 3.2 patient-initiated messages. In adjusted models, those with any abdominal pain (RR 1.45; p = 0.002), buttock pain (RR 1.30; p = 0.050), or increased stool frequency (RR 1.26; p = 0.046) had more clinic visits in the following 6 months than those without these symptoms. Including these three symptoms in one model revealed that only abdominal pain was statistically significantly associated with increased clinic visits (RR 1.36; p = 0.016). Patients with any blood or mucus in stool (RR 2.46; p = 0.009) had significantly more telephone encounters, and those with any abdominal pain (RR 1.65; p = 0.002) had significantly more patient-initiated messages than those without these symptoms.ConclusionsOur findings identify GI symptoms associated with increased use of oncologic specialty care among colon cancer survivors, with abdominal pain as an important predictor of utilization.Implications for cancer survivorsEarly identification and anticipatory management of colon cancer survivors experiencing abdominal pain may decrease healthcare utilization.

Public Health Insurance Status and Utilization of Healthcare Services Across India: A Narrative Review.

Health insurance literacy gauges how knowledgeable people are regarding the comparison of health insurance plans to find out the optimal health plan that suits their needs and preferences. Enrolling in a comprehensive plan and proactively addressing health and financial aspects can fortify the stability of families. The plan needs to be used effectively by adapting to evolving circumstances and prioritizing the well-being and prosperity of the household. Having public health insurance can significantly impact an individual's utilization of healthcare services. Having health insurance encourages individuals to promptly seek medical attention without hesitating or avoiding treatment due to financial worries. This results in higher utilization of healthcare services, encompassing routine check-ups, preventive care, and timely intervention for illnesses and injuries. Public health insurance can also improve access to specialized care and expensive treatments that may otherwise be unaffordable for individuals without insurance. By having health insurance, individuals and families can experience a decrease in the economic strain associated with healthcare expenses, thereby enhancing the accessibility and affordability of healthcare services.

Regional variations in multimorbidity burden among office-based physicians in Germany.

Multimorbidity is associated with higher utilization of healthcare services. However, many countries do not consider multimorbidity when estimating physician supply. The main aim of this study was to assess how regional multimorbidity levels can be integrated when estimating the need for office-based physician supply. Claims data were used to measure and compare the proportions of multimorbid patients of GPs, ophthalmologists, orthopaedic specialists and neurologists, and examine spatial variations through Bernoulli cluster analysis of regional multimorbidity levels. To explore the interrelationship between current capacities and spatial occurrence of high-rate clusters, clusters were compared with the current supply of physicians. About 17239488 individuals out of approximately 67 million records were classified as multimorbid. Multimorbidity levels varied greatly between physician disciplines (31.5-60.1%). Bernoulli cluster analysis demonstrated that many high-rate areas were found for all specialized physicians, but clusters varied partially by size and location. The comparison with current physician supply at cluster level showed that more than a third of clusters with a significantly higher share of morbid patients seeing a GP are met, on an average, by GP supply below targeted values. In turn, clusters with significantly higher multimorbidity levels of specialized physicians were met, on an average, by supply that exceeded targeted values. Our study offers an approach to how to include discipline-specific multimorbidity at area level when estimating physician supply and discusses its relevance. The outcomes of our article can be used by policymakers to advance current planning strategies and to improve the quality of office-based care.

Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization.

The goal of our study was to evaluate the burden of endometriosis in the community by comparing healthcare resource utilization, total direct medical costs, infertility, and comorbidity rates of women with and without a diagnosis of endometriosis. A retrospective case–control study was performed using the databases of a 2.1 million-member nationwide healthcare plan. The study population included women aged 15–55 years enrolled in the healthcare plan. Women with a diagnosis (ICD-9) of endometriosis were compared to controls without diagnosed endometriosis. Women were individually matched (1:4) on age and residence area. Patient characteristics were described, including infertility, comorbidities, and annual healthcare resource utilization. Total direct medical costs were analyzed in a generalized linear model adjusting for age. Women with endometriosis (n = 6146, mean age ± SD: 40.4 ± 8.0 y) were significantly more likely than controls (n = 24,572) to have a lower BMI and a higher socioeconomic status. After adjusting for BMI and socioeconomic status, endometriosis was significantly associated with infertility (OR = 3.3; 95% CI 3.1–3.5), chronic comorbidities, higher utilization of healthcare services (hospitalization: OR = 2.3; 95% CI 2.1–2.5), pain medications, and antidepressants. Women aged 15–19 y with endometriosis had substantially higher utilization of primary care visits (57.7% vs. 14.4%) and oral contraceptive use (76.9% vs. 9.6%). Direct medical costs associated with endometriosis were higher than those for controls (OR = 1.75; 95% CI 1.69–1.85). Endometriosis is associated with a high burden of comorbidities, increased healthcare resource utilization, and excess costs, particularly for younger patients whose healthcare needs may differ widely from the older population.

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program.

The Chronic Care Program introduced in Catalonia in 2011 focuses on improving the identification and management of complex chronic (CCPs) and advanced chronic patients (ACPs) by implementing an individualized care model. Its first stage is their identification based on chronicity, difficult clinical management (i.e., complexity), and, in ACPs, limited life prognosis. Subsequent stages are individual evaluation and implementation of a shared personalized care plan. This retrospective study, including all CCPs and ACPs identified in Catalonia between 2013 and 2019, was aimed at describing the characteristics and healthcare service utilization among these patients. Data were obtained from an administrative database and included sociodemographic, clinical, and service utilization variables and morbidity-associated risk according to the Adjusted Morbidity Groups (GMA) stratification. During the study period, CCPs’ and ACPs’ prevalence increased and was higher in lower-income populations; most cases were women. CCPs and ACPs had all comorbidities at higher frequencies, higher utilization of healthcare services, and were more frequently at high risk (63% and 71%, respectively) than age-, sex-, and income level-adjusted non-CCP (23%) and non-ACP populations (30%). These results show effective identification of the program’s target population and demonstrate that CCPs and ACPs have a higher burden of multimorbidity and healthcare needs.

PP391 Economic Analysis Of Treatment For Spinal Muscular Atrophy: A Scoping Review

IntroductionSpinal muscular atrophy (SMA) is a rare, life-threatening, and seriously debilitating neuromuscular disorder, which has a heavy burden on patients, caregivers and the health system. Technological advances have improved clinical effect, but have also increased the financial burden. There is limited information in the literature on the resource utilization and economic burden of SMA. Our research aims to summarize the current literature on resource use, cost and economic evaluations of treatments for SMA, to inform further research and policy decision making.MethodsDatabases, including PubMed, Embase, Cochrane Library and CRD Database, were searched from inception. Two reviewers undertook title and abstract screening followed by full-text screening, and any disagreement was resolved in consensus. Data extraction was conducted using a customized form. Included studies were summarized using narrative synthesis structured around general and economic characteristics. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to where applicable.ResultsWe reviewed 552 abstracts and included twenty-six from 2015 to 2019. Four-fifths were published in the United States and Europe. Five full economic evaluations and one budget impact analysis compared nusinersen with AVXS-101 or best supportive care, and the remaining evaluated the economic burden of SMA. The most common outcomes were healthcare resource utilization and direct medical costs, only a few studies evaluated direct non-medical costs or indirect cost.ConclusionsSMA patients have significant medical expenditures and high utilization of healthcare services, including nusinersen-treated patients. The results highlight the substantial burden of treatment for SMA, not only for patients but also for their caregivers. SMA represents a significant hidden cost that society should be made aware of, and that should be considered in the design, implementation and evaluation of support programs for people who suffer from this disease and their families, as well as in the economic evaluation of new treatments.

Transplant Recipients Using Tacrolimus Had Higher Utilization of Healthcare Services Than Those Receiving Cyclosporine in Taiwan.

To date, population-based studies on the healthcare service utilization among stable heart, kidney, and liver transplant recipients with different calcineurin inhibitors are still scarce. Therefore, we used the Taiwan National Health Insurance Research Database to conduct a nationwide cross-sectional study to estimate the healthcare utilization of stable transplant recipients with tacrolimus or cyclosporine (n = 3,482). The sampled patients in this study comprised 377 heart, 1,693 kidney, and 1,412 liver transplant recipients between 1 January 2011 and 31 December 2011. Each subject was followed for a 1-year period to evaluate his/her healthcare service utilization. Outcome variables of the healthcare service utilization were stated as below: numbers of outpatient visits, outpatient costs, numbers of inpatient days, inpatients costs, and total costs of all healthcare services. As for all healthcare service utilization, stable transplant recipients on tacrolimus had significantly more outpatient visits (40.7 vs. 38.6), outpatient costs (US$10,383 vs. US$8,155), and total costs (US$12,516 vs. US$10,372) of all healthcare services than those on cyclosporine during the 1-year follow-up period. Additionally, further analysis showed that heart transplant recipients receiving tacrolimus incurred 1.7-fold higher inpatient costs compared to patients receiving cyclosporine. We concluded that transplant recipients using tacrolimus had significantly higher utilization of all healthcare services than those receiving cyclosporine as immunosuppressive therapy.

Predicting different factors that affect hospital utilization and outcomes Among diabetic patients admitted with hypoglycemia using structural equation modeling

BackgroundHypoglycemia (HG) is a common complication among diabetic patients. Many diabetics who experience HG are admitted to hospitals and usually utilize more resources. While plenty of studies examined multiple HG risk factors, there is limited knowledge about the correlation between different risk factors of HG and their impact on utilization. ObjectiveTo identify key factors influencing utilization among diabetic HG patients and to examine the mechanisms and interactions between those factors. DesignA quantitative, non-experimental, and retrospective design that is based on the selection of the study subjects from the Healthcare Cost and Utilization Project National database for the years of 2012–2014. We employed Andersen Behavioral Model of Health Services Use as the main framework for this study. ResultsStructural Equation Modeling was used as the main multivariate statistical method for the analysis. Total sample size was 4822 patients. We found that diabetes complications, renal disease, hypertension, and high Charlson comorbidity index score had the strongest impact on length of stay (LoS) as well as total charge. Geographical location of patients strongly influenced total charge. Age had an indirect impact on LoS and total charge. LimitationsThe use of secondary data seems to be the primary limitation for this study as some relevant risk factors for hypoglycemia were not available in the database. ConclusionsThis study examined the multilevel character of different factors leading to high utilization of healthcare services among HG patients admitted to hospitals. Findings of this study help clinicians and policy makers to formulate policies and protocols that aid in providing efficient care to HG patients with less utilization of resources.

Utilizing health records to characterize obesity, comorbidities, and health-care services in one human service agency in the United States.

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age was 49.5 years, 53% were males. Prevalence of overweight, obese, and morbidly obese was 28%, 58%, and 23%, respectively. Primary diagnosis was intellectual disability (50% mild, 33% moderate, 10% severe, and 8% profound), 85% had mental health disorders (67.5% with affective or mood and 42.5% had anxiety disorders). On average, residents consumed 2.63 psychotropic medications daily with additional 5.75 medications for axis 3 diagnoses and made 39.2 health visits over past 18 months. Our analysis supports increased prevalence of overweight/obesity, higher comorbidities, dual psychiatric diagnosis, substantial medication consumption, and higher utilization of health-care services in adults with intellectual disabilities. Targeted health interventions are therefore essential to improve their health and quality of life.

Prevent Depression: Improving Access to Brazil's Mental Health Services

Brazil consistently ranks as one of the most violent and socially inequitable countries across the globe. Both violence and social inequality are associated with depression, resulting in Brazil having a high prevalence of the disease compared to other countries. Depression leaves a large burden on the residents of Brazil in terms of disability-adjusted life years (DALYs), resulting in higher utilization of healthcare services, more hospitalizations, and lost productivity. Brazil is deinstitutionalizing mental health care by utilizing Psychosocial Community Centers (CAPS) to provide mental healthcare to the population. However, there are a lack of centers in lower socioeconomic areas consequently creating a discrepancy in coverage and access to mental healthcare. Other Latin American countries such as Chile and Panama have taken steps to improve access to mental health via integrating primary care and mental healthcare. Brazil can utilize similar ideas, along with better education of primary care staff to improve access to mental healthcare.

The economic burden of spinal muscular atrophy

Aim: To evaluate the economic burden of spinal muscular atrophy (SMA).Materials and methods: This study used Department of Defense Military Healthcare System (MHS) data from 2003–2012. Healthcare costs were determined for patients with at least one inpatient or three outpatient claims with a diagnosis of SMA before 18 years of age and who had ≥ 6 months of data after first SMA diagnosis or expired within 6 months of initial diagnosis. A comparator cohort was selected using a 3:1 match based on age and gender.Results: A total of 239 individuals with SMA diagnosis met the inclusion criteria along with 717 matched comparator patients. More patients with SMA had hospitalizations (69.5%) compared to the comparator cohort (17.2%, p < 0.001). Median total expenditures across all years of data for patients with SMA were $83 652 (25–75th percentile = $29 620–228 754) vs the comparator group of $4329 (25–75th percentile = $1229–10 062 (p < 0.001)) over an average (SD) of 6.9 ± 3.6 years. The annualized mean costs of total healthcare expenditures were significantly higher for the SMA cases than the comparison cohort, $47 862 ± 88 607 compared to $1861 ± 6374, respectively (p < 0.001). The sub-group of patients with early diagnosis (n = 45) had 4.3 ± 2.9 years of observation with a median cost of $167 921 ($53 349–678 412). Mean age (SD) at first observed SMA diagnosis was 7.5 ± 6.4 years. Mean (SD) duration of follow-up after initial SMA diagnosis was 4.8 ± 3.3 years, with a median post-diagnosis cost of $60 213 ($18 229–192 559). The major costs for all patients were outpatient visits [median = $53 152 ($23 902–136 150)], followed by inpatient costs [median = $11 258 ($0–51 987)] and total prescription costs [median = $3167 ($943–13 283)].Limitations: The analysis is limited to the data available and may under-estimate the total cost of SMA.Conclusions: Individuals with SMA have a high degree of morbidity, particularly those diagnosed during infancy. SMA patients have significant medical expenditures and high utilization of healthcare services.

Utilización de servicios sanitarios en ancianos (España 2006-2012): influencia del nivel de salud y de la clase social

Objectiveto explore health-care utilization (primary and specialized health-care, hospitalizations, day hospital and emergency services) and overuse in elderly in Spain, considering the influence of health status, sex, social class and its temporal trend. Designcross sectional study in two phases. SettingSpain. Participantspeople surveyed in the National Health Surveys 2006 and 2011-12. Main measurementsHealth status was measured using self-rated and diagnosed health (number and diagnoses). Social class was obtained from the last occupation of the main supporter (manual and non-manual workers). Logistic regression analyses were conducted adjusting by sex, age, health status, social class and year, obtaining its predictive capacity. Resultsthe percentage of elderly population with health-care utilization decreased during the period analyzed. Women who belonged to the manual workers category presented the highest prevalence of low health (low self-rated health in 2006: 70.6%). Low health status was associated with a higher utilization of health-care services. Self-rated health was a better predictor of health-care utilization and overuse than diagnosed health, getting the highest predictive capacity for specialized health-care (C = 0.676). Old people from low social class used with higher frequency primary health-care and emergency services. On the other hand, specialized health-care and day hospital were more used by high social classes. Conclusionsinequalities in health and health-care utilization have been observed in elderly according social class. It is necessary to consider self-rated health as a health-care utilization predictor and to review our health-care services accessibility and equity.

Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients.

We investigated the relationship between fear of cancer recurrence (FCR), anxiety, supportive care needs, and utilization of health-care services in a mixed sample of 335 cancer patients. We used validated questionnaires including the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the General Anxiety Disorder Scale (GAD-7) and the Supportive Care Needs Survey (SCNS-SF34). Health-care services utilization was measured by a self-constructed questionnaire recording the use of 22 health and supportive care offers. In our sample, 3.9% of patients were classified as having high anxiety and 5.1% had high FCR. Patients reported the highest unmet supportive care needs in the domain health system and information followed by psychological needs. Integrated care and complementary support services were the most frequently used (32%) followed by medical (31%), psychological (23%), spiritual and religious (8%) and other support services (9%). Whereas anxiety was related to both unmet psychological and physical/daily living needs (p < 0.01), FCR was associated with unmet supportive care needs in all five domains further including needs with regard to health system and information, patient care, and sexuality (p < 0.01). However, higher levels of anxiety and FCR were not related to higher utilization of health-care services. Our findings show that FCR plays a significant role in unmet supportive care needs in cancer patients but not for health-care service utilization. We recommend that clinicians monitor supportive care needs in patients struggling with FCR and anxiety.

Primary Care Physician Describes Health Care ‘Hot Spotting’

Primary Care Physician Describes Health Care ‘Hot Spotting’

Smoking and Other Correlates of Health Care Services Utilization Among Mandatory Military Recruits in Israel

Data on utilization of ambulatory care and the impact of lifestyle on health among young adults are scarce. Israeli mandatory military service provides a unique opportunity to investigate these topics. Study objective was to analyze the utilization of health care services (HCS) during the first year of military service, and its associations with health behavior at recruitment, in order to plan health services, health classification, and health promotion activities. We conducted a retrospective cohort study among a representative sample of 5,751 mandatory new recruits between January 1, 2004, and December 31, 2008. Data were collected from the Israeli Defense Force computerized medical and administrative records and from an ongoing health survey among military recruits. During their first year of service, recruits had, on average, more than 7 visits to the primary care clinic, more than 10 dispensed nonchronic medications, and more than 5 days of sick leave. Female sex (OR = 1.27; 1.06-1.51) and current cigarette smoking (OR = 1.57; 1.34-1.84) were significantly associated with increased use of HCS, after controlling for possible confounders. Our findings indicate high utilization of HCS during the first year of military service and highlight the potential effect of cigarette smoking as a risk factor for increased morbidity among apparently healthy young adults. These findings support adding smoking status to fitness assessments and could aid health promotion efforts to reduce smoking rates among adolescents.

Depression, suicidality and antidepressants: A coincidence?

Byline: Vithyalakshmi. Selvaraj, Snehamala. Veeravalli, Sriram. Ramaswamy, Richard. Balon, Vikram. Yeragani Major depressive disorder is currently one of the leading causes of disability world-wide and projected by the World Health Organization (WHO) to become the second leading cause of disability after heart disease by the year 2020. Suicidal ideation and behavior are the most serious and common psychiatric emergencies among the depressed population. In 2004, suicide was the eleventh leading cause of death in the U.S.[sup] [1] The overall rate was 10.9 suicide deaths per 100,000 people. An estimated 8 to 25 attempted suicides occur per every suicide death. It is reassuring that depressed patients usually respond to treatment with antidepressants. In fact, population-based studies examining rates of antidepressant use and suicide over time, have generally found lower rates of suicide with increasing rates of antidepressant use.[sup] [2],[3],[4],[5],[6],[7],[8] However, in 2003, publication of data linking antidepressant use to suicide and suicidal behavior in children and teenagers sparked off worldwide public health concern. This prompted the US Food and Drug Administration (FDA) to mandate manufacturers of all antidepressants (including tricyclic antidepressants [TCAs] and monoamine oxidase inhibitors) to include a warning stating that antidepressants may increase the risk of suicidal ideation and behavior in children, adolescents and young adults less than 25 years old. The 'black box' warning, although meant to safeguard public health has had serious spillover effects on pharmacotherapy of depression. There have been recent reports of a rise in suicide rates among the youth and a decline in depression care among the older adults. We critically evaluate this association in order to provide more clarity while assessing the benefits of antidepressant use versus any risk of self-harm associated with them. Impact of Depression Depression is a pathological and pervasive state of mood. The lifetime risk of developing major depressive disorder is 16.2% in the United States. Recurrence is the rule, and about one-third of patients go on to develop chronic depression. Depression increases mortality because it worsens many medical conditions such as cardiovascular disease and diabetes and increases the risk of suicide. Depressed patients are high utilizers of healthcare services and typically perform poorly in the workplace. The mean age of onset, from a number of studies, is in the late 20s. Although twice as many females as males report or receive treatment for clinical depression, this gap has significantly narrowed in the recent past. Also, this difference disappears after the age of 50-55, when most females are post-menopausal. Suicidal ideation and attempts are common in depressed patients. Each year, about 30,000 people in the United States and one million worldwide die by suicide. Approximately 650,000 people in the United States receive emergency treatment each year after attempting suicide. Antidepressants Benefits and Risks Mono amine oxidase inhibitors (MAOI) and tricyclic antidepressants (TCA) were the mainstays of treatment for depression until the introduction of Serotonin Reuptake Inhibitors (SSRIs) in the late 1980's. Currently, SSRIs are the most commonly prescribed antidepressants. The therapeutic effects of antidepressants are believed to be related to their ability to facilitate serotonin, norepinephrine and/or dopamine neurotransmission. Despite the early increase in concentration of monoamine neurotransmitters at receptor sites, clinical antidepressant benefits are not evident until several weeks. One explanation for this therapeutic lag is the theory that down-regulation of neurotransmitter receptors is a consequence of excess signaling, a process that takes several weeks and ultimately responsible for the alleviation of depressive symptoms. Overall, antidepressants are very effective in treating depression and its associated complications. …