Higher Healthcare Utilization Research Articles

Understanding sex-related differences in healthcare utilisation among patients with inflammatory arthritis: a population-based study

ObjectivesOur aim was to compare patterns of musculoskeletal-related healthcare utilisation between male and female patients before and after the diagnosis of inflammatory arthritis (IA).MethodsWe used Ontario administrative health data to...

Long-term health-related quality of life, healthcare utilisation and back-to-work activities in intensive care unit survivors: Prospective confirmatory study from the Frisian aftercare cohort.

More substantial information on recovery after Intensive Care Unit (ICU) admission is urgently needed. In a previous retrospective study, the proportion of non-recovery patients was 44%. The aim of this prospective follow-up study was to evaluate changes in Health-Related Quality of Life (HRQoL) in the first year after ICU-admission. Long-stay adult ICU-patients (≥ 48 hours) were included. HRQoL was evaluated with the Dutch translation of the RAND-36 item Health Survey (RAND-36) at baseline via proxy measurement, and at three, six, and twelve months after ICU admission. Subsequently, the relation between physical functioning, healthcare utilisation, and work activities was explored. A total of 81 patients were included in this study. Fifty-five percent of patients did not meet criteria for full recovery and were allocated to the Non Recovery (NR)-group (Physical Functioning domain-score: 35 [15-55]). Baseline physical HRQoL differed significantly between the Recovery (R) and NR-group. Patients in the NR-group received home care more often and had higher healthcare utilisation (44 versus 17% in the first three months post-ICU, p = 0.013). Only fourteen percent of NR-patients were able to participate in work activities. Moreover, NR-patients persistently showed impaired overall HRQoL throughout the year after critical illness. Limited recovery in ICU survivors is reflected in overall impaired HRQoL, as well as in far-reaching consequences for patients' healthcare needs and their ability to reintegrate into society. In our study, baseline HRQoL appeared to be an important predictor of long-term outcomes, but not Clinical Frailty Scale (CFS) score. And, (proxy-derived) HRQoL may help to identify patients at risk of long-term non-recovery.

A home-based, multidisciplinary liver optimisation programme for the first 28 days after an admission for acute-on-chronic liver failure (LivR well): a study protocol for a randomised controlled trial

BackgroundAcute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease complexity and a high prevalence of socio-economic disadvantage, there are deficits in quality of care and adherence to guideline-based treatment in this cohort. Compared to other chronic conditions such as heart failure, those with liver disease have reduced access to integrated ambulatory care services. The LivR Well programme is a multidisciplinary intervention aimed at improving 28-day mortality and reducing 30-day readmission through a home-based, liver optimisation programme implemented in the first 28 days after an admission with either ACLF or hepatic decompensation. Outcomes from our feasibility study suggest that the intervention is safe and acceptable to patients and carers.MethodsWe will recruit adult patients with chronic liver disease from the emergency departments, in-patient admissions, and an ambulatory liver clinic of a multi-site quaternary health service in Melbourne, Australia. A total of 120 patients meeting EF-Clif criteria will be recruited to the ACLF arm, and 320 patients to the hepatic decompensation arm. Participants in each cohort will be randomised to the intervention arm, a 28-day multidisciplinary programme or to standard ambulatory care in a 1:1 ratio. The intervention arm includes access to nursing, pharmacy, physiotherapy, dietetics, social work, and neuropsychiatry clinicians. For the ACLF cohort, the primary outcome is 28-day mortality. For the hepatic decompensation cohort, the primary outcome is 30-day re-admission. Secondary outcomes assess changes in liver disease severity and quality of life. An interim analysis will be performed at 50% recruitment to consider early cessation of the trial if the intervention is superior to the control, as suggested in our feasibility study. A cost-effectiveness analysis will be performed. Patients will be followed up for 12 weeks from randomisation. Three exploratory subgroup analyses will be conducted by (a) source of referral, (b) unplanned hospitalisation, and (c) concurrent COVID-19. The trial has been registered with the Australian New Zealand Clinical Trials Registry.DiscussionThis study implements a multidisciplinary intervention for ACLF patients with proven benefits in other chronic diseases with the addition of novel digital health tools to enable remote patient monitoring during the COVID-19 pandemic. Our feasibility study demonstrates safety and acceptability and suggests clinical improvement in a small sample size. An RCT is required to generate robust outcomes in this frail, high healthcare resource utilisation cohort with high readmission and mortality risk. Interventions such as LivR Well are urgently required but also need to be evaluated to ensure feasibility, replicability, and scalability across different healthcare systems. The implications of this trial include the generalisability of the programme for implementation across regional and urban centres.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001703897. Registered on 13 December 2021.WHO Trial Registration Data Set. See Appendix 1

Profiling Disease and Economic Burden in CRSwNP Using Machine Learning.

PurposeChronic rhinosinusitis with nasal polyps (CRSwNP) is associated with high healthcare resource utilization (HRU) and economic cost; however, heterogeneity of clinical burden among patients with differing clinical characteristics has not been fully elucidated. Here, an unsupervised machine learning approach supported by clinical validation identified distinct clusters of patients with CRSwNP and compared healthcare burden.Patients and MethodsThis retrospective analysis identified adult patients with ≥2 claims for CRSwNP and date of first diagnosis (index date) between January 2015 and June 2019 from a healthcare database. Patients were required to have enrollment in the database 6-months pre- and 12-months post-index. Patients were assigned to clusters using latent class analysis. All-cause and nasal polyp (NP)-related HRU and costs were compared between clusters.ResultsAmong 12,807 patients, 5 clusters were identified: cluster 1: no surgery/low comorbidity/low medication use (n = 4076); cluster 2: no surgery/low comorbidity/high medication use (n = 2201); cluster 3: no surgery/high comorbidity/high medication use (n = 2093); cluster 4: surgery/low comorbidity/moderate medication use (n = 3168); cluster 5: surgery/high comorbidity/high medication use (n = 1269). All-cause HRU was similar across clusters. NP-related HRU was highest in the surgical clusters (clusters 4 and 5). All-cause costs were similar in clusters 1–3 ($15,833–$17,461) and highest in clusters 4 ($31,083) and 5 ($31,103), driven by outpatient costs. Total NP-related costs were also highest for clusters 4 and 5 ($14,193 and $16,100, respectively).ConclusionSubstantial heterogeneity exists in clinical and economic burden among patients with CRSwNP. Machine learning offers a novel approach to better understand the diverse, complex burden of illness in CRSwNP.

Patterns of Healthcare Utilization Leading to Diagnosis of Young-Onset Colorectal Cancer (yCRC): Population-Based Case-Control Study.

Simple SummaryThere is a rising incidence of colorectal cancer among young patients. We attempted to characterize how young colorectal cancer patients use the healthcare system prior to diagnosis to see if there is a potential window where we could diagnose patients earlier. We found that young colorectal cancer patients did not seem to present more frequently than healthy controls in the years leading up to their diagnosis, contrary to prior studies. Other interventions are needed to diagnose yCRC patients earlier.Background: The increasing risk of young-onset colorectal cancer (yCRC) in adults < 50 years has called for better understanding of patients’ pathways to diagnosis. This study evaluated patterns of healthcare utilization before diagnosis of yCRC. Methods: Using linked administrative health databases in British Columbia, Canada, we identified yCRC cases and cancer-free controls matched (1:10) on age, sex, and healthcare utilization. The index date was the date of diagnosis for yCRC cases and matched date for controls. Outpatient visits, emergency department visits, and hospitalizations over a 5-year prediagnosis period (e.g., year-1 to year-5) were compared using descriptive statistics and Poisson regression models. Results: The study included 2567 yCRC cases (49.6% females, 43.0 ± 5.8 years) and 25,455 controls (48.6% females, 43.0 ± 5.8 years). We observed an increasing number of outpatient visits from prediagnosis year-5 (median = 3) to year-1 (median = 8) for yCRC cases. Among controls, outpatient visits were stable and did not have a pattern of increase. Poisson regression models indicated higher adjusted count ratios for outpatient visits for yCRC cases compared to controls in the year before diagnosis (1.11; 95% CI, 1.07 to 1.15). In the year before diagnosis, 35.1% of yCRC cases had potentially related visits to CRC (e.g., nausea, vomiting) and 16.9% had potentially red flag visits (e.g., gastrointestinal hemorrhage or iron deficiency anemia). Conclusions: Using population-based data, we found that individuals with yCRC did not have higher healthcare utilization than individuals without in the prediagnosis period except for the year before diagnosis.

P05-17 Assessing the impact of care-physical activity initiatives for people with a low socioeconomic status on healthcare utilisation: an exploratory study

BackgroundCare-physical activity (care-PA) initiatives are being implemented in the Netherlands to stimulate the health of citizens with a low socioeconomic status (SES), with the aim of reducing health inequality and healthcare utilisation. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. As the impact of care-PA initiatives on healthcare utilisation has not yet been studied, our research question was: ‘What is the impact of participation in a care-PA initiative on the healthcare utilisation of citizens with a low SES?’.MethodsWe studied the healthcare utilisation of 44 former participants of X-Fittt 2.0, focussing on general practitioner care, pharmaceutical care, hospital care, paramedical care, medical aids and mental healthcare. We compared utilisation intensity (number of healthcare claims) during the two years before participation in X-Fittt 2.0 (period 1) with utilisation intensity during the two years after initial participation (period 2) using paired t-tests.ResultsAs expected, utilisation intensity increased significantly for paramedical care for non-chronic disorders after participation. No differences in utilisation intensity were observed for the other healthcare categories. Furthermore, although it was not the core focus of this study, our results show that people with a low SES tend to have higher healthcare utilisation than those with a higher SES.ConclusionsThis exploratory study, which is unique for its use of healthcare claims data for participants of a care-PA initiative, shows a statistically significant increase in utilisation intensity for paramedical care (supplementary healthcare insurance for non-chronic conditions) in period 2 compared with period 1, as expected. This increase is likely caused by a greater utilisation intensity for physiotherapy, which covers respectively 95% and 92% of the paramedical healthcare claims of the supplementary healthcare insurance in periods 1 and 2. The design of our study can be used as a template for future research that aims to study health care utilisation over a longer time period. The results of this and future studies can be used to improve health policies.

47. Economic consequences of waiting for lumbar disc herniation surgery

<h3>BACKGROUND CONTEXT</h3> Despite the well-established benefits of lumbar discectomy, many patients wait for their surgery which delays their return to work and potentially increases health care costs. The economic repercussions of such delays have not been well studied. <h3>PURPOSE</h3> This study aims to provide meaningful comparisons of costs to decisions-makers who plan health care services. The main goal of this study was to quantify the cost differences in terms of direct and indirect costs of early surgery for symptomatic disc herniation compared to late surgery. In other words, this study aimed to unveil what is the cost of being on a surgical waitlist for a lumbar discectomy. Secondarily, we report PROS and compared the proportions of patients reaching meaningful patient reported outcomes (PROs) between early and late surgery. <h3>STUDY DESIGN/SETTING</h3> This is a retrospective analysis of prospectively collected data from the CSORN registry. <h3>PATIENT SAMPLE</h3> Comparisons were made between patients receiving surgery less than 60 days after consent (short wait) and 60 days or more after consent (long wait). <h3>OUTCOME MEASURES</h3> The Ontario Health Insurance Plan (OHIP) claims history database was used for direct costs estimates. Canada Income Statistics and the human capital method were used to calculate indirect costs. The primary outcome was defined as the cost difference between short wait and long wait groups to determine the overall cost of waiting for surgery. <h3>METHODS</h3> Continuous data are summarized using means and standard deviations, compared using Student's t-tests. Categorical data are expressed as numbers and percentages, compared using chi-square tests. The minimum clinically important difference (MCID) was defined as 30% improvement in NRS leg and NRS back from baseline to 3 months. The proportion of patients reaching MCID was compared between patients who returned to work at 3 months or not and between short- and long-wait groups. PROs at 3 months were adjusted for baseline score. A p-value <0.05 was considered statistically significant. Analyses were performed with IBM SPSS for Windows release 28. <h3>RESULTS</h3> A total of 493 patients were included in this study with 272 patients (55.2%) in the short-wait group and 221 patients (44.8%) in the long-wait group. Demographics were similar between the two groups. The proportions of patients who returned to work at 3 months and 12 months postoperatively were similar (p <0.596; p <0.798). Time from surgery to return to work was similar between both groups (34.0 vs 34.9 days, p<0.804). Inherently, the longer wait group had significantly longer time from consent to return to work. This extended wait corresponded to an additional $11,753.10 indirect cost due to productivity loss while waiting for surgery. The short-wait group showed increased health care usage with patients more commonly visiting the emergency department (52.6% vs 25.0%, p <0.032), using physiotherapy (84.6% vs 72.0%, p <0.001) and receiving MRI (65.2% vs 41.4%, p <0.043). This corresponded to an additional direct cost of $518.21 per patient. The short wait group had higher baseline NPR leg, ODI, EQ5D, PCS and MCS. A higher proportion of patients reached MCID in terms of NRS leg pain at 3-month follow-up in the short wait group (84.0% vs 75.9%, p <0.040). <h3>CONCLUSIONS</h3> Early surgery is associated with cost saving of $11,234.89 per patient when compared to late surgery for lumbar disc herniation. The higher health care utilization in patients receiving early surgery is counterbalanced by the additional productivity loss of the long waiters. From a societal economic perspective, early surgery seems beneficial and should be promoted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The Journey and Barriers to Treatment of Patients With Renal Nutcracker Syndrome

ObjectiveTo better understand renal nutcracker syndrome (NCS) from a patients’ perspective starting at presentation and followed through to diagnosis and management MethodsThis descriptive study was conducted on a national level via a self-selected online survey distributed via river sampling by a post on the Facebook Page ‘Renal Nutcracker Syndrome Support Group.’ ResultsOf the 22 responses collected, 95.5% were female and 91% self-identified as White. 43% experienced symptoms as teenagers and 62% were diagnosed as young adults. Prior to receiving a definitive diagnosis, over half of the respondents were worked up for kidney stones (57%) and ovarian cysts (48%) and saw at least 10-15 providers. Nearly 80% experienced constant pain throughout the day. Pain management included prescription oral pain relievers (38%), prescription patches (29%), and physical therapy (19%). Surgical procedures included nephrectomy with auto transplant (38%), left renal vein transposition (10%), and laparoscopic extravascular stent placement (10%). Respondents had high healthcare utilization for management of NCS. Nearly 30% were unable to work and had filed for disability. ConclusionAwareness of NCS should increase among healthcare providers of all specialties to improve quality of care to those living with NCS. It is crucial to keep NCS within the differential diagnosis in patients presenting with gross hematuria and unusual abdominal and/or flank pain.

Health Care Utilization in the First 7 Years in Children with Fetal Growth Abnormalities: A Retrospective Cohort Study

To investigate the relationship between birth weight for gestational age and health care utilization of term offspring from birth to 7years. We used a population-based retrospective cohort study of infants (≥37weeks' gestational age) born between 2003 and 2007 in the Canadian province of Nova Scotia (n=42 050). Perinatal records were linked to provincial administrative health data from birth to age 7years. The primary outcome was health care utilization (physician visits and hospital admissions) and costs. Birth weight was categorized as small for gestational age (SGA, <10th percentile), appropriate for gestational age (AGA), or large for gestational age (LGA, >90th percentile). Regression models adjusted for potential confounders were used to investigate the associations. Children born SGA had a higher number of specialist visits and hospital admissions, a longer length of stay for the birth admission, and, as a result, higher physician and hospital costs amounting to a cost differential of Can $1222 during the first 7years of life compared with children born AGA. By contrast, health care use and costs did not differ between children born LGA and AGA. Former SGA term infants have a moderate increase in health care use and costs in early childhoodcompared with former AGA infants, and LGA birth at term is not associated with higher health care utilization.

A-115 Identifying Factors Related to High Healthcare Utilization in a Group Of Persons with Dementia and their Caregivers

Abstract Objective: Identify factors related to high healthcare utilization in dementia patients to determine a high-risk profile and tailor the Care Ecosystem Program to subgroup needs. Methods: Cross-sectional data on persons with dementia (PWD) and caregivers (CG) enrolled in a branch of the Care Ecosystem Program (memory.ucsf.edu/Care-Ecosystem) were used. PWD had one emergency department (ED) visit or hospitalization prior 12-months. Data for 273 dyads included sociodemographics, healthcare utilization, dementia severity (Quick Dementia Rating Scale), and emotional wellbeing (i.e., Short-Form Zarit Burden Interview, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7). High utilizers (HU) were more than two standard deviations above the mean for ED visits (N = 40) or hospitalizations (N = 42). Analyses included descriptive, frequencies, independent sample t-tests, and negative binomial regressions. Results: Mean age was 80 years for PWD and 64 years for CGs. Both were predominantly female (PWD = 60%, CG = 78%) and white (64%) with high school education or higher (PWD = 83.5%, CG = 97.4%). Dementia severity was mild to moderate (QDRS M = 11.4; SD = 6). ED-HU had higher/more dementia severity (p = 0.03, d = 6.2), medical comorbidities (p &amp;lt; 0.001, d = 2.4), medications (p = 0.047, d = 4.5), and preventable (p = 0.013, d = 0.7) and unpreventable (p &amp;lt; 0.001, d = 1.5) visits. Hospitalization HU presented increased neuropsychiatric severity (p = 0.048, d = 6.5) and medications (p = 0.012, d = 4.4). Negative binomial regression model for ED visits (p = 0.025) showed increased comorbidities as the only predictor (p = 0.034), while the model for hospitalizations (p = 0.010) was associated with Black race (p = 0.004), younger PWD (p = 0.033), and more medications (p &amp;lt; 0.001). Conclusions: Increased medical complexity was associated with HU for ED visits and hospitalizations in PWD-CG dyads. Additional research and possible need for variation in care management services are warranted.

Healthcare utilization and health-related quality of life of severe asthma patients in Singapore

Background Notwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilization, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not been appraised. Objectives To determine the burden of disease and extent of quality of life impairment in SA patients in Singapore. Methods A cross-sectional analysis of SA patients seen in Singapore General Hospital (2020–2021) to investigate emergency healthcare utilization, oral corticosteroid (OCS) burden and health-related quality of life (HRQoL) with primary endpoint EuroQoL-5 Dimension three-level (EQ-5D-3L) scores. The empirical measurement properties of the EQ-5D utility index in SA were comprehensively assessed through multivariate regression analyses. Results A total of 336 SA patients were recruited, 51.2% of SA patients had at least one acute healthcare resource utilization during the previous year, with 25.6% of patients having an emergency healthcare visit to the hospital. Overall mean (SD) EQ-5D-3L and EQ-5D-3L utility scores in SA patients were 6.22 (1.51) and 0.77 (0.30), respectively. EQ-5D utility scores were 0.14 lower in uncontrolled vs controlled asthma and 0.09 lower in the presence of severe exacerbation, whereas barely changed by maintenance OCS dose and airflow limitation. Conclusion SA patients were found to have high disease burden, high healthcare resource utilization and OCS use, low biologics usage, poor HRQoL and utility in comparison with other chronic diseases.

Humanistic and economic burden associated with depression in the United States: a cross-sectional survey analysis

BackgroundDepression (major depressive disorder [MDD]) affects the functioning of patients in many facets of life. Very few large-scale studies to date have compared health and economic related outcomes of those with versus without depression, and across various depression severity groups. We aimed to evaluate humanistic and economic burden in respondents with and without depression diagnosis, and across symptom severity groups.MethodsData from the 2017 US National Health and Wellness Survey (NHWS) were utilized. Of the adult respondents (N = 75,004), 59,786 were < 65 years old. Respondents not meeting eligibility criteria were excluded (e.g., those self-reporting bipolar disorder or experiencing depression in past 12 months but no depression diagnosis). Overall, data from 39,331 eligible respondents (aged 18–64 years) were analyzed; and comprised respondents ‘with depression diagnosis’ (n = 8853; self-reporting physician diagnosis of depression and experiencing depression in past 12 months) and respondents ‘without depression diagnosis’ (n = 30,478; no self-reported physician diagnosis of depression and not experiencing depression). Respondents with depression were further examined across depression severity based on Patient Health Questionnaire-9 (PHQ-9). Outcome measures included health-related quality-of-life (HRQoL; Medical Outcomes Study 36-item Short Form [SF-36v2]: mental and physical component summary [MCS and PCS]; Short-Form 6 Dimensions [SF-6D]; and EuroQol 5 Dimensions [EQ-5D]), work productivity and activity impairment (WPAI), and health resource utilization (HRU). Multivariate analysis was performed to examine group differences after adjusting covariates.ResultsRespondents with depression diagnosis reported significantly higher rates of diagnosed anxiety and sleep problems versus those without depression (for both; P < 0.001). Adjusted MCS, PCS, SF-6D, and EQ-5D scores were significantly lower in respondents with depression versus those without depression (all P < 0.001). Consistently, respondents with depression reported higher absenteeism, presenteeism, and overall WPAI, as well as greater number of provider visits, emergency room visits, and hospitalizations compared with those without depression (all P < 0.001). Further, burden of each outcome increased with an increase in disease severity.ConclusionsDiagnosed depression was associated with lower health-related quality-of-life and work productivity, and higher healthcare utilization than those without depression, and burden increased with an increase in symptom severity. The results show the burden of depression remains high even among those experiencing minimal symptoms.

Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients.

US primary care practices are actively identifying strategies to improve outcomes and reduce costs among high-need high-cost (HNHC) patients. HNHC patients are adults with high health care utilization who suffer from multiple chronic medical and behavioral health conditions such as depression or substance abuse. HNHC patients with behavioral health conditions face heightened challenges accessing timely primary care and managing their conditions, which is reflected by their high rates of emergency department (ED) utilization and preventable spending. Structural capabilities (i.e., care coordination, chronic disease registries, shared communication systems, and after-hours care) are key attributes of primary care practices which can enhance access and quality of chronic care delivery. The purpose of this study was to analyze the association between structural capabilities and ED utilization among HNHC patients with behavioral health conditions. We merged cross-sectional survey data on structural capabilities from 240 primary care practices in Arizona and Washington linked with Medicare claims data on 70,182 HNHC patients from 2019. Using multivariable Poisson models, we found shared communication systems were associated with lower rates of all-cause and preventable ED utilization among HNHC patients with alcohol use (all-cause: aRR 0.72, 95% CI: 0.62, 0.84; preventable: aRR 0.5, 95% CI: 0.40, 0.64) and HNHC patients with substance use disorders (all-cause: aRR 0.76, 95% CI: 0.68, 0.85; preventable: aRR 0.61, 95% CI: 0.52, 0.71). Care coordination was also associated with decreased rates of ED utilization among the overall HNHC population and those with alcohol use, but not among HNHC patients with depression or substance use disorders. Shared communication systems and care coordination have the potential to increase the effectiveness of primary care delivery for specific HNHC patients.

Colostomy for large bowel obstruction at the end of life: What do patients gain from palliative surgery? (598)

Colostomy for large bowel obstruction at the end of life: What do patients gain from palliative surgery? (598)

Depressive Symptoms and Healthcare Utilization in Late Life. Longitudinal Evidence From the AgeMooDe Study.

ObjectiveThe aim of this study was to investigate the longitudinal impact of depressive symptoms on utilization of healthcare in terms of GP visits as well as specialist visits and hospital admission in late life among community-dwelling individuals.MethodsLongitudinal data (baseline and follow-up) were derived from the German multicentre, prospective cohort study “Late-life depression in primary care: needs, health care utilization and costs” study (AgeMooDe). At baseline, n = 1,230 patients aged 75 years and older were recruited from primary care practices. Main outcomes of interest were use of health care services: the number of GP visits, the number of medical specialist visits, and hospital admission. We used the Geriatric Depression Scale (GDS-15) to measure depression. Outcomes were analyzed with multilevel random intercept negative binominal regression and logistic random-effects models.ResultsAt baseline (n = 1,191), mean age was 80.7 (SD 4.6) years, 62.9% were female, and 196 individuals (16.5%) had depression (GDS-15 ≥6). Our longitudinal analyses indicated that older individuals with more depressive symptoms visited their GP more often (IRR=1.03; CI [1.01-1.04], p < 0.001), were visiting medical specialists more frequently (IRR=1.03; CI [1.01-1.04], p < 0.01), and had higher odds of being hospitalized (OR=1.08; CI [1.02-1.13], p < 0.01).ConclusionsBased on this large longitudinal study we showed that, after adjustment for important covariates, older individuals with more depressive symptoms had higher health care utilization over time. They visited their GP and specialists more frequently and they had higher odds of being hospitalized. This may suggest that higher utilization of specialist care and increased likelihood of being hospitalized may be also attributable to unspecific symptoms or symptoms that are elevated through depressive symptoms.

The overlap of medical child abuse and central sensitization in adolescents: An exploratory qualitative study

BackgroundBoth medical child abuse (MCA) and central sensitization (CS) may present in adolescents with chronic pain, disability, high healthcare utilization, and unremarkable medical evaluations. ObjectiveThis study aimed to identify themes in the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. Participants and settingParticipants were 28 adolescents (ages 13–18 years) with chronic pain referred to either the Child Abuse Pediatrics team or the Pediatric Pain Medicine team at a tertiary children's hospital between 2011 and 2019, and diagnosed with MCA or CS, respectively. MethodsThis was a qualitative, retrospective study. Qualitative themes were derived through a process of inductive content analysis utilizing open coding, grouping, and secondary review by an interdisciplinary panel of experts. The relative prevalence of each code, theme, and overarching category was examined between groups to identify areas of convergence and divergence. ResultsSeveral themes appeared to be more prevalent in the MCA group (n = 9) compared to the CS group (n = 19). These included sick identity, homeschooling, caregiver with mental health disorder, maternal catastrophizing, maternal misrepresentation, persistence in healthcare-seeking, mandated reports made, medical neglect, and unnecessary and harmful medical care. ConclusionsThis exploratory work identified themes from the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. A visual reference, two illness scripts, and management recommendations are presented to aid pediatric providers in facilitating appropriate referrals for adolescents with chronic pain and disability out of proportion to diagnostic workup.

The Prevalence of Obesity Among Employees of a Tertiary Healthcare Organization in Saudi Arabia and Its Impact on the Organization.

Background: Obesity is a significant risk factor for multiple diseases such as diabetes mellitus and cardiovascular diseases. Many healthcare organizations worldwide have identified a high prevalence of obesity among their employees. In this study, we are looking at the prevalence of obesity among the employees of our healthcare organization and its impact on the employees' productivity and if its current prevalence is costly to the employer.Methods: This is a non-interventional cross-sectional study conducted at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. Data on the current employees were obtained from medical records. We investigated a random sample of employees who worked in the hospital for at least one year between January 1, 2021 and January 1, 2022. We explored the prevalence of obesity among hospital employees at the beginning of their employment and its current prevalence. In addition, we aimed to investigate the effect of having employees suffering from obesity on their productivity and their utilization of healthcare during their employment period.Results: We identified that our hospital has relatively younger healthcare workers and more employees who are suffering from obesity than in different other countries. The percentage of obese male and female employees was comparable. We had a relatively high increase in the prevalence of obesity among our employees during the last few years. We found a higher number of obesity-related medical problems, more office visits, more sick leaves, and more medications prescribed for overweight and employees who are suffering from obesity compared to those with normal weight.Conclusion: Healthcare workers suffering from obesity had lower productivity and they had higher utilization of healthcare. Therefore, employers should investigate the prevalence of obesity in their organization and implement diverse strategies to prevent and manage this issue to help their employees have better health and, at the same time, be more productive and lower their utilization of healthcare.

Healthcare resource utilization and costs associated with renal, bone and cardiovascular comorbidities among persons living with HIV compared to the general population in Quebec, Canada.

There is limited understanding on healthcare utilization and costs of age-related comorbidities such as cardiovascular, bone and renal disease/disorder in people living with human immunodeficiency virus, so we compared comorbidity prevalence and associated healthcare utilization and costs. Through the Quebec health insurance database, people living with human immunodeficiency virus on antiretroviral therapy for ≥6 months from January 2006 to June 2012 were categorized by their comorbidity status using International Classification of Diseases (ICD)-9 codes, and controls without human immunodeficiency virus diagnosis or antiretroviral therapy use were age and gender matched. We compared healthcare utilization and costs. A total of 3,905 people living with human immunodeficiency virus and 11,715 control individuals were included. The mean age of people living with human immunodeficiency virus was 45.3 years and 77.3% were men. Prevalence of comorbidities was higher and occurred earlier in people living with human immunodeficiency virus and increased with older age regardless of human immunodeficiency virus status. Interestingly, bone comorbidity was high (37%) and 5-fold greater in people living with human immunodeficiency virus <20 years than the controls. Polypharmacy and comorbidity scores were greater in people living with human immunodeficiency virus than controls (p<0.01), as were cardiovascular, bone and renal comorbidities (40.3%, 26.0% and 5.5%, respectively; p<0.01). People living with human immunodeficiency virus had higher healthcare utilization and costs than controls largely due to longer hospital stays and prescriptions. Mean total healthcare cost/person/year for people living with human immunodeficiency virus was CAD$6,248 and was highest for those with renal disease (CAD$19,617). Comorbidities in people living with human immunodeficiency virus are more prevalent, occur earlier and incur a higher burden on the healthcare system; earlier screening and improved preventative and management strategies may reduce the burden to people living with human immunodeficiency virus and to the healthcare system.

Healthcare utilization and comorbidity shortly before suicide mortality in patients with attention-deficit/hyperactivity disorder: a nested case-control study.

Few studies have analyzed healthcare utilization before suicide among individuals with attention-deficit/hyperactivity disorder (ADHD). This study examined the pattern of healthcare utilization and comorbidities shortly before death among patients with ADHD who died by suicide and compared these data with those of living controls. This study used Taiwan's National Health Insurance Research Database to identify patients with ADHD (N = 379,440) between January 1, 2001, and December 31, 2016. Subsequently, the researchers identified 159 suicide decedents by linking each patient with the National Mortality Database. By conducting a nested case-control study with risk-set sampling from the ADHD cohort, the researchers selected 20 age- and sex-matched controls (n = 3180) for each patient who died by suicide (cases). The researchers then applied conditional logistic regression to investigate differences in healthcare utilization as well as psychiatric and physical comorbidities between case patients and controls. Case patients had higher healthcare utilization within 3months before suicide, particularly in the psychiatry, emergency, internal medicine, neurosurgery, and plastic surgery departments. These patients also had higher risks of psychiatric comorbidities, including schizophrenia, bipolar disorder, depressive disorder, and sleep disorder, as well as physical comorbidities such as hypertension and other forms of heart disease. Among patients with ADHD, suicide decedents had increased healthcare utilization and higher risks of specific psychiatric and physical comorbidities than living controls. Thus, for suicide prevention among individuals with ADHD, suicide risk must be detected early and comorbidities should be adequately managed.

Associations between comorbidities and annual incidence plus frequency of asthma exacerbation hospitalisation during the past year: data from CARN study

PurposeWhile asthma comorbidities are associated with higher health care utilisation, lower quality of life and poorer asthma control, the impact of asthma comorbidities on hospitalisation for asthma exacerbation (H-AX) remains less recognised. We aim to analyse the impact of asthma comorbidities on H-AX.MethodsBased on a national survey on asthma control and disease perception (CARN 2015 study), we analysed the impact of comorbidities on annual incidence and frequency of H-AX in China. Information on demographic characteristics, asthma comorbidities and annual incidence and frequency of H-AX were presented in this study.ResultsAmong 3875 ambulatory asthma patients, 75.9% (2941/3875) had comorbidities, and 26.4% (1017/3858) experienced H-AX during past year. After adjusting for confounding factors such as demographic data, smoking status and asthma control, COPD [OR = 2.189, 95% CI (1.673, 2.863)] and coronary heart disease [OR = 1.387, 95% CI (1.032, 1.864)] were associated with higher annual incidence, while allergic rhinitis [OR = 0.692, 95% CI (0.588, 0.815)] was associated with lower annual incidence, of H-AX. In terms of frequency, allergic rhinitis [OR = 1.630, 95% CI (1.214, 2.187)], COPD [OR = 1.472, 95% CI (1.021, 2.122)] and anxiety [OR = 2.609, 95% CI (1.051, 6.477)] showed statistically significant correlation with frequent H-AX.ConclusionsCOPD and coronary heart disease were associated with higher annual incidence, while allergic rhinitis was associated with lower annual incidence of H-AX. Allergic rhinitis, COPD and anxiety were associated with frequent H-AX. Comorbidities may have an important role in the risk and frequency of annual hospitalisations due to asthma exacerbation. The goal of asthma control should rely on a multi-disciplinary treatment protocol.