High Health Service Utilization Research Articles

Predictive modeling for identification of older adults with high utilization of health and social services

Aim Machine learning techniques have demonstrated success in predictive modeling across various clinical cases. However, few studies have considered predicting the use of multisectoral health and social services among older adults. This research aims to utilize machine learning models to detect high-risk groups of excessive health and social services utilization at early stage, facilitating the implementation of preventive interventions. Methods We used pseudonymized data covering a four-year period and including information on a total of 33,374 senior citizens from Southern Finland. The endpoint was defined based on the occurrence of unplanned healthcare visits and the total number of different services used. Input features included individual’s basic demographics, health status and past usage of healthcare resources. Logistic regression and eXtreme Gradient Boosting (XGBoost) methods were used for binary classification, with the dataset split into 70% training and 30% testing sets. Results Subgroup-based results mirrored trends observed in the full cohort, with age and certain health issues, e.g. mental health, emerging as positive predictors for high service utilization. Conversely, hospital stay and urban residence were associated with decreased risk. The models achieved a classification performance (AUC) of 0.61 for the full cohort and varying in the range of 0.55–0.62 for the subgroups. Conclusions Predictive models offer potential for predicting future high service utilization in the older adult population. Achieving high classification performance remains challenging due to diverse contributing factors. We anticipate that classification performance could be increased by including features based on additional data categories such as socio-economic data.

Prevalence and Symptom Profile of Long COVID among Schoolchildren in Vietnam.

Long COVID is a recognized condition that can follow SARS-CoV-2 infection. It has been primarily observed and studied in adults. Evidence on long COVID among children is scarce. We aimed to estimate its prevalence and symptom profile among schoolchildren, and its effects on studying, daily activities, and quality of life. We conducted a cross-sectional online survey among caregivers of 2226 schoolchildren aged 12-17 in Thai Nguyen, Vietnam, from 11 April to 16 May 2023 using WHO definitions and a validated quality of life questionnaire. Among 1507 children with confirmed SARS-CoV-2 infection ≥ 5 months prior, 85 (5.6%) had long COVID. Memory loss (85.9%), poor concentration capacity (58.8%), and fatigue (57.6%) were their most common symptoms. They reported more frequent interference with their studies, observed differences in school absence rates, reduced daily activities, worsened overall health status, and relatively higher utilization of health services compared with children who only suffered from acute COVID-19 symptoms after infection. Given the near-ubiquitous exposure to SARS-CoV-2 among children at this stage of the pandemic, our findings contribute invaluable evidence of an emerging public health burden among the pediatric population in Vietnam and globally. Concerted public health measures are needed to reduce long-term impacts on health, education, and wellbeing.

Food prescribing in Canada: evidence, critiques and opportunities.

There is growing interest in food prescriptions, which leverage health care settings to provide patients access to healthy foods through vouchers or food boxes. In this commentary, we draw on our experiences and interest in food prescribing to provide a summary of the current evidence on this intervention model and critically assess its limitations and opportunities. Food insecurity is an important determinant of health and is associated with compromised dietary adequacy, higher rates of chronic diseases, and higher health service utilization and costs. Aligning with recent discourse on social prescribing and "food is medicine" approaches, food prescribing can empower health care providers to link patients with supports to improve food access and limit barriers to healthy diets. Food prescribing has been shown to improve fruit and vegetable intake and household food insecurity, although impacts on health outcomes are inconclusive. Research on food prescribing in the Canadian context is limited and there is a need to establish evidence of effectiveness and best practices. As food prescribing continues to gain traction in Canada, there is a need to assess the effectiveness, cost-efficiency, limitations and potential paternalism of this intervention model. Further, it is necessary to assess how food prescribing fits into broader social welfare systems that aim to address the underlying determinants of food insecurity.

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990–2017

BackgroundThe United Nations (UN) Sustainable Development Goal − 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990–2017.MethodsWe obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR.ResultsFirst, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was − 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR.ConclusionThe decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.

Identifying potential cases of eating disorders in an acute medical hospital.

To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED. The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit. Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record. Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment. People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.

The impact of urban family physician program on health service access and utilization in Iranian children and adolescents: Results of the national health services utilization survey in 2015

Background. The Urban Family Physician Program (UFPP) has been implemented in Fars and Mazandaran provinces of Iran since 2013 with the aim of improving access and utilization of health services, with a particular focus on children and adolescents. In order to evaluate the effectiveness of the program in achieving this goal, this study aimed to compare the access and utilization of health services among children living in areas covered by the UFPP with those living in other regions of Iran. Methods. A secondary analysis was performed using data from the 2015 National Health Utilization Survey. The data of people aged under 18 were extracted and indicators on the use of health services based on three main models of health service provisions were compared: (1) cities in Fars and Mazandaran provinces (UFPP implemented); (2) cities in other Iranian provinces (excluding Fars and Mazandaran); and (3) villages and cities with a population under 20,000. Results. The study included 20,689 children. The outpatient and inpatient visits in children living in Fars and Mazandaran provinces were higher than in children from other provinces and smaller towns (11.89 vs. 7.92 and 7.21 for outpatient and 4.74 vs. 3.51 and 4.27 for inpatient, respectively). Furthermore, UFPP was found to be associated with a higher utilization of health services in children residing in cities (odds ratio=1.50 (1.98-1.15)). Additionally, the cost of outpatient and inpatient health services in areas where the UFPP was implemented was lower compared to other parts of the country. Conclusion. The urban family physician program has been successful in increasing the access to health services and reducing health costs in children. Practical Implications. The findings suggest that the urban family physician program can be an effective strategy for improving healthcare access and reducing costs, especially in areas with high population density. Policymakers and healthcare providers can use the results of this study to inform the development and implementation of similar programs in other countries, with the aim of improving healthcare access and reducing healthcare costs in children and adolescents.

Incremental burden on health-related quality of life, health service utilization and direct medical expenditures associated with cognitive impairment among non-institutionalized people with diabetes aged 65 years and older.

To quantify the incremental health and economic burden associated with cognitive impairment (CI) among non-institutionalized people with diabetes ≥65 years in the United States. Using 2016-2019 Medical Expenditure Panel Surveys data, we identified participants ≥65 years with diabetes. We used propensity score weighting to quantify the CI-associated incremental burden on health-related quality of life measured by the 12-item Short Form Survey (SF-12), including the mental component summary score, physical component summary score and health utility. We also compared the annual health service utilization and expenditures on ambulatory visits, prescriptions, home care, emergency room (ER), hospitalizations and total annual direct medical expenditures. We included 5094 adults aged ≥65 with diabetes, of whom 804 had CI. After propensity score weighting, CI was associated with a lower mental component summary score (-8.4, p < .001), physical component summary score (-5.2, p < .001) and health utility (-0.12, p < .001). The CI group had more ambulatory visits (+4.4, p = .004) and prescriptions (+9.9, p < .001), with higher probabilities of having home care (+11.3%, p < .001) and ER visits (+8.2%, p = .001). People with CI spent $5441 (p < .001) more annually, $2039 (p = .002) more on prescriptions, $2695 (p < .001) more on home care and $118 (p < .001) more on ER visits. There is no statistically significant difference in the utilization and expenditure of hospitalizations. CI was associated with worse health-related quality of life, higher health service utilization and expenditures. Our findings can be used to monitor the health and economic burden of CI in non-institutionalized older persons with diabetes.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs.

Healthcare utilization among people living with inflammatory bowel disease (IBD) in Canada has shifted from inpatient management to outpatient management; fewer people with IBD are admitted to hospitals or undergo surgery, but outpatient visits have become more frequent. Although the frequency of emergency department (ED) visits among adults and seniors with IBD decreased, the frequency of ED visits among children with IBD increased. Additionally, there is variation in the utilization of IBD health services within and between provinces and across ethnocultural and sociodemographic groups. For example, First Nations individuals with IBD are more likely to be hospitalized than the general IBD population. South Asian children with Crohn's disease are hospitalized more often than their Caucasian peers at diagnosis, but not during follow-up. Immigrants to Canada who develop IBD have higher health services utilization, but a lower risk of surgery compared to individuals born in Canada. The total direct healthcare costs of IBD, including the cost of hospitalizations, ED visits, outpatient visits, endoscopy, cross-sectional imaging, and medications are rising rapidly. The direct health system and medication costs of IBD in Canada are estimated to be $3.33 billion in 2023, potentially ranging from $2.19 billion to $4.47 billion. This is an increase from an estimated $1.28 billion in 2018, likely due to sharp increases in the use of biologic therapy over the past two decades. In 2017, 50% of total direct healthcare costs can be attributed to biologic therapies; the proportion of total direct healthcare costs attributed to biologic therapies today is likely even greater.

Assessment of reproductive health service utilization in urban slums

Objective: To assess the utilization of reproductive health services in urban slum of Jodhpur city, India. Methods: A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021. Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care (ANC) services, delivery and post-partum services. Results: The majority of females were aged less than 25 years (n=195; 65.0%), married after 18 years (n=240; 80%), living in extended families (n=265; 88.3%) and with monthly family income less than 10000 rupees (n=182; 60.7%). Statistically significant associations were found between ≥4 ANC visits and educational level of secondary and above (OR 2.47, 95% CI 1.03-6.28; P=0.04), older age (OR 15.70, 95% CI 14.87–16.54 for women aged 26–35 years, OR 16.14, 95% CI 12.12–20.01 for women aged ≥36 years; P&lt;0.01), and backward and general castes (OR 15.91, 95% CI 13.57–17.85 for backward caste and OR 8.11, 95% CI 8.07–8.26 for general category of caste; P&lt;0.01). Seven percent of females had undergone parturition. Older age was associated with higher risks of postpartum complications (OR 1.06, 95% CI 1.01–1.57 for women aged 26-35 years, OR 3.56, 95% CI 1.29–4.69 for women aged ≥36 years; P&lt;0.01). In addition, risks of postpartum complications were associated with backward and general castes (OR 1.69, 95% CI 1.34–2.13 for backward classes and OR 5.01, 95% CI 4.29–5.31 for general category castes; P&lt;0.01), and more than 4 ANC visits (OR 0.20, 95% CI 0.09-0.34; P&lt;0.01). Conclusions: More frequent ANC visits are associated with a lower risk of postpartum complications. Furthermore, a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Abstract P120: Neighborhood Factors Influence Cardiovascular Outcomes for Depressed and Non-Depressed Individuals With Heart Failure With Reduced Ejection Fraction

Introduction: Neighborhood-level measures including Area Deprivation Index (ADI) and walkability are associated with increased cardiovascular disease (CVD) morbidity, higher utilization of health services, and mortality. We sought to understand the impact of these neighborhood-level factors on hospital readmissions and mortality among recently hospitalized depressed and non-depressed individuals with heart failure and reduced ejection fraction (HFrEF) who enrolled in the NHLBI-funded Hopeful Heart Trial of “blended” collaborative care for HFrEF and co-morbid depression. . Hypothesis: We hypothesized worse ADI and Walk Scores will be associated with increased 12-month incidence of all-cause or cardiac-specific hospital readmission and mortality. Methods: From 3/14-10/17, Hopeful Heart enrolled 756 hospitalized HFrEF patients (EF&lt;45%) and NYHA class II-IV symptoms including 629 depressed (screen-positive on 2-item Patient Health Questionnaire (PHQ-2) for depression prior to discharge and scored ≥10 on the PHQ-9 administered via telephone two weeks post-discharge) and 127 non-depressed HFrEF patients (PHQ-2 negative and PHQ-9 &lt;5). We determined participants’ ADI score (0-100 scale, higher scores indicating greater deprivation) and Walk Score (0-100 scale, higher meaning more walkable) using home addresses at the time of hospital discharge. We categorized participants into top quartile (Q4) ADI and Walk score groups versus all other quartiles combined (Q1-Q3), and then compared these two groups using unadjusted, nonparametric Kaplan-Meier analyses with log-rank tests for differences in 12-month mortality and unadjusted chi-square tests for differences in 12-month incidence of readmission. Results: Of the 756 HFrEF participants (44% female; 73% white; EF: 28.3±9.1% mean; ADI: mean 66.7±23.5; Walk Score: mean 33.4±25.9), the mean PHQ-9 score for both ADI and Walk Score Q4 groups was similar to the Q1-3 groups. Participants in the Q4 group for ADI had a higher incidence of readmission that those in Q1-Q3 (81% -144 out of 178 - versus 70% - 400 out of 572, p=0.004), while those in the Q4 group for Walk Score were readmitted at a similar level to those in Q1-Q3. Those individuals in the top quartile for ADI and Walk Score showed no differences in cardiovascular (CV) mortality (14% incidence, 24 out of 171, for ADI; 14% total incidence, 25 out of 175 for Walk Score) or all-cause mortality (23% total incidence, 171 out of 750, for ADI; 23% total incidence, 175 out of 756 for Walk Score) compared with all other quartiles. Conclusions: Worse ADI but not Walk Score is predictive of higher risk of 12-month hospital readmission, and neither measure is predictive of 12-month CV or all-cause mortality. Further studies are needed to elaborate how area deprivation and other neighborhood factors affect outcomes for individuals with heart failure and design interventions to address these disparities.

Comparison of health services utilization, medical costs, and activity limitations between cancer survivors with and without a disability.

21 Background: Cancer survivors are one of the most vulnerable cohorts regarding health status and financial hardship. They are also more likely to have a disability than individuals without a cancer history. No prior research has systematically examined whether and how disability interacts with cancer survivorship. This study examines the association of disability with health services utilization, medical costs, and activity limitations among cancer survivors. Methods: We constructed a nationally representative cohort of cancer survivors using 2015-2019 Medical Expenditure Panel Survey Household Component File. Outcomes included health services utilization, measured by six service types (inpatient, institutional outpatient, office-based physician, office-based non-physician, ED, and prescription), total health care expenditure for all services combined and for each service type, and activity limitations (work at job, housework, and social relationship). Primary independent variables included six binary variables of functional disability conditions (hearing, vision, cognition, ambulation, self-care, and independent living) in the first model and a categorized total number of disabilities (0, 1, 2, 3, ≥4) in the second model. We employed multivariable generalized linear models and two-part models, adjusting for socio-demographics, general health status, and chronic conditions as well as accounting for complex survey design. Results: On average, cancer survivors (n = 9,359; weighted n = 21,046,285) had 0.57 days of hospital stays, 6.07 physician visits, and 16.3 prescriptions annually. The average annual health care expenditure for all services were $10,840, and 7.1% had one or more activity limitation. Notably, 38.8% of cancer survivors had at least one disability condition (ambulation 24.5%, hearing 13.8%, independent living 12.7%, cognition 11.5%). Compared to survivors without any disability, disability in self-care and ambulation was most strongly associated with the higher utilization of inpatient care (adjusted average marginal effect [AME] 0.85 days; 95% confidence interval [CI] 0.44-1.27) and physician visits (AME 1.03 visits; 95% CI 0.53-1.53), respectively. Disability in independent living (AME $5,046; 95% CI $2,638-7,455) and ambulation (AME $3,702; 95% CI $2,029-5,375) substantially increased total health care expenditure of all services. Survivors with four or more disabilities were 21.4 times more likely to have any activity limitations than those without a disability. Conclusions: Disability was associated with higher health services utilization and medical costs, and more activity limitations among cancer survivors, with the magnitude of increase varying by type of disability. Strategies to mitigate cancer disparities and financial hardship should take into account of the patients’ disability profiles.

Understanding the Extent of Polypharmacy and its Association With Health Service Utilization Among Persons With Cancer and Multimorbidity: A Population-Based Retrospective Cohort Study in Ontario, Canada

Background: Cancer often co-occurs with other chronic conditions, which may result in polypharmacy. Polypharmacy is associated with adverse outcomes, including increased health service utilization. Objectives: This study examines the overall prevalence of polypharmacy (5 or more medications) among adults with cancer and multimorbidity, as well as the association of both minor polypharmacy (5-9 medications) and hyper-polypharmacy (10 or more medications) on high use of emergency room visits and hospitalizations, while controlling for age, sex, and type and stage of cancer. Methods: This retrospective longitudinal study used linked health administrative databases and included persons 18 years and older diagnosed with cancer between April 2010 and March 2013 in Ontario, Canada. Data on the number of health service utilizations at or above the 90th percentile (high users), was collected up to March 2014 and multivariate logistic regression was used to determine the impact of polypharmacy. Results: The prevalence of polypharmacy was 46% prior to cancer diagnosis, and 57% one year after diagnosis. Polypharmacy prior to and after cancer diagnosis increased with the level of multimorbidity, increasing age, but did not differ by sex. It was also highest in persons with lung cancer (52.4%) and those diagnosed with stage 4 cancer (51.3%). Minor polypharmacy increased the odds of being a high user of emergency rooms (1.16; 99% CI: 1.09-1.24) and hospitalizations (1.03; 0.98-1.09) and the odds of high use was greater with hyper-polypharmacy (1.41; 1.33-1.51) and (1.23; 1.17-1.29) respectively. Conclusion: Polypharmacy is highly prevalent and is associated with high health service utilization among adults with cancer and multimorbidity

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

ObjectiveMiddle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to.MethodsThe data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE.ResultsThe incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents’ Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30–3.24) and 2.16 times (95% CI 1.81–2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them.ConclusionsRelatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.

Health Literacy in the Canton of Zurich: First Results of a Representative Study.

Managing health information and services is difficult for nearly half of the population in Switzerland. Low health literacy has been shown to result in poorer health and health outcomes as well as a higher utilization of health services. To date, studies on health literacy in Switzerland have focused on a national level. However, Switzerland is a federal state with 26 cantons and a strongly decentralized health system. Therefore, the aim of this study is to understand how health literacy is distributed within the population of the canton of Zurich specifically, and to develop methods to determine whether an individual has a higher or lower level of health literacy. There were a total of 1000 participants in this representative study. Data was collected by an adapted version of the HLS-EU-Q47 and additional sociodemographic questions. The majority (56%) of the reported difficulties concerned accessing, understanding, appraising, and applying health information. The findings confirm that health literacy follows a social gradient, whereby financially deprived individuals and those with a low educational level report lower health literacy. The need for action to strengthen the health literacy of these population groups is therefore urgent. Interventions should pay particular attention to these vulnerable groups and tailor resolutions to their needs and preferences.

Dental Diseases and Factors Defining Utilization of Dental Care Services among Rural Children Aged 12 Years in Nellore District, Andhra Pradesh: A Community-Based Study.

Background:Rural children are predisposed to variety of dental problems, which may influence their overall health and well-being. Despite relentless efforts and achievements in oral health promotion by authorities, its impact seems limited in rural areas of developing countries.Aim:To generate data on the prevalence of dental caries and gingivitis, among 12-year-old rural children of Nellore district, Andhra Pradesh and factors facilitating or impeding uptake of dental care services.Methods:A cross-sectional, house-to-house survey was conducted in Kavali revenue division of Nellore district by random selection. A cluster sampling methodology was followed, and a total of 169 adolescents were involved in the study. Dental caries detection was performed according to the World Health Organization dentition status criteria and gingivitis according to modified Community Periodontal Index as gingivitis present or absent. Descriptive statistics were calculated.Results:Overall prevalence of dental caries and gingivitis was 39% and 35%, respectively, with <15% utilization of oral health care services. The main hurdle for this notably low utilization of oral health care services was that dental issues were not fatal or life-threatening.Conclusion:The prevalence of dental caries and gingivitis was high and poor utilization of oral health services was an importunate finding in this study. Understanding the trends of common oral diseases and hurdles in uptake of oral health care services could provide a basis for further research and improvement in accessibility to oral health care services in rural areas of developing nations.

Treatment compliance and risk and protective factors for suicide ideation to completed suicide in adolescents: a systematic review.

Objective:To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts.Methods:PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples.Results:Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts.Conclusion:Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.

Trends and outcomes of serious complications associated with non-fatal opioid overdoses in Ontario, Canada

BackgroundNon-fatal opioid overdoses can lead to serious complications and consequently, long-term health effects. We sought to characterize trends of hospitalizations for serious complications associated with opioid overdoses in Ontario, Canada and report health services utilization and mortality in the year following hospital discharge. MethodsWe conducted a cross-sectional study in Ontario among individuals who experienced a hospitalization for a serious complication (required intubation, rhabdomyolysis, or a brain injury) associated with an opioid overdose between 2010 and 2019. We examined inpatient characteristics at the time of hospital admission, and health services utilization and mortality rates in the year following hospital discharge. ResultsThe rate of hospitalizations for serious complications associated with opioid overdoses increased by 66.7 % from 1.8 per 100,000 population in 2010 to 3.0 per 100,000 population in 2019 in Ontario. Individuals that were discharged alive from hospital experienced high health services utilization in the following year; 71.2 % (N = 953 of 1,338) visited the emergency department (ED), 34.2 % (N = 458) were admitted to hospital, and 16.4 % (N = 219) were treated in hospital for an opioid overdose. However only a quarter of individuals (N = 332; 24.8 %) initiated on opioid agonist therapy within 90 days. Additionally, 8.0 % (N = 127) of hospitalizations resulted in death within 1 year. ConclusionsThis study highlights increasing rates of serious complications associated with opioid overdoses, with a high demand of health services and a high mortality rate in the following year. These findings highlight an ongoing need for support and harm reduction services to allow for early intervention and follow-up care.

The Electronic Health Insurance Card for Asylum-Seekers in Berlin: Effects on the Local Health System.

In debates on asylum-seekers' access to healthcare it is frequently claimed that restrictions are necessary to prevent unduly high health service utilization and costs. Within Germany, healthcare provision for asylum-seekers varies across the different states. Berlin's authorities removed some barriers to healthcare for asylum-seekers by introducing an electronic health insurance card (HIC) in 2016. We used the HIC introduction in Berlin as an opportunity to investigate the effects of improved healthcare access for asylum-seekers on the local health system. The study applied a mixed-methods design. A cost analysis compared expenses for outpatient and inpatient health services for asylum-seekers before and after the HIC introduction, based on aggregate claims data and information on expenses for humanitarian healthcare provision that were retrieved from the Berlin authorities. Semi-structured interviews with 12 key informants explored organizational effects like administrative workloads and ethical dilemmas for staff. We performed a content analysis and used respondent validation to enhance the accuracy and trustworthiness of our results. The HIC has reduced bureaucratic complexity and administrative workloads; it has enabled unprecedented financial transparency and control; and it has mitigated ethical tensions. All the while, average per person expenses for outpatient health services have declined since the HIC introduction. However, our cost analysis also indicates a rise in the utilization and costs of inpatient care. The HIC introduction in Berlin suggests that the removal of barriers to healthcare for asylum-seekers can create win-win-situations by reducing administrative workloads, advancing financial transparency, and mitigating ethical tensions, whilst cutting the costs of outpatient healthcare provision. Removing barriers to healthcare thus appears to be a more prudent policy choice than maintaining mechanisms of restriction and control. However, high inpatient care utilization and costs warrant further research.

Integrated care management for older people with chronic diseases in domesticity: evidence from Cochrane reviews

HintergrundDie Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor.Ziel der ArbeitBewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland.MethodenSystematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein.ErgebnisseAus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme.SchlussfolgerungenDie identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01796-1) enthalten.

Gender-Specific Utilization of Outpatient Medical and Preventive Programs in a Rural Area

The aim of this study was to provide representative results on gender-specific utilization of outpatient medical and preventive care in a peripheral rural area. 1,246 adult inhabitants were interviewed in the Rural Health Study 2008. Answers to the utilization of outpatient care and behavioral health preventive programs were analyzed by bivariate analyses and by multiple regression analyses. Bivariate analyses show gender-specific differences in the utilization of the services of not only urologists and gynecologists but also of general practitioners, dentists, oculists, radiologists and preventive programs for weight reduction, healthy nutrition, back gymnastics and stress handling. Multivariate models show that women compared with men independent of age, social status and health status have higher opportunities to utilize outpatient care (OR 1,81; 95%-CI 1,11-2,94) and behavioral health preventive programs (OR 2,46; 95%-CI 1,62-3,74). The results of the present study confirm existing results on higher utilization of health services by women independent of their health status. Although regional studies never can be transmitted directly to other regions, we assume that as long as no other regional studies are available, these results could be extrapolated to other peripheral regions in Germany.