Men's Health Care Utilization Research Articles

Sex-related differences in pre-dialysis trajectories and dialysis initiation: A French nationwide retrospective study.

In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start. Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups. Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18). This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making.

Indifferent, ambiguous, or proactive? Young men's discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study.

Chlamydia trachomatis (C. trachomatis) infection is the most commonly reported sexually transmitted infection in Sweden and globally. C. trachomatis is often asymptomatic and if left untreated, could cause severe reproductive health issues. In Sweden, men test for C. trachomatis to a lesser extent than women. To explore factors facilitating and constraining Swedish young men's health care utilization for C. trachomatis detection and treatment. A qualitative situational analysis study including data from 18 semi-structured interviews with men (21-30 years). Data collection took place in Stockholm County during 2018. A situational map was constructed to articulate the positions taken in the data within two continuums of variation representing men's risk perception and strategies to test for C. trachomatis. Based on the informants' risk perception, strategies adopted to test and the role of social support, three different discourses and behaviours towards C. trachomatis testing were identified ranging from a) being indifferent about C. trachomatis -not testing, b) being ambivalent towards testing, to c) being proactive and testing regularly to assure disease free status. Several factors influenced young men's health care utilization for C. trachomatis detection, where the role of health services and the social support emerged as important factors to facilitate C. trachomatis testing for young men. In addition, endorsing traditional masculinity domains such as leaning on self-reliance, beliefs on invulnerability and framing men as more carefree with their sexual health than women delayed or hindered testing. Testing must be promoted among those young men with indifferent or ambivalent discourses. Health systems aiming to increase testing among those at risk should take into consideration the positive role that young men's social support have, especially the level of social support coming from their peers. Additionally, endorsement of traditional masculinity values may delay or hinder testing.

Are marital relationships a barrier to health care utilization in Southern Appalachia?: A dyadic examination of the link between marital quality and individual health care usage.

There are substantial health disparities in Appalachia partially due to the poor access and utilization of health care. Social support, especially in Appalachia, is consistently linked to the utilization of available health care. The present study aims to identify how on aspect of social support, relationship functioning, are associated with health care utilization for couples in Southern Appalachian. Individual and couple data (N = 147, individuals; n = 76, couples) were collected from participants interested in a brief couple interventions. Individuals and Dyadic Path analyses were conducted in Mplus using methods to account for the dependence in the data. Relational aggression was the only marital factor linked to health care utilization in multivariate analyses while constructive communication was only linked to health care utilization in bivariate correlations, r = .24, p < .05. Dyadic results indicate that men's health care utilization may benefit from partner's relational aggression while women's utilization may be negatively influenced by her own self-reported relational aggression. An individual's social context must be considered in order to completely understand barriers to health care utilization. Further, the inclusion of couple/dyadic level interventions should be considered in order to improve health care utilization in the Appalachian region and similarly rural regions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men.

The purpose of this study was to use focus groups to explore married men’s avoidance of health-care utilization. Five focus groups of 8 to 10 married, heterosexual, male participants (N = 44) were conducted and analyzed using grounded theory methods. Several important themes emerged connected to how masculine norms were associated with health-care utilization at several domains including at the organizational level (perceptions of doctors), interpersonal level (past family context and current family context), and individual level (illness severity, money concerns). These themes were all connected with the societal theme of masculine norms, where men’s reasons for health-care utilization (or underutilization) seemed in large part to emerge because of their perceptions of male gender roles. Implications for married men’s health-care utilization and health prevention education will be discussed.

Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy.

Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. A total of 411 men who completed the baseline survey and at 90days postoperatively were included. On multivariate linear regression, younger age (p<0.01), higher preoperative sexual function (<0.01), single marital status (p=0.04) and more post-surgery email contacts (p=0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p=0.01), higher baseline continence (p<0.01) and more post-surgery physical therapy visits (p<0.01) were associated with higher declines. Patients with the poorest quality of life outcomes at 90days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.

Predictors of men's health care utilization.

Predictors of men's health care utilization.

Relationship of sex to symptom severity, psychiatric comorbidity, and health care utilization in 163 subjects with borderline personality disorder

Objective The objective of the study was to compare symptom severity, frequency, and pattern of psychiatric comorbidity, quality of life, and health care utilization in men and women with borderline personality disorder (BPD). Methods The analysis is based on a sample of 163 subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD recruited for participation in a clinical trial at an academic medical center. Subjects were administered structured interviews and questionnaires of known reliability. Results Men (n = 25) and women (n = 138) with BPD were compared across multiple domains. Men were significantly older than women (34.5 vs 30.4 years), but subjects were otherwise similar in their demographic characteristics. Overall syndrome severity and frequency of past suicide attempts and self-harm behaviors were also similar. Women were more likely than men to have an anxiety disorder (particularly generalized anxiety disorder), somatoform disorders, and histrionic personality disorder. Antisocial personality disorder was more common in men. Women had higher dimensional ratings of depression, anxiety, obsessive-compulsiveness, work dysfunction, and negative affectivity; they were also more likely to endorse the “paranoia/dissociation” BPD criterion. On the Short Form-36 Health Survey, women reported significantly worse emotional role, social role, and mental health functioning than men. Contrary to expectation, there were no significant cross sex differences in the use of health care resources. Conclusion Men and women with BPD show important differences in their pattern of psychiatric comorbidity, dimensional symptom ratings, and in quality of life variables. Women have more negative views of themselves, and worse overall emotional and social role functioning. Implications for clinicians and researchers are discussed.

Health Care Utilization by Canadian Women.

Health IssuesWhile women are reported to be more frequent users of health services in Canada, differences in women's and men's health care utilization have not been fully explored. To provide an overview on women's healthcare utilization, we selected two key issues that are important for public policy purposes: access to care and patterns of utilization. These issues are examined using primarily data from the 1998/99 National Population Health Survey, complemented by the 2000 Canadian Community Health Survey and the 2001 Health Service Access Survey.Key Findings• Women are twice as likely as men to report a regular family physician, but that proportion is very low (15.8%).• Women report significantly shorter specialist wait times (20.9 days) than men (55.4 days) for mental health, while the reverse is true for asthma and other breathing conditions (10.8 for men, 78.8 for women).• Reported mean wait times are significantly lower for men than for women pertaining to overall diagnostic tests: for MRI, 70.3 days for women compared to 29.1 days for men.Data Gaps and Recommendations• Measurement of possible system bias and its implication for equitable and quality healthcare for women requires larger provincial samples of the national surveys, along with a longitudinal design.• Either a national database on preventive services, or better alignment of provincial databases pertaining to health promotion and preventive services, is needed to facilitate data linkage with national surveys to undertake longitudinal studies that support gender based analyses.