National Health Insurance Enrollees Research Articles

Analysis of post-extraction bleeding in patients taking antithrombotic therapy using data from the longevity improvement and fair evidence study.

Several studies have investigated post-extraction bleeding in patients on antithrombotic therapy, but most included a small sample size. This study aimed to analyse post-extraction bleeding in patients on antithrombotic therapy using data from a large database. Claims data of National Health Insurance and Late-Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of "post-extraction bleeding" as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post-extraction bleeding in detail, multiple logistic regression analysis was performed with post-extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables. Antithrombotic therapy was administered in 14 343 patients (13.3%), and post-extraction bleeding was observed in 419 patients (0.4%). The rate of post-extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00-9.02). The frequency of post-extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients.

Does Maintained Medical Aid Coverage Affect Healthy Lifestyle Factors, Metabolic Syndrome-Related Health Status, and Individuals' Use of Healthcare Services?

Concerns about the moral hazards and usage of universal health insurance require examination. This study aimed to analyze changes in lifestyle, metabolic syndrome-related health status, and individuals' tendency to use healthcare services according to changes in the eligibility status of medical aid recipients. This paper reports a retrospective cohort study that involved analyzing data from 2366 medical aid recipients aged 40 years or older who underwent national health screenings in 2012 and 2014. Of the recipients, 1606 participants continued to be eligible for medical aid (the "maintained" group) and 760 changed from being medical aid recipients to National Health Insurance (NHI) enrollees (the "changed" group). Compared to the "changed" group, the "maintained" group was less likely to quit smoking, more likely to begin smoking, less likely to reduce binge drinking to moderate drinking, and had a significant increase in blood glucose and waist circumference. Annual total medical expenses also increased significantly in the "maintained" group. Since the mere strengthening of healthcare coverage may lead to moral hazards and the failure to link individuals' tendency to use healthcare services and outcomes, establishing mechanisms is necessary to educate people about the health-related outcomes of maintaining a healthy lifestyle and ensure the appropriate use of healthcare services.

Adherence to International Guidelines in Antihypertensive Prescriptions among National Health Insurance Enrollees in a Tertiary Hospital Located in Abuja, Nigeria

Abstract: Background: Irrational prescription of antihypertensive drugs has become a major problem worldwide. The study aimed at investigating the conformity of antihypertensive prescriptions to current international guidelines among NHIS enrollees in a tertiary hospital and to determine the comorbidities among the patients. Materials and Methods: This was a descriptive and retrospective cross-sectional study. A total of 311 case notes of patients who accessed care from January 1st to December 31st, 2018 were retrieved from the Health Information Department of the Hospital. Information on antihypertensive drugs prescribed and their co-morbidities were retrieved. Results: Study participants mean age was 49.02 ± 9.16 with age groups of 40 - 59 and 20 - 39 years as the highest and lowest participants, respectively in the study population. Calcium channel blockers (32.44%) were the most prescribed of the antihypertensive drugs, followed by diuretics (13.93%). The majority (84.0%) of the study participants were on combined therapy. Amongst the combination therapies, the 2-drug therapy (28.97%) was most preferred. The commonly used combinations were CCB + ARB (92, 84.40%), CCB + ARB + Diuretic (30, 30.92% and CCB + ACEI + 2 Diuretics (22, 53.65%) for 2-, 3- and 4-drug, respectively. The common comorbidities found among the patients were diabetes mellitus followed by hypertensive heart disease then dyslipidaemia. Antihypertensive prescriptions conformed more with JNC 8 but partially to JNC 7 and ACC/AHA. Conclusion: Antihypertensive prescriptions among NHIS enrollees in the University of Abuja Teaching Hospital were in conformity with JNC 8 and adheres partially to other guidelines. Keywords: Antihypertensives, Prescriptions, Conformity, International guidelines.

Effects of a Medical Aid program on medical utilization patterns for low-income patients with affective disorder in Seoul.

Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively.Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM).The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries.Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.

Food store accessibility affects nutritional intake through shopping frequency and food intake in middle-aged to older adults in rural Nagasaki, Japan.

The food environment is an important determinant of dietary and nutritional intake, but studies thus far have reported mixed results. We examined associations between food store accessibility and nutritional intake among middle-aged to older adults in rural Japan using data from a questionnaire survey of national health insurance enrollees. The survey was conducted in Nagasaki, Japan, for individuals aged 40-74 years. Direct distances from home and food store density were estimated using a geographic information system (GIS). We focused on protein, vitamin D, and calcium intake for their preventive effects on frailty and sarcopenia. To examine the effects of food store accessibility on nutritional intake, we hypothesized a model with a chain of associations of food store accessibility, shopping frequency, food intake frequency, and nutritional intake. We performed a path analyses to explore the food items to be included in the models, associations between the variables, and fitness of the models. We obtained final models with satisfactory fit indices. The resultant models included significant associations between: 1) accessibility indicators and shopping frequency, 2) shopping frequency and intake frequency for two or four categories of food, and 3) intake frequency and nutritional intake. The results demonstrated that accessibility to food stores, assessed in terms of direct distance from home and food store density, can affect the intake of protein, vitamin D, and calcium through the effect on shopping frequency and intake frequency of some categories of food items, among middle-aged to older adults in Nagasaki, Japan.

Changes in percutaneous coronary intervention practice in Japan during the COVID-19 outbreak: LIFE Study.

AimThe global outbreak of coronavirus disease (COVID‐19) has had widespread effects on clinical practice, and is reportedly associated with reduced percutaneous coronary intervention (PCI) rates in the US and Italy. This study aimed to ascertain the influence of the COVID‐19 outbreak on PCI practice in Japan.MethodsIn a retrospective analysis of claims data from National Health Insurance and Later‐Stage Elderly Healthcare System enrollees in Kobe City, Japan, we examined the changes in PCI incidence before and during the COVID‐19 outbreak. Percutaneous coronary intervention incidence during the COVID‐19 outbreak in 2020 was compared with that of the same (pre‐outbreak) period in 2019 using a Poisson regression analysis with the monthly number of PCIs as the dependent variable.ResultsA total of 639 patients underwent PCI in Kobe City between February and May 2020. The results showed a 19% reduction in all PCI procedures during the outbreak relative to the pre‐outbreak period (P = 0.001). There were no significant changes in non‐elective PCIs for acute coronary syndrome (ACS) cases, but a 25% reduction in elective PCIs for non‐ACS cases (P < 0.001).ConclusionsThe COVID‐19 outbreak was associated with a decline in elective PCIs for non‐ACS cases, but did not appear to influence non‐elective PCIs for ACS cases in Japan.

Generalized anxiety disorder in type 2 diabetes mellitus: prevalence and clinical characteristics.

Objective:This study investigated the prevalence of generalized anxiety disorder (GAD) in Taiwanese patients with type 2 diabetes mellitus (T2DM).Methods:This retrospective observational study was conducted with a random sample of patients from the entire population of National Health Insurance enrollees during 2000-2010 and used ICD-9-CM diagnostic codes to identify T2DM patients and GAD. The prevalence of GAD was compared between T2DM patients and the general population.Results:Between 2000 and 2010, the prevalence of GAD was significantly greater in the T2DM patients than the general population, while the increase of GAD was higher in the general population (from 0.25 to 0.63%) than among T2DM patients (from 0.81 to 1.03%). In T2DM patients, GAD was associated with female gender, a Charlson Comorbidity Index ≥ 1, diabetes mellitus duration > 9 years, and the following comorbidities: congestive heart failure, peripheral vascular disease, and depressive disorder. The prevalence of GAD among T2DM patients was negatively associated with rapid-acting insulin injection therapy and with the use of metformin and sulfonylureas.Conclusion:Since the prevalence of GAD was greater among T2DM patients than the general population, public health initiatives are needed to prevent and treat GAD in T2DM patients, specifically those with the above mentioned risk factors.

Association Between Pioglitazone Use and Prostate Cancer: A Population-Based Case-Control Study in the Han Population.

To date, few epidemiologic studies have investigated the relationship between pioglitazone use and prostate cancer. The available studies show conflicting findings. This case-control study explored the association between prior pioglitazone usage and prostate cancer using a large, population-based data set. Data were derived from the Longitudinal Health Insurance Database 2005 in Taiwan, a population-based sample of National Health Insurance enrollees with longitudinal claims data since 1995. Cases were 3513 patients with prostate cancer aged over 40years, and the controls were 3513 patients without prostate cancer, matched with prostate cancer cases on age, and having a medical care utilization episode in the year of the index prostate cancer (1 control per case). We performed conditional logistic regression to examine the odds ratio and 95% confidence intervals for prior pioglitazone use between cases and controls. Analysis showed that 178 of the total sample patients (2.53%) had used pioglitazone prior to the index date. Prior pioglitazone use was found in 72 (2.05%) cases and 106 (3.02%) controls. The crude odds ratio of prior pioglitazone usage for cases was 0.67 (95% confidence interval, 0.50-0.91) compared to controls. After adjusting for demographic characteristics and comorbidities, the negative association of prior pioglitazone with prostate cancer persisted (adjusted odds ratio, 0.59; 95% confidence interval, 0.43-0.80). We concluded that there was an inverse association between prior pioglitazone usage and prostate cancer in this study.

Perception of Factors Influencing Primary Health-Care Facility Choice Among National Health Insurance Enrollees of a Northwest Nigerian Hospital.

Background:The National Health Insurance Scheme (NHIS) of Nigeria was designed to eliminate known cultural, physical, and resource-related barriers to quality health-care access. Although choice of primary health-care facility (PHF) remains in the domain of the scheme enrollees, little is known about factors influencing their choice. Hence, the study of the perception of factors influencing PHF choice among NHIS enrollees of a northwest Nigerian hospital becomes imperative.Methods:This was a cross-sectional study of 284 principal enrollees randomly selected from patients attending the NHIS clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, using a designed, pretested, investigator-administered questionnaire. Their sociodemographics and factors influencing their choice of the clinic were assessed.Results:Respondents’ mean age was 40.9 ± 9.0 years and they were predominantly males (83.1%) with tertiary education. Median distance between their homes and PHF was 7.6 ± 12.5 km. Most respondents were aware of other accredited PHFs in the city and believed it was their right to choose a PHF. Among the various factors influencing their choice of index PHF were better functioning equipment (83.5% of respondents), more specialists/trained health workers (78.5%), ease in receiving specialist care (69.4%), and better overall quality of care (78.9%).Conclusion:There are multiple factors associated with enrollee choice of PHF in this study. The NHIS enrollees value the presence of functioning equipment/facilities, ease in receiving specialist care, and overall high quality of care in their choice of PHF. Improving enrollee enrollment at accredited PHF may require addressing these factors.

The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care.

Relapse insomnia increases greater risk of anxiety and depression: evidence from a population-based 4-year cohort study

ObjectiveWe investigated the longitudinal impacts of insomnia on the subsequent developments of anxiety and depression during a four-year follow-up. We further categorized individuals with insomnia into different insomnia subgroups to examine whether the risk of anxiety and depression varies by subtype. MethodsParticipants were identified from National Health Insurance enrollees in Taiwan during 2002–2009. The study included 19,273 subjects with insomnia and 38,546 matched subjects without insomnia. All subjects did not have previous diagnosis of insomnia, sleep apnea, anxiety, or depression. ResultsCompared with non-insomniacs, insomniacs had a higher risk of developing anxiety only [adjusted hazard ratio (HR) = 8.83, 95% CI = 7.59–10.27], depression only (adjusted HR = 8.48, 95% CI = 6.92–10.39), and both anxiety and depression (adjusted HR = 17.98, 95% CI = 12.65–25.56). When breaking down the insomnia subgroups, individuals with a relapse of insomnia (adjusted HR = 10.42–26.80) had the highest risk of anxiety only, depression only, and both anxiety and depression, followed by persistent insomnia (adjusted HR = 9.82–18.98), then remitted insomnia (adjusted HR = 4.50–8.27). All three insomnia subgroups had a greater four-year cumulative incidence rate than the non-insomnia group for anxiety only, depression only, and both anxiety and depression (p < 0.0001). ConclusionOur findings reinforce the clinical predictor role of insomnia in the future onset of anxiety or/and depression. Awareness of insomnia and treatment of insomnia should be recommended at clinics, and patterns of insomnia should be monitored to help treatment and control of subsequent psychiatric disorders. Future research with comprehensive data collection is needed to identify factors that contribute to different insomnia subtypes.

Suicide rates across income levels: Retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea.

BackgroundThe relation of income and socioeconomic status with suicide rates remains unclear. Most previous studies have focused on the relationship between suicide rates and macroeconomic factors (e.g., economic growth rate). Therefore, we aimed to identify the relationship between individuals' socioeconomic position and suicide risk.MethodsWe analyzed suicide mortality rates across socioeconomic positions to identify potential trends using observational data on suicide mortality collected between January 2003 and December 2013 from 1,025,340 national health insurance enrollees. We followed the subjects for 123.5 months on average. Socioeconomic position was estimated using insurance premium levels. To examine the hazard ratios of suicide mortality in various socioeconomic positions, we used Cox proportional hazard models.ResultsWe found that the hazard ratios of suicide showed an increasing trend as socioeconomic position decreased. After adjusting for gender, age, geographic location, and disability level, Medicaid recipients had the highest suicide hazard ratio (2.28; 95% CI, 1.87–2.77). Among the Medicaid recipients, men had higher hazard ratios than women (2.79; 95% CI, 2.17–3.59 vs. 1.71; 95% CI, 1.25–2.34). Hazard ratios also varied across age groups. The highest hazard ratio was found in the 40–59-year-old group (3.19; 95% CI, 2.31–4.43), whereas the lowest ratio was found in those 60 years and older (1.44; 95% CI, 1.09–1.87).ConclusionsOur results illuminate the relationship between socioeconomic position and suicide rates and can be used to design and implement future policies on suicide prevention.

Older Age, Low Socioeconomic Status, and Multiple Comorbidities Lower the Probability of Receiving Inpatient Rehabilitation Half a Year After Stroke

ObjectiveTo determine the predictors of receiving inpatient rehabilitation during 7 to 12 months after stroke. DesignRetrospective cohort study. SettingA nationally representative sample of 1 million National Health Insurance enrollees. ParticipantsPatients with new-onset stroke (N=13,828) were included. Studied participants were patients who received inpatient rehabilitation during 4 to 6 months after stroke. Patients who died within 1 year of the stroke event were excluded (n=488). InterventionsNot applicable. Main Outcome MeasuresThe outcome variable of interest was the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke. The characteristics of both patients and medical care providers were investigated to determine their effect on patients receiving inpatient rehabilitation. ResultsOlder patients, patients of low socioeconomic status, patients with Charlson Comorbidity Index ≥5, and patients who received outpatient rehabilitation during 4 to 6 months after stroke have a lower rate of receiving inpatient rehabilitation than do their counterparts. In addition, receiving inpatient rehabilitation during 7 to 9 months after stroke is a strong positive predictor of receiving inpatient rehabilitation during 10 to 12 months after stroke (odds ratio, 38.556; P<.0001). ConclusionsThis study revealed that older age, lower socioeconomic status, and multiple comorbidities are negative predictive factors with a cumulative predictive power for the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke.

Impact of continuity of care on preventable hospitalization of patients with type 2 diabetes: a nationwide Korean cohort study, 2002-10.

To determine whether patients with greater continuity of care (COC) have fewer preventable hospitalizations. We conducted a cohort study using a stratified random sample of Korean National Health Insurance enrollees from 2002 to 2010. The COC index was calculated for each year post-diagnosis based on ambulatory care visits. We performed a recurrent event survival analysis via Cox proportional hazard regression analysis of preventable hospitalizations. A total of 5163 patients newly diagnosed with type 2 diabetes mellitus in 2003-6 and receiving oral hypoglycemic medication. Preventable hospitalization. Of 5163 eligible participants, 6.4% (n=328) experienced a preventable hospitalization during the study period. The adjusted hazard ratio (HR) was 8.69 (95% CI, 2.62-28.83) for subjects with a COC score of 0.00-0.19, 7.03 (95% CI, 4.50-10.96) for those with a score of 0.20-0.39, 3.01 (95% CI, 2.06-4.40) for those with a score of 0.40-059, 4.42 (95% CI, 3.04-6.42) for those with a score of 0.60-0.79 and 5.82 (95% CI, 3.87-8.75) for those with a score of 0.80-0.99. The difference in cumulative incidence of preventable hospitalizations in patients with COC scores of 0.00-0.19 relative to those with COC scores of 1.00 was the greatest, at 0.97% points. Greater COC was associated with fewer preventable hospitalizations in subjects with type 2 diabetes.

Disparities in socioeconomic status and neighborhood characteristics affect all-cause mortality in patients with newly diagnosed hypertension in Korea: a nationwide cohort study, 2002-2013.

BackgroundPrevious studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes.MethodsWe conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002–2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003–2006, who received oral medication to control their hypertension. We generated a frailty model using Cox’s proportional hazard regression to assess risk factors for mortality.ResultsA total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00–1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08–1.26) and 1.27 (95% CI, 1.17–1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22–1.49 vs HR, 1.28; 95% CI, 1.16–1.41).ConclusionsNeighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0288-2) contains supplementary material, which is available to authorized users.

병원서비스지역 내 병원자원과 의료서비스 이용 간의 관련성 분석

Background: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hos-pital service area (HSA) in Korea.Methods: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the de-gree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by sum-ming the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and num-ber of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly pre-mium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index.Results: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also local-ization index was found to have positive significant relationships with service uses.Conclusion: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.Keywords: Hospital service area; Health care utilization; Health resources; Localization index

Association Between Physical Therapy and Risk of Coronary Artery Disease and Dyslipidemia Among Osteoarthritis Patients: A Nationwide Database Study

ObjectiveTo provide empirical evidence on the effect of early physical therapy (PT) within the first year of osteoarthritis (OA) diagnosis on reduction in OA-related comorbidities in patients with OA. DesignRetrospective cohort study. SettingThe study was conducted using a nationally representative sample of 1 million National Health Insurance enrollees. ParticipantsNewly diagnosed patients with OA (N=13,545). One-to-one propensity score matching was used to match patients who received PT within the first year of OA diagnosis (PT group; n=3403) with an equal number of patients with OA who did not receive PT (non-PT group). InterventionsNot applicable. Main Outcome MeasuresThe 4-year cumulative risk of comorbidities including coronary artery disease (CAD), diabetes mellitus, dyslipidemia, osteoporosis, gastrointestinal tract ulcer, and renal failure was estimated. A Cox proportional hazards regression analysis was performed to identify the dose-response relation between the PT dosage and the risk of OA-related comorbidities. ResultsA total of 3403 patients (25.1%) received PT within the first year of OA diagnosis. The PT group had a significantly lower 4-year cumulative risk of dyslipidemia (P=.05) and a potentially lower 4-year cumulative risk of CAD (P=.09). After adjusting for other potential confounders, the Cox proportional hazards regression analysis showed that patients with OA who received a high PT dosage had a low risk of CAD and dyslipidemia. ConclusionsPatients with OA who received PT had a lower risk of OA-related comorbidities such as dyslipidemia or CAD.

Receipt of Physical Therapy Among Osteoarthritis Patients and Its Influencing Factors

ObjectiveTo explore major patient and provider characteristics influencing the receipt of physical therapy (PT) among patients newly diagnosed with osteoarthritis. DesignA population-based, cross-sectional study on outpatient PT for patients newly diagnosed with osteoarthritis within the period of 2005 to 2010. SettingSample of 1 million National Health Insurance enrollees. ParticipantsPeople aged ≥18 years with an incidence of osteoarthritis and receiving initial outpatient treatment. A total of 29,012 patients were included (N=29,012). InterventionsNot applicable. Main Outcome MeasuresThe outcome variable of interest was the probability of receiving PT within 1 year of osteoarthritis diagnosis. Both individual and provider characteristics were investigated to determine their influence on PT receipt. ResultsOf the 29,012 included patients with osteoarthritis, only 24.8% of them received PT within the first year of diagnosis. Men and older adults were less likely to receive PT. In addition, low-income patients with osteoarthritis were less likely to receive PT. Furthermore, PT receipt was increased in patients treated by physicians who were women and by physicians who specialized in rehabilitation medicine. In addition, we observed a pattern indicating that the lower the accreditation level of the practice setting, the greater the probability of receiving PT. ConclusionsBecause of the National Health Insurance program in Taiwan, direct medical costs of PT have been substantially reduced; however, variations are still observed among different patient and provider characteristics. The major role of providers in PT receipt for patients with osteoarthritis should not be ignored.

Incidence rates of tuberculosis in chronic hepatitis C infected patients with or without interferon based therapy: a population-based cohort study in Taiwan.

BackgroundIt is debated whether interferon-based therapy (IBT) would affect the incidence of active tuberculosis (TB) among hepatitis C virus (HCV) infected patients. Although some case reports have demonstrated a possible association, the results are currently inconclusive. Therefore, we conducted a nation-wide population study to investigate the incidence of active TB in HCV infected patients receiving IBT in Taiwan.MethodsThis 9-year cohort study was based on the Longitudinal Health Insurance Database 2000 (LHID 2000) consisting of 1,000,000 beneficiaries randomly selected from all Taiwan National Health Insurance enrollees in 2000 ( >23.7 million). This insurance program covers all citizens in Taiwan. We conducted a retrospective cohort study that identified subjects with HCV infection. IBTs were defined as regimens that included interferon α, peginterferon α2a and peginterferon α2b for at least 2 months. Among them, 621 subjects received IBT, and 2,460 age- and gender-matched subjects were enrolled for analysis. The Cox proportional hazards models were used to estimate the hazard ratio (HR) for active TB, and associated confidence intervals (CIs), comparing IBT cohort and untreated cohort. The endpoint in this study was whether an enrolled subject had a new diagnosis of active TB.ResultsDuring the 9-year enrollment period, the treated and untreated cohorts were followed for a mean (± SD) duration of 6.97 ± 0.02 years and 8.21 ± 0.01 years, respectively. The cumulative incidence rate of active TB during this study period was 0.150 and 0.151 per 100 person-years in the IBT treated and untreated cohorts, respectively. There was no significant difference in the incidence of active TB in either cohort during a 1-year follow-up (Adjusted Hazard Ratio (AHR): 2.81, 95% Confidence Interval (95% CI): 0.61–12.98) or the long-term follow-up (AHR: 1.02, 95% CI: 0.28 – 3.78). The Cox proportional hazards model demonstrated that IBT was not a risk factor for active TB . The only risk factor for active TB was the occurrence of hepatic encephalopathy.ConclusionOur results showed that IBT is associated with increased hazard of active TB in HCV infected patients in 1-year follow-up; however, the effect sizes were not statistically significant.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0705-y) contains supplementary material, which is available to authorized users.

Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea.

Continuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors. We conducted a cohort study of a 3% nationwide random sample of Korean National Health Insurance enrollees. A total of 47,433 patients who had received new diagnoses of hypertension, diabetes, hypercholesterolemia, or their complications in 2003 or 2004 were included. We determined standard indices of continuity of care-most frequent provider continuity (MFPC), modified, modified continuity index (MMCI), and continuity of care index (COC)-and evaluated their association with study outcomes over 5 years of follow-up. Outcome measures included overall mortality, cardiovascular mortality, incident cardiovascular events, and health care costs. The multivariable-adjusted hazard ratios (HRs) for all-cause mortality, cardiovascular mortality, incident myocardial infarction, and incident ischemic stroke comparing participants with COC index below the median to those above the median were HR = 1.12 (95% CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28-1.95), and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. Lower continuity of care was also associated with increased inpatient and outpatient days and costs. Lower indices of continuity of care in patients with newly diagnosed hypertension, diabetes, and hypercholesterolemia were associated with higher all-cause and cardiovascular mortality, cardiovascular events, and health care costs. Health care systems should be designed to support long-term trusting relationships between patients and physicians.