Number Of Annual Outpatient Visits Research Articles

The electronic medical record management systems may improve monitoring and control of disease activity in patients with ankylosing spondylitis

To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. The number of annual outpatient visits increased after ASDAS assessment (4.0 (4.0, 7.0) vs. 4.0 (4.0, 8.0), p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (6.4 (8.5, 11.2) vs. 6.3 (8.3, 10.8) min, p = 0.073), especially among patients whose with an inactive disease activity was < 1.3 (ASDAS C-reactive protein (CRP) 6.7 (8.8, 11.1) vs. 6.1 (8.0, 10.3) min, p = 0.033; ASDAS erythrocyte sedimentation rate (ESR) 6.4 (8.7, 11.1) vs. 6.1 (8.1, 10.0) min, p = 0.027). Among patients who received at least three ASDAS assessments, the third ASDAS-CRP tended to be lower than the first (1.5 (0.9, 2.1) vs. 1.4 (0.8, 1.9), p = 0.058). The use of an EMRMS increased the frequency of ambulatory visits among AS patients with high and very high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS.

Healthcare Resource Utilization Among Veterans with Alzheimer’s Disease

AbstractBackgroundWe evaluated healthcare utilization patterns to understand the care pathways for Veterans with Alzheimer’s disease (AD) from the Department of Veterans Affairs (VA) healthcare system.MethodVA electronic health records (EHR) were used to extract data from clinical notes and identify patients with AD. The patient cohort was merged with the VA Informatics and Computing Infrastructure (VINCI) administrative database from October 2008–to October 2021 to obtain systematic healthcare utilization records including total inpatient admissions and outpatient visits. A control group was extracted for comparison and matched to the patient cohort using the propensity score on age, sex, and race. A linear mixed‐effects model was used to compare the total outpatient and inpatient utilization, adjusting for patient demographics and comorbidities.ResultWe extracted 21,442 AD patients from the EHR clinical notes. A cohort of 85,684 non‐AD and non‐dementia Veterans was constructed as a control group. In the AD vs control groups, the mean age was 82 vs 79 years, 83 vs 84% was White, and 97% were male in both groups. The number of annual outpatient visits 1 year before, and at 1 and 2 years after the first AD diagnosis code was 30, 34 and 27, respectively. The control group maintained 12 annual outpatient visits throughout the three‐year period. The average annual hospital admission rate was 1.8 vs 1.7 in the AD vs control group. The average length of inpatient stay in the year prior to the first AD diagnostic code was 23.1 days, increased to 27.4 days at year 1 after AD diagnosis, and declined back to 20.5 days at year 2, as compared to 13.1, 13.0, and 11.9 days, respectively, in the control group. The mixed‐effects analysis showed significantly higher healthcare utilization trends across VA outpatient and inpatient care settings (p&lt;0.001) in the AD vs control groups, after controlling for age, gender, race, ethnicity, and select comorbidities.ConclusionHealthcare resource utilization in patients with AD identified from the medical notes is more than doubled that in outpatient care and nearly doubled in inpatient length of stay relative to the matched controls in the VA healthcare system.

The impact of the COVID-19 pandemic on outpatients of internal medicine and pediatrics: A descriptive study.

This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.The average annual number of outpatient visits between 2017 and 2019 (before COVID-19) and the total number of outpatient visits in 2020 (COVID-19 period) were compared. Diagnostic codes were identified during 2 periods to analyze changes in the number of outpatient visits according to disease and month.The average annual number of outpatient visits was 47,105 before, and 40,786 during the COVID-19 pandemic, with a decrease of 13.4%. The number of outpatient visits in internal medicine decreased by 10.2% during the COVID-19 pandemic and tended to rebound during the second half of the year. However, the number of outpatient visits in the pediatric department decreased by 37.5% overall throughout the COVID-19 period and continued to decline in the second half of the year. The number of outpatients with infectious diseases decreased significantly (35.9%) compared to noninfectious diseases (cancer, 5.0%; circulatory disease, 4.1%). In addition, the number of outpatient visits due to viral diseases continued to decline, while the incidence of bacterial diseases increased rapidly in the second half of the year.This study confirmed that the number of outpatient visits due to bacterial or viral infections decreased throughout the COVID-19 crisis. Therefore, expanding public health and telemedicine services is necessary to prevent secondary health problems caused by essential medical use restrictions.

The impact of changed treatment patterns in multiple myeloma on health-care utilisation and costs, myeloma complications, and survival: A population-based comparison between two time periods in Denmark.

To evaluate health-care utilisation and costs, myeloma complications and survival in Danish patients with multiple myeloma (MM) before and after implementation of new early-line treatments in 2009. Based on data from the Danish National Health Registers, 3518 patients diagnosed with MM during 2002-2005 or 2010-2013 and randomly matched control individuals were identified, and health-care utilisation and costs were estimated. Health-care utilisation showed a marked shift from inpatient admissions towards outpatient visits. From early to late period, the mean annual number of outpatient visits increased by 22% and 28% in patients <65years and ≥65years, respectively. Additionally, the mean annual outpatient service costs increased correspondingly from 17001€ to 23643€ in younger patients and from 11317€ to 16144€ in the elderly. Increasing outpatient costs were outbalanced by lower inpatient admission costs and the adjusted total mean annual costs decreased in younger patients, probably partly due to fewer myeloma complications. The five-year survival rates increased markedly in both younger (HR=0.51) and elderly (HR=0.69) patients. Despite the introduction of new expensive early-line MM treatments in 2009, health-care costs remained stable due to a shift in health-care utilisation towards outpatient clinic care and fewer complications.

Different impacts of the zero-markup drug policy on county general and traditional Chinese medicine hospitals: evidence from Shandong province, China

BackgroundAs a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals.MethodsWe obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007–2017. We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP.ResultsOn average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47 and 10.42%, the revenue from medicine sales reduced by 24.04 and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22 and 89.3% in county general and TCM hospitals, respectively. The ZMDP reform was not significantly associated with the revenue and expenditure surplus, the number of annual outpatient visits and the number of annual inpatient visits in county general hospitals, the gross revenue, the revenue and expenditure surplus and the number of annual inpatient visits in county TCM hospitals. In terms of dynamic effects, the share of revenue from medicine sales, revenue from medicine sales, and gross revenue decreased by 20.20, 32.58 and 6.08% respectively, and up to 28.53, 63.89 and 17.94% after adoption, while government subsidies increased by around 170 to 200% in county general hospitals. The number of annual outpatient visits decreased by 9.70% and up to 18.84% in county TCM hospitals.ConclusionThe ZMDP achieved its some initial goals of removing the profits from western medicines in county hospitals’ revenue without disrupting the normal operation, and had different impacts between county general and TCM hospitals. Meanwhile, some unintended consequences were also recognized through the analysis, such as the decline of the utilization of the TCM.

PCN162 Disease Burden of Castration-Resistant Prostate Cancer (CRPC) in China

In China and even in the Asia Pacific region, study quantified the disease burden of NM-CRPC is lacking. This study aims to evaluate the disease burden (including epidemiology, survival, direct and indirect cost) of CRPC patients (including NN-CRPC and mCRPC) from the society perspective. First of all, to design the questionnaire, a systematic literature review on the CRPC’s epidemiology, economic burden and quality of life (QoL) was conducted. Furthermore, one-to-one web-meeting among 35 clinical experts specialized in urological diseases was conducted to collect relevant epidemiological, survival and costs information based on the pre-designed questionnaire. CRPC economic burden model was developed using Microsoft Excel 2013, and one-way sensitivity analysis was performed. Finally, Delphi panel meetings were organized to discuss the disease burden results. A total of 35 urologists from 33 class-3A hospitals in 21 cities participated in the questionnaire survey, 34 questionnaire results were eligible. In China, mCRPC accounts for a large proportion in CRPC (88.5%), and the diagnosed rate of NM-CRPC is low (39.3%). In current treatments, the metastasis-free survival (MFS) of NM-CRPC is only 13.3 months. The average total annual cost per NM-CRPC patient and per mCRPC patient were 69,145 CNY and 223,738 CNY respectively, with annual direct medical cost of 48,815 CNY and 171,082 CNY respectively. Sensitivity analysis results indicate that the direct medical costs per outpatient visit and the annual number of outpatient visits are the top two factors which impact the results. In China, NM-CRPC is associated with poor diagnosed rate and low metastasis-free survival. NM-CRPC imposes heavy economic burden, and mCRPC is more serious. This study highlights the critical need to introduce innovative therapies with better clinical efficacy with the delay in metastatic progression, to extend survival and improve QoL, and to reduce total cost and hospitalization admission for CRPC patients in China.

Comparison of health service use and costs in stroke with and without comorbidities: a cross-sectional analysis using China urban medical claims data

ObjectivesStroke is the leading cause of death and disability in China, but there is scare of evidence on whether and to what extent comorbidity affects the stroke-related costs in health...

Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China.

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.

Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China

BackgroundIt is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China.MethodsWe used claims data from China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively.ResultsAmong 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941.9), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI:1.012–1.441) and chemotherapy (1.363, 1.196–1.554), and decreased possibility of choosing surgery (0.850, 0.730–0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions.ConclusionComorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.

Association between asthma and risk of benign prostatic hyperplasia: a retrospective population-based study

Objective The association between asthma and benign prostatic hyperplasia (BPH) has rarely been explored. We investigated whether male asthmatic patients had an increased risk of BPH by conducting this retrospective nationwide population-based study. Methods We utilized data derived from the National Health Insurance Research Database (NHIRD) in Taiwan. A total of 9778 male patients aged >40 years who were newly diagnosed with asthma between 2000 and 2006 were included in the asthma group. Male enrollees without asthma were selected as the non-asthma group from the same database. Both the groups were followed up until the end of 2013. We performed Cox proportional hazard regression analysis to estimate the risk of BPH and transurethral resection of the prostate (TURP) in the male patients with asthma compared with that in those without asthma. Results The risk of BPH and TURP in the asthma group was 1.40-fold (95% confidence interval [CI] = 1.30–1.42) and 1.30-fold (95% CI= 1.31–1.50) higher than that in the non-asthma group, respectively, after adjusting for comorbidities, relevant medications and number of annual outpatient visits. Conclusions The male patients with asthma were found to have a higher risk of BPH than did those without asthma.

PCN119 - SECONDARY CARE RESOURCE UTILIZATION AND COST OF CARE AMONG FINNISH NON-SMALL CELL LUNG CANCER PATIENTS

Lung cancer is the most common cancer worldwide. In Finland, 2,500 people are diagnosed with lung cancer yearly. The majority, 80-85%, of all lung cancers are non-small cell lung cancers (NSCLC), which are commonly diagnosed at an advanced stage. In this study, we characterized secondary healthcare resource utilization and associated costs of Finnish NSCLC patients in a real-life clinical setting. The treatment lines and outcomes will also be characterized in subsequent complete analyses of Finnish NSCLC population. All adult patients with newly diagnosed NSCLC at the Hospital District of Southwest Finland between the years of 2013-2014, were included in the study. Data on resource use and costs was collected retrospectively from electronic healthcare records via the Turku Clinical Research Centre (TurkuCRC) database. Data was collected one year prior to diagnosis and one year after the diagnosis. A total of 464 NSCLC patients were included in the study. The mean number of annual outpatient visits per patient was 6.7 one year prior to diagnosis and 12.5 one year after the diagnosis. The mean number of inpatient visits during the pre-diagnosis year was 0.8 and 1.4 during the post-diagnosis year. The mean number of inpatient days per year was 3.8 and 10.0, respectively. One year prior to diagnosis the mean annual total costs of secondary care resource use were 5377€ and one year after the diagnosis 11423€. There was a clear increase in healthcare resource utilization and costs after the NSCLC diagnosis. NSCLC patients had a higher number of outpatient visits and inpatient stays during the post-diagnosis year, compared to the year before NSCLC diagnosis, which resulted over 2-fold increase in annual healthcare cost.

Economic burden of hepatitis C patients and related influencing factors in Guangdong province

Objective: To investigate the economic burden of hepatitis C patients and related factors in Guangdong province. Methods: In this study, cluster sampling method was used to select cases, including acute hepatitis C, chronic hepatitis C and liver cirrhosis cases from eligible outpatients and inpatients in 1 or 2 large general hospitals in all the 21 cities in Guangdong province. Questionnaire survey was conducted for all the hepatitis C patients to analyze their economic burden, while multivariate linear regression model was used to identify the related influencing factors. Results: A total of 356 hepatitis C patients were enrolled in the study, with 176 outpatients (49.4%) and 180 inpatients (50.6%) respectively. The average age of the study subjects was (44.79±11.73) year-olds. The annual direct economic costs of patients with acute hepatitis C, chronic hepatitis C and liver cirrhosis were 10 703.22 (IQR: 7 396.75-16 891.91), 14 886.63 (IQR: 7 274.00-30 228.25) and 28 874.00 (IQR: 13 093.69-56 350.00) Yuan (RMB) respectively. The annual indirect costs appeared as 2 426.99 (IQR: 1 912.18-7 354.52), 3 235.99 (IQR: 1 323.81-6 619.07) and 5 442.35 (IQR: 3 235.99-10 296.33) Yuan (RMB) respectively. The annual intangible costs were 5 000.00 (IQR:2 000.00-10 000.00), 10 000.00 (IQR: 4 000.00-30 000.00) and 10 000.00 (IQR: 3 000.00-100 000.00) Yuan (RMB) respectively. The annual total costs were 22 306.17 (IQR: 14 581.24-50 569.17), 38 050.33 (IQR: 17 449.57-68 319.62) and 80 152.18 (IQR: 40 856.09-228 460.79) Yuan (RMB) respectively. Results from the multiple linear regression analysis showed that factors as: annual hospitalization days, annual number of outpatient visits, annual number of hospitalization, type of disease and the levels of the hospitals were related to the economic burden of patients with hepatitis C. Conclusion: Patients with HCV-related diseases presented serious economic problem which calls for close attention in Guangdong province.

Determinants of the receipt of the 9-valent human papillomavirus vaccine in the first year after introduction in North Carolina

ObjectivesThe objective of this study was to describe the transition from bi- and quadrivalent HPV vaccines to 9vHPV in aggregate and identify determinants of the receipt of 9vHPV among youth following the introduction of 9vHPV in North Carolina. MethodsThe study used a retrospective cohort design with data from the North Carolina Immunization Registry (NCIR). Our sample included all doses of HPV vaccine administered between July 2015 and October 2016 to age-eligible youth (ages 9–17). We used a logistic regression model to associate individual child-level and ZIP Code Tabulation Area (ZCTA)-level characteristics with an indicator variable for receiving 9vHPV (vs. other HPV vaccines). ResultsYouth receiving the HPV vaccine were more likely to receive 9vHPV if they lived in a ZCTA with a larger age-eligible (i.e., 9–17) population, a health professional shortage area, or a higher number of annual outpatient visits per capita. They were less likely to receive 9vHPV if they were older, received a publicly-funded dose, or lived in a ZCTA with a higher percentage of the population with less than a high-school education or a higher number of religious organizations. ConclusionsWhile the transition from other HPV vaccines to 9vHPV was relatively quick, there were disparities in the diffusion of 9vHPV across North Carolina.

Prevalence and incidence of urinary tract and genital infections among patients with and without type 2 diabetes

ObjectiveEpidemiological data on genitourinary infections (GUIs) comparing patients with and without type 2 diabetes (T2DM) is scant. We aimed to estimate the incidence of urinary tract infections (UTIs), genital infections (GIs), or any GUI in total and stratified by history of GUI and sex. Research design and methodsWe identified 39,295 patients in the Kaiser Permanente Northwest health plan with T2DM and an equal number of age and sex matched patients without diabetes. The cohort was followed for up to 9years (2006–2014). We calculated incidence rates and corresponding 95% confidence intervals (CI) of any GUI, UTIs and GIs adjusting for age, sex, race, BMI, presence of chronic kidney disease, annual number of outpatient visits, and diuretic use. ResultsAdjusted incidence of any GUI was 97.2/1000person-years (p-y) (95% CI 95.5–98.8) among the T2DM cohort vs. 79.7/1000 p-y (78.3–81.2) among those without diabetes. T2DM was associated with an adjusted 25% increased risk of UTI (rate ratio 1.25, 95% CI 1.22–1.29), a 26% increased risk of GI (1.26, 1.22–1.31) and a 22% increased risk of any GUI (1.22, 1.19–1.25). Incidence rates were lower among those with no GUI history, but the relative risks were similar. Women in both groups had higher incidence rates of GUIs than men. ConclusionsT2DM was associated with increased risks of any GUI, UTIs and GIs. Incidence rates of UTIs were higher than rates of GIs, but the relative risk of GIs was essentially identical. A similar pattern was observed when stratifying by sex. Significance of the study•Limited research suggests the risk of genitourinary infections is greater among patients with diabetes compared with nondiabetic individuals.•Our findings confirm the elevated risk of genitourinary infections and further show that the risk is greater among women and persist when limiting the analysis to patients with no prior history of genitourinary infections.•Clinicians should be alert to the increased risk of genitourinary infections especially among patients with newly diagnosed diabetes and long-term exposure to hyperglycemia. Research questions•Exposure to hyperglycemia may be a more important risk factor for new cases of genitourinary infections vs. historically recurrent cases among patients with diabetes, a possibility that warrants further investigation.•More research is needed to determine whether hyperglycemia increases the risk of new genitourinary infections in a dose/time-dependent manner.•The extent to which genitourinary infections increase the risk of chronic kidney disease needs more study.

Association of Occupational Class with Healthcare Utilization among Economically Active Korean Adults from 2006 to 2014: A Repeated Cross-Sectional Study of Koreans Aged 19 Years and Older.

BackgroundTo investigate the impact of indicators of occupational class on healthcare utilization by using longitudinal data from a nationally representative survey.MethodsData were obtained from the Korean Welfare Panel Study conducted from 2006 (wave 1) through 2014 (wave 9). A total of 5,104 individuals were selected at baseline (2006). Analysis of variance and longitudinal data analysis were used to evaluate the following dependent variables: number of outpatient visits and number of days spent in the hospital per year.ResultsThe number of annual outpatient visits was 4.298 days higher (P<0.0001) in class IV, 0.438 days higher (P=0.027) in class III, and 0.335 days higher (P=0.035) in class II than in class I. The number of days spent in the hospital per year was 0.610 days higher (P=0.001) in class IV, 0.547 days higher (P<0.0001) in class III, and 0.115 days higher (P=0.136) in class III than in class I. In addition, the number of days spent in the hospital in class IV patients with unmet healthcare needs showed an opposite trend to that predicted on the basis of socioeconomic status (estimate,−8.524; P-value=0.015).ConclusionPatients whose jobs involved manual or physical labor were significantly associated with higher healthcare utilization. Thus, the results suggest that healthcare utilization in different occupational classes should be improved by monitoring work environments and promoting health-enhancing behaviors.

Medication use patterns, health care resource utilization, and economic burden for patients with major depressive disorder in Beijing, People's Republic of China.

ObjectiveThe objective of the study was to investigate medication usage patterns, health care resource utilization, and direct medical costs of patients with major depressive disorder (MDD) in Beijing, People’s Republic of China.MethodsData were extracted from a random sample of the Beijing Urban Employee Basic Medical Insurance database. Patients aged ≥18 years, with ≥1 primary diagnosis of MDD and 12-month continuous enrollment after their first observed MDD diagnosis between 2012 and 2013 were identified. Those with a diagnosis of schizophrenia, bipolar disorder, or cancer during the analysis period were excluded.ResultsIn total 8,484 patients, with a mean age of 57.2 years, were included and 63% were female. The top three commonly observed comorbidities were hypertension (70.9%), anxiety disorder (68.6%), and coronary heart disease (65.1%). Furthermore, 71.4% of patients were treated with antidepressant medications, including 60.5% of patients treated with selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (9.0%) and serotonin–norepinephrine reuptake inhibitors (8.3%). The proportions of patients who discontinued their initial antidepressant within the first and second months after the index date were 45.4% and 77.0%, respectively. Concomitant medications were prescribed for 76.8% of patients. Only 0.42% of patients experienced ≥1 MDD-related hospitalization(s) during the 1-year follow-up, and the average annual number of hospitalization was 1.2 for those hospitalized. The mean length of stay was 33.4 days per hospitalization. All patients had ≥1 MDD-related outpatient visit(s). The mean annual number of outpatient visits per patient was 3.1. The mean annual direct medical costs per patient with MDD was RMB ¥1,694.1 (48.5% for antidepressant medications), and that for hospitalized patients was RMB ¥21,291.0 (15.0% for antidepressant medications).ConclusionIn Beijing, the majority of patients with MDD were treated in the outpatient setting only and they received antidepressants. Selective serotonin reuptake inhibitors were the most commonly used antidepressants. However, the duration to antidepressant medication was short, and persistence was low. The economic burden of MDD-related hospitalization was considerable.

Healthcare Utilization and Expenditures for Persons with Diabetes Comorbid with Mental Illnesses.

The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.

Association of PNPLA3 rs738409 and TM6SF2 rs58542926 with health services utilization in a population-based study.

BackgroundHepatic steatosis confers an increased risk of metabolic and cardiovascular disease and higher health services use. Associations of the single nucleotide polymorphisms (SNP) PNPLA3 rs738409 and TM6SF2 rs58542926 with hepatic steatosis have recently been established. This study investigates the association between rs738409 and rs58542926 with health services utilization in a general population.MethodsData of 3759 participants from Study of Health in Pomerania (SHIP), a population-based study in Germany, were obtained. The annual number of outpatient visits, hospitalization and length of hospital stay was regressed on rs738409 and rs58542926 and adjusted for socio-economic factors, lifestyle habits, clinical factors, and health status.ResultsMinor allele homozygous subjects of rs738409 had an increased odds of hospitalization as compared to major allele homozygous subjects (odds ratio [OR] 1.51; 95 % confidence interval [CI], 1.02 to 2.15). Heterozygous subjects did not differ from major allele homozygous subjects with respect to their odds of hospitalization. The three genotype groups of rs738409 were similar with respect to the number of outpatient visits and inpatient days. Minor allele homozygous and heterozygous subjects of rs58542926 had higher outpatient utilization (+53.04 % and +67.56 %, p < 0.05, respectively) and inpatient days than major allele homozygous subjects.ConclusionsAfter adjustment for several confounding factors, PNPLA3 rs738409 and TM6SF2 rs58542926 were associated with the number of outpatient visits, hospitalization, and inpatient days. Further studies are warranted to replicate our findings and to evaluate whether genetic data can be used to identify subjects with excess health services utilization.

Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study

ObjectiveThe aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. MethodsHealth care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000–2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. ResultsIn the study period, the average number of annual outpatient visits was 43.11–50.37 and 29.82–31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875–92,781 and NT$63,764–81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. ConclusionsHealth care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time.

Impact of practice recommendations on patient follow‐up and cystic fibrosis centres' activity in France

The French cystic fibrosis (CF) practice recommendations were published at the end of 2002. They advise each patient to be checked up at least once every 3 months in a reference centre for cystic fibrosis. To describe the activity of the four reference centres in the Rhône-Alpes area and the patients' follow-up. All patients with cystic fibrosis consulting one of the four CF centres between 1996 and 2005 were retrospectively included. All outpatient visits were recorded and classified according to (i) patient and year; and (ii) month and year. The two series were assessed graphically to determine a transition threshold, that is, the 2 consecutive years between which practices differed the most. A total of 616 patients were included, representing 17 594 outpatient visits. The average number of visits per patient increased from 3.7 in 1996 to 5.0 in 2005, the graphical representation showed a sharp change between 2000 and 2001. Among patients with less than 4 visits in 2000, 88 of them visited a centre 4 times or more in 2001 (44%). The annual number of outpatient visits went from 1035 to 2420. The monthly average number of outpatient visits was 86 in 1996 and 202 in 2005. The graphical representation of activity also showed a sharp change from 2001. We showed that the implementation of guidelines occurred the year before its official publication. We also showed that the growth of this implementation was sharp rather than gradual.