Number Of Healthcare Visits Research Articles

The association between women’s health information use and health care visits

To determine the effect of the type of information sources used on health services use. Population-based random-digit dialing survey of 498 women, between December 1999 and January 2000, on use of health information sources and health visits. After adjustment for sociodemographic and medical factors, use of print health media and computer-based resources was associated with 1.9 and 1.6 more visits, respectively compared to non-use (Regression coefficients 1.9; [95% confidence interval {CI} 0.1, 3.7] and 1.6; [95% CI 0.3, 3.0]). Print health media and computer-based sources are associated with a higher number of health care visits.

Association between infant continuity of care and pediatric emergency department utilization.

The objective of this study was to examine the association between continuity of care (COC) and emergency department (ED) utilization during infancy, when the bonds between a provider and a family are first forming and health care utilization is at it highest levels. A retrospective birth cohort was conducted of children who were born between December 1, 1999, and April 30, 2000; health care use during the first 25 months of life was analyzed. A COC score was calculated from well-child visits in the first 7 months of life. Subsequent ED utilization, for both a 12-month and an 18-month period, was evaluated through 2 measures: 1) ED reliance (the fraction of all visits that occurred in the ED) and 2) number of ED visits. Spearman rank correlation coefficients (r(s)) between COC and ED utilization were calculated. Partial rank correlations were calculated controlling for Medicaid status, income, gender, and the total number of health care visits. A total of 181 children were included in the study; 96 (53%) were male, and 48 (27%) were covered by Medicaid. COC scores ranged from 0 to 1, with a median of 1. COC scores were negatively correlated with both ED reliance (r(s) = -.214) and number of ED visits (r(s) = -.215) with 12 months of follow-up. The negative correlation was even stronger at 18 months of follow-up (ED reliance: r(s) = -.247; number of ED visits: r(s) = -.242), and this relationship remained significant with partial rank correlations. Improved COC in infancy is associated with a decrease in subsequent ED utilization. Interventions aimed at increasing the continuity of early well-child visits may decrease ED utilization.

Do childhood adversity and recent social stress predict health care use in patients presenting with upper abdominal or chest pain?

A comprehensive model of health care use by patients with functional gastrointestinal disorders has not been fully tested. This study aimed to establish whether reported childhood and/or recent adversity are independent predictors of health care use when all other relevant factors are also included in the model. Consecutive new patients with upper abdominal or chest pain presenting to a secondary/tertiary clinic were assessed using the Childhood Experience of Care and Abuse and Life Events and Difficulties Schedules. They completed the Hospital Anxiety and Depression and Health Anxiety Questionnaires. Outcome was total number of health care visits recorded in hospital and general practice (GP) records over 18 months. One hundred fifty-one patients were included (65% response rate). Health care visits were most frequent in unmarried (p < 0.0005), females (p < 0.0005), and those lacking social support (p = 0.012). In multiple regression analysis to predict number of health care visits, reported sexual abuse (p = 0.042) and death of a sibling during childhood (p = 0.026) were also independent predictors, together with SF36 subscale scores for physical function, health perception, and mental health (35% of variance explained). Childhood adversity predicted health care use in patients with functional gastrointestinal disorders and recent social stress did so in patients with demonstrated pathological findings. After adjustment for demographic, physical, and psychological factors, childhood adversity, especially in severe form, is an independent predictor of health care use in patients with upper functional gastrointestinal disorders. The same was not true for patients consulting for demonstrable pathological abnormalities, for whom ongoing social stress was an independent predictor.

Certified Safe Farm

ABSTRACT Data is presented on the health insurance coverage of approximately 260 farmers in Northwest Iowa. A combination of telephone interview and self-administered questionnaire was used to collect information on health insurance premiums, coinsurance rates, and deductibles. Data was also collected on the injury and illness experiences of the subjects. Thirty-nine percent (100) of primary farm operators and 63.5% (154) of spouses worked off the farm. Of those who worked off-farm, 30 primary operators (30%) had coverage through their off-farm employer, and 41 spouses (27%) received health insurance through their off-farm employer. In addition to a general description of demographics and insurance coverage, the following research questions were investigated: 1. Are farmers with high cost coverage less likely to seek health care when they have illnesses and injuries than are farmers who have low cost insurance coverage? 2. Do farmers with off farm employer coverage have lower insurance costs than farmers who have individual coverage? No conclusive evidence supported a relationship between the cost of coverage and the number of health care visits. However, persons with off-farm employer sponsored coverage had significantly lower premiums than those without off-farm coverage. Additionally, those with family coverage from an off-farm employer had significantly lower deductibles. Implications for use of health insurance premium reductions as an incentive for safe farms are also discussed.

A Simulation Model for Analysing Patient Activity in Dermatology

We developed a general model to assess patient activity within the primary and secondary health-care sectors following a dermatology outpatient consultation. Based on observed variables from the UK teledermatology trial, the model showed that up to 11 doctor-patient interactions occurred before a patient was ultimately discharged from care. In a cohort of 1000 patients, the average number of health-care visits was 2.4 (range 1-11). Simulation analysis suggested that the most important parameter affecting the total number of doctor-patient interactions is patient discharge from care following the initial consultation. This implies that resources should be concentrated in this area. The introduction of teledermatology (either realtime or store and forward) changes the values of the model parameters. The model provides a quantitative tool for planning the future provision of dermatology health-care.

Introducing managed care in Switzerland impact on use of health services

The objectives of this study were to assess changes in the self-reported use of health care services after gatekeeping by general practitioners and a global budget were introduced in the health insurance plan for students at the University of Geneva, Switzerland, in October 1992. A random sample of 336 members of the University plan answered questions about their use of health care services during the year before (1992) and the year after (1993) the introduction of managed care. Similar data were collected among a random sample of 300 members of a comparison plan. All participants were 18–44 y old in 1992, spoke French and lived in Geneva. The proportion of insurees who visited specialists decreased by 10% in the University plan between 1992 and 1993 and remained unchanged in the comparison group. The proportion of insurees who visited general practitioners increased by 12% in the University plan and remained unchanged in the comparison group. No effects on the total number of health care visits, on hospitalisations or on use of medications were detected. The introduction of gatekeeping and of a global budget managed by physicians was associated with a transfer of patient visits from specialists to general practitioners.

Introducing managed care in Switzerland: impact on use of health services

The objectives of this study were to assess changes in the self-reported use of health care services after gatekeeping by general practitioners and a global budget were introduced in the health insurance plan for students at the University of Geneva, Switzerland, in October 1992. A random sample of 336 members of the University plan answered questions about their use of health care services during the year before (1992) and the year after (1993) the introduction of managed care. Similar data were collected among a random sample of 300 members of a comparison plan. All participants were 18–44 y old in 1992, spoke French and lived in Geneva. The proportion of insurees who visited specialists decreased by 10% in the University plan between 1992 and 1993 and remained unchanged in the comparison group. The proportion of insurees who visited general practitioners increased by 12% in the University plan and remained unchanged in the comparison group. No effects on the total number of health care visits, on hospitalisations or on use of medications were detected. The introduction of gatekeeping and of a global budget managed by physicians was associated with a transfer of patient visits from specialists to general practitioners.

Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population

The current study identifies characteristics that predict change in use of prescription and nonprescription drugs over a period of 3 years. A modified health care services use model was applied to information obtained from a probability-based sample of black ( n = 1778) and white ( n = 1446) community-resident elderly, interviewed in 1986–1987 and 1989–1990. Analysis was by means of logistic and ordinary least-squares regression, with sample weights and design effects taken into account. The number of users and average number of prescription drugs used increased over the 3 years, and was best predicted by extent of prior drug use, older age, white race, poorer health, and number of health care visits. Conversely, nonprescription drug use declined significantly, and was best predicted by prior use, white race, and female gender. The reduced use of prescription drugs by blacks as compared to whites is of concern, suggesting that attention is needed to assure equitable access to prescription drugs.

Quality of life issues in chronic otitis media with effusion: parameters for future study

This pilot project studied 61 children with chronic otitis media with effusion. The 12-month period prior to ventilation tube surgery was compared with the 12 months after surgery with respect to numbers of health care visits, the use of antibiotics, parental perceptions of hearing and speech problems, and other selected parameters. Significant decreases were found in total health care visits (mean decrease: 6.18 visits, P < 0.001). Ear-related health care visits also decreased significantly (mean decrease = 10.93, P < 0.001). Total health care visits correlated strongly with visits for ear problems both before and after surgery ( r = 0.4474, P < 0.001). Usage of antibiotics significantly decreased. Parental reports concerning the issues of secondary speech and hearing problems raised questions for additional study. In addition, the qualitative comments offered by parents suggest the breadth of impact of chronic otitis media with effusion in this patient population, and point the direction for future research.

Chronic pain and use of ambulatory health care.

Chronic pain status and health care utilization were assessed in a probability sample of 1016 adult HMO enrollees, and among 242 HMO enrollees seeking treatment for Temporomandibular Disorder (TMD) pain. Likelihood of health care contact for a painful symptom: Among persons reporting back pain, headache, chest pain, abdominal pain or temporomandibular pain in the prior six months, we evaluated whether (1) pain characteristics (severity, persistence, recency of onset), and (2) psychological distress were associated with the likelihood of recent use of health care for each pain symptom. Severity, persistence, and recency of onset of pain were generally associated with recent health care contact for a pain symptom. Females with a pain symptom were no more likely than males to report recent health care contact for the symptom after controlling for pain characteristics. The presence of psychological distress did not increase the likelihood of health care contact for individual pain symptoms. However, psychologically distressed persons were more likely to report pain at multiple anatomical sites and to report recent health care contact for one or more of the five pain symptoms (as a group). Chronic pain status and total use of ambulatory health care: Total number of health care visits (irrespective of reason for visit) was measured by automated data. Chronic pain status (summarized across all five anatomical sites) showed a modest correlation with the volume of health care use. Persons with recurrent pain and severe-persistent pain with no pain-related disability days used ambulatory care at rates close to population means. Persons with severe-persistent pain and seven or more pain related disability days used health care at rates substantially above population means. There was a statistically significant association between the volume of health care use and chronic pain after controlling for age, sex, self-rated health status, and psychological distress.

Response to symptoms in healthy, low utilizers of the health care system

From the literature, it is clear that a small proportion of people account for an inordinately high number of health care visits. Conversely, there exists a group of individuals who rarely seek professional medical intervention and, yet, who remain healthy. This study examines a sample of adults who have not received remedial treatment for any symptom in the previous year, who consider themselves as healthy and who pass a comprehensive physical examination. A gender and age balanced group of healthy low utilizers was administered the Symptom Response Questionnaire, an instrument designed to elicit response tendencies to thirteen standardized symptoms. There were significant differences between age groups in response to symptoms with the older individuals more likely to seek professional help. There were few gender differences within the healthy sample. This sample of healthy low-utilizers was not without symptoms, reporting an average of 20 symptoms occuring in the previous week as measured by the SCL-90. A clinical headache group was also administered the SRQ to provide information about their response tendencies to symptoms. This preliminary study suggests that response to illness may be significantly influenced by age and patient status and that reported gender differences in health care utilization may need to be examined more carefully. It is proposed that behavior patterns of healthy, low utilizers may have direct implications for intervention with high utilizers of the health care system.