Number Of Primary Care Visits Research Articles

THE IMPACT OF HEALTH SUPPLY AND DEMAND ON HEALTH OUTCOMES IN PRIMARY HEALTH CARE SERVICES: PANEL DATA ANALYSİS

The aim of this study is to determine the impact of health supply and demand on health outcomes in primary health care services. For this purpose, the population of the study consists of the Eastern Anatolia Region. Sampling was not determined in the study, and data from 14 provinces in the region were evaluated. The dependent variable of the study is the number of deaths, while the independent variables are the number of family medicine units and the number of primary care applications. The research data were tested separately for each province considering the time period 2012-2021. According to the results of the study, the increase in the number of family medicine units leads to a decrease in the number of deaths in Erzurum, Van and Ağrı, as in the whole panel. On the other hand, the increase in the number of primary care visits decreases the number of deaths in Muş and Hakkari, but increases it in Malatya and Bitlis.

Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus

To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Receipt of care at a practice participating in CPC+. Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.

A Retrospective Database Analysis to Investigate Treatment Patterns and Health Care Resource Utilisation in Patients who CYCLe AntiMuscarinics in ENgland (CYCLAMEN)

BackgroundPatients with overactive bladder may cycle through different antimuscarinic medications even though there is limited evidence to support this approach. ObjectiveTo describe treatment patterns and the associated health care resource utilisation (HCRU) according to antimuscarinic cycling groups. Design, setting, and participantsThe CYCLe AntiMuscarinics in ENgland (CYCLAMEN) study was a retrospective observational investigation that used primary care records from the Clinical Practice Research Datalink GOLD database linked to Hospital Episode Statistics secondary care data. Eligible patients (≥18 yr) were prescribed their first antimuscarinic between January 2014 and December 2017. Patients were categorised into groups prescribed one, two, or three or more (groups 1–3) consecutive unique antimuscarinics over 18 mo. Outcome measurements and statistical analysisThe HCRU rate and costs were calculated for the period of continuous antimuscarinic therapy (first antimuscarinic treatment episode) and the 18-mo follow-up period. Treatment sequence patterns were displayed using sunburst plots and Kaplan-Meier analysis was used to assess time on treatment. Results and limitationsOverall, 35 369 patients were included, of whom 31 760 (89.8%) received one antimuscarinic (group 1), 3182 (9.0%) received two (group 2), and 427 (1.2%) received three or more (group 3). The most common initial antimuscarinics were solifenacin (13 628 patients, 42.9%) in group 1, and oxybutynin in group 2 (1267 patients, 39.8%) and group 3 (200 patients, 46.8%). The median duration of the first antimuscarinic treatment episode was 57 d and <20% of patients were receiving any antimuscarinic after 18 mo. The number of primary care visits and mean costs increased across groups. The reasons for cycling could not be identified in this study. ConclusionsApproximately 10% of patients underwent sequential cycling with two or more antimuscarinics. Furthermore, as the majority discontinued treatment within 18 mo, there is a need to improve the management of these patients in the clinical care setting. Patient summaryWe investigated treatment patterns and health care use for patients with overactive bladder who were prescribed at least one antimuscarinic drug (AMD), which are drugs that reduce some of the impulses passing from the bladder to the brain. Around 10% of patients accessing primary health care in England received more than one sequential AMD. Most patients discontinued treatment, which may indicate inadequate management of their condition. Prescription of a higher number of AMDs was associated with higher health care costs.

Real-World Data of Adherence and Drug Survival of Biologics in Treatment-Naïve and Treatment-experienced Adult Patients with Rheumatoid Arthritis.

Biologic disease-modifying anti-rheumatics drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) are important treatments for rheumatoid arthritis (RA). As more of these drugs become available, there is a greater need to assess their real-world adherence and drug survival. Treatment-naïve and treatment-experienced patients with RA who initiated treatment with bDMARDs and tofactinib during 2015-2018 in a large Israeli health maintenance organization were included. Adherence and time to treatment suspension were recorded. Odds for adherence were estimated using a multivariable logistic regression model. Risk for treatment suspension was estimated using a mixed-effect Cox proportional hazard model. The analysis included 753 eligible patients (61.8% treatment-naïve) treated with 1287 treatment episodes (tofacitinib 24.2%, tocilizumab 17.5%, etanercept 16.0%, adalimumab 10.4%, abatacept 9.9%, rituximab 9.0%, golimumab 6.9%, certolizumab pegol 3.6%, infliximab 1.9%, and sarilumab 0.5%). Good adherence was measured for almost all drugs, yet over 50% of all treatment episodes were suspended. Older age was associated with reduced risk for treatment suspension while higher number of primary care visits and higher Charlson's comorbidity score were associated with increased risk. Compared to etanercept, treatment with adalimumab, certolizumab, or rituximab was associated with increased risk for treatment suspension (HR 1.68 95% CI 1.27-2.22, HR 1.62 95% CI 1.00-2.60, and HR 2.72 95% CI 2.02-3.67, respectively). Treatment choice primarily depends on disease activity and prognosis. Real-world data, showing differences in drug survival of bDMARDs and tsDMARD, can also be used in the variety of considerations when choosing treatment. Future studies could separate patients with RA into subgroups, which would also account for potential drug survival differences and enable personalized therapy.

Lung cancer screening utilization rate varies based on patient, provider, and hospital factors

ObjectiveLow-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening. MethodsWe performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened. ResultsA total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05). ConclusionsLung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.

Spatio-temporal Analysis of Demand for Elderly Care Services and Its Key Influencing Factors in Chinese Cities: A Web Search Engine Approach.

The demand for elderly care services (DECS) in Chinese Cities is one of the most concerned issues. The aim of this study was to understand the spatial and temporal evolution and external factors of DECS in Chinese cities and support the formulation of elderly care policies. We collected Baidu Index data for 287 prefecture-level and above cities and 31 provinces in China from January 1, 2012 to December 31, 2020. The Thiel Index was employed to describe the differences of DECS at different regional levels, and multiple linear regression was used to explore the external factors affecting DECS by calculating the variance inflation factor (VIF) to identify multicollinearity. The DECS of Chinese cities increased from 0.48 million in 2012 to 0.96 million in 2020, and the Thiel Index decreased from 0.5237 in 2012 to 0.2211 in 2020. Per capital GDP, number of primary beds, proportion of population aged 65 and over, number of primary care visits, and proportion of illiterate population over the age of 15 have significant influences on DECS (P < .05). DECS was on the rise in Chinese cities, with significant regional differences. At the provincial level, regional differences were influenced by level of economic development, primary care provision, aging population, educational attainment, and health status. It is suggested to pay more attention to DECS in small and medium-sized cities or regions, to strengthen primary care, and to improve the health literacy and health status of the elderly population.

Comparative Analysis of Quality of Life of Patients with Dermatological Problems: Teledermatology Versus Face-to-Face Dermatology.

The health-related quality of life (HRQoL) of the patients cared for with teledermatology (TD) services was analyzed as compared with face-to-face dermatology (F-F/D) at the hospital. This study was a controlled, non-blinded, intra-level, and multicenter randomized clinical trial, with a 6-month follow-up. A total of 450 patients were randomly assigned to two different groups. The Spanish version of the generic EuroQol-5-dimensions-5-Levels (EQ-5D-5L) questionnaire and the specific Skindex-29 questionnaire were used at 0 and 6 months. The number of primary care visits (2.24 TD; 1.68 F-F/D) and number of hospital visits (0.01 TD; 1.48 F-F/D) were statistically significant. It was observed that from month 0 onwards, the users included in the F-F/D group self-perceived a lower HRQoL than the users included in the TD group (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). At the end of the study, the patients included in the F-F/D group still obtained lower scores in their perception of HRQoL, as compared to those included in the other type of follow-up (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). TD was an effective diagnosis and follow-up tool. At the end of the study period, the HRQoL of the patients in both groups was significantly higher as compared to their baseline levels. Additionally, both the general and specific HRQoL perceived by the TD patients was higher than the F-F/D group from the start of the study.

Comprehensiveness of care for women with depression: Association between primary care use and cervical cancer screening.

To explore comprehensiveness of care in patients with depression by examining associations between a diagnosis of depression, frequency of primary care visits, and Papanicolaou test completion. Cross-sectional retrospective survey using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network. Primary care practices in Ontario. Women aged 21 to 69 eligible to receive Pap tests in 2015. Associations between 2 predictors (depression and number of primary care visits in 2015) and Pap test completion were measured. Overall, 125,258 women were included: 20.5% completed a Pap test and 16.4% had a diagnosis of depression. Having a diagnosis of depression was associated with lower likelihood of Pap test completion (adjusted odds ratio [AOR]=0.92, 95% CI 0.88 to 0.95). A greater number of primary care visits was associated with a higher likelihood of Pap test completion; this association was stronger in women with a diagnosis of depression (AOR=4.9, 95% CI 4.16 to 5.69) than in those without (AOR=3.4, 95% CI 3.25 to 3.60). While depression was associated with fewer completed Pap tests, women with depression who saw their family doctors more often were more likely to be screened for cervical cancer. More primary care visits for depression treatment may be associated with an improved likelihood of screening for cervical cancer.

Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada

BackgroundHaving a regular family physician is associated with many benefits. Formal attachment – an administrative patient-family physician agreement – is a popular feature in primary care, intended to improve access to and continuity of care with a family physician. However, little evidence exists about its effectiveness. In Quebec, Canada, where over 20% of the population is unattached, centralized waiting lists help attach patients. This provides a unique opportunity to observe the influence of attachment in previously unattached patients. The aim was to evaluate changes in access to and continuity of primary care associated with attachment to a family physician through Quebec’s centralized waiting lists for unattached patients.MethodsWe conducted an observational longitudinal population cohort study, using medical services billing data from public health insurance in the province of Québec, Canada. We included patients attached through centralized waiting lists for unattached patients between 2012 and 2014 (n = 410,140). Our study was informed by Aday and Andersen’s framework for the study of access to health services. We compared outcomes during four 12-month periods: two periods before and two periods after attachment, with T0–2 years as the reference period. Outcome measures were number of primary care visits and Bice-Boxerman Concentration of Care Index at the physician and practice level (for patients with ≥2 visits in a given period). We included age, sex, region remoteness, medical vulnerability, and Charlson Comorbidity Index as covariates in regression models fitted with generalized estimating equations.ResultsThe number of primary care visits increased by 103% in the first post attachment year and 29% in the second year (p < 0.001). The odds of having all primary care visits concentrated with a single physician increased by 53% in the first year and 22% (p < 0.001) in the second year after attachment. At the practice level, the odds of perfect concentration of care increased by 19% (p < 0.001) and 15% (p < 0.001) respectively, in first and second year after attachment.ConclusionOur results show an increase in patients’ number of primary care visits and concentration of care at the family physician and practice level after attachment to a family physician. This suggests that attachment may help improve access to and continuity of primary care.

Evaluation of the 2018–2019 vaccine effectiveness against medically attended influenza-like illness using medical records and claims data

BackgroundHealthcare administrative databases are a rich source of information that could be leveraged to estimate real-world influenza vaccine effectiveness (VE). We aimed to evaluate the VE of standard egg-based influenza vaccines and determine if administrative healthcare data provide accurate VE estimates compared to the US CDC data. MethodsThis retrospective cohort study was conducted during the 2018–2019 influenza season. Individuals who had at least one relevant record per year between 2015 and 2019 in their electronic medical record were included. Individuals were considered protected 14 days after receiving an influenza vaccine. The outcome was the occurrence of medically attended influenza-like illness (MA-ILI) defined by clinical diagnostic codes. Adjusted odds ratios (aORs) were derived from multivariate logistic regression and adjusted VE (aVEs) were calculated using 100 × (1-aORs). ResultsA total of 5,066,980 individuals were included in the analysis with 1,307,702 (25.8%) considered vaccinated. Overall, the median age was 54 (IQR, 32–66) and 58.1% were female. Vaccine protection against MA-ILI was moderate in children and low in adults. All estimates were lower than VEs reported by the CDC for the 2018–2019 influenza season. Our results were robust to potential loss to follow up, but misclassification bias and residual confounding led to underestimation of the 2018–2019 aVE. When stratified by the number of primary care visits, aVE estimates and vaccination coverage increased with the number of primary care visits, reaching estimates similar to those obtained by the US CDC and US national vaccination coverage among those with ≥ 6 primary care visits, resulting in significant positive vaccine protection in frequent healthcare users. ConclusionsModerate and low aVEs were observed during the 2018–2019 season using administrative healthcare data, which was likely due to detection and misclassification biases, correlated with healthcare seeking behaviour, leading to an underestimation of the 2018–2019 influenza VE.

Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study

BackgroundMigraine represents a serious burden for national health systems. However, preventive treatment is not optimally applied to reduce the severity and frequency of headache attacks and the related expenses. Our aim was to assess the persistence to traditional migraine prophylaxis available in Spain and its relationship with the healthcare resource use (HRU) and costs.MethodsRetrospective observational study with retrospective cohort design of individuals with migraine treated with oral preventive medication for the first time from 01/01/2016 to 30/06/2018. One-year follow-up information was retrieved from the Big-Pac™ database. According to their one-year persistence to oral prophylaxis, two study groups were created and describe regarding HRU and healthcare direct and indirect costs using 95% confidence intervals (CI). The analysis of covariance (ANCOVA) was performed as a sensitivity analysis. Patients were considered persistent if they continued on preventive treatment until the end of the study or switched medications within 60 days or less since the last prescription. Non-persistent were those who permanently discontinued or re-initiated a treatment after 60 days.ResultsSeven thousand eight hundred sixty-six patients started preventive treatment (mean age (SD) 48.2 (14.8) and 80.4% women), of whom 2,545 (32.4%) were persistent for 6 months and 2,390 (30.4%) for 12 months. Most used first-line preventive treatments were antidepressants (3,642; 46.3%) followed by antiepileptics (1,738; 22.1%) and beta-blockers (1,399; 17.8%). The acute treatments prescribed concomitantly with preventives were NSAIDs (4,530; 57.6%), followed by triptans (2,217; 28.2%). First-time preventive treatment prescribers were mostly primary care physicians (6,044; 76.8%) followed by neurologists (1,221; 15.5%). Non-persistent patients required a higher number of primary care visits (mean difference (95%CI): 3.0 (2.6;3.4)) and days of sick leave (2.7 (0.8;4.5)) than the persistent ones. The mean annual expenditure was €622 (415; 829) higher in patients who not persisted on migraine prophylactic treatment.ConclusionsIn this study, we observed a high discontinuation rate for migraine prophylaxis which is related to an increase in HRU and costs for non-persistent patients. These results suggest that the treatment adherence implies not only a clinical benefit but also a reduction in HRU and costs.

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic.

The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care. We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared. ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years. Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

PD40-08 RENAL COLIC IMAGING PRACTICE PATTERNS IN ONTARIO: A POPULATION-BASED STUDY

You have accessJournal of UrologyCME1 May 2022PD40-08 RENAL COLIC IMAGING PRACTICE PATTERNS IN ONTARIO: A POPULATION-BASED STUDY Danielle Jenkins, Greg Hosier, Marlo Whitehead, Rebecca Griffiths, Thomas McGregor, and D. Robert Siemens Danielle JenkinsDanielle Jenkins More articles by this author , Greg HosierGreg Hosier More articles by this author , Marlo WhiteheadMarlo Whitehead More articles by this author , Rebecca GriffithsRebecca Griffiths More articles by this author , Thomas McGregorThomas McGregor More articles by this author , and D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002601.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: CT scans are associated with increased cost and exposure to radiation when compared to ultrasound (US) in patients presenting with renal colic. Consequently, a Choosing Wisely recommendation from 2014 states that US should be used over CT in uncomplicated presentations of renal colic in patients under the age of 50. The objective of this study was to describe imaging practice patterns in Ontario among patients presenting with renal colic and the relationship between initial imaging modality, subsequent imaging, and burden of care indicators. METHODS: This is a population-based study of patients who presented with renal colic in Ontario between 2003 and 2019 using administrative data. Patients were assessed according to the first imaging modality they had during their index visit. Descriptive statistics and the Chi-square test were used to examine differences between these groups. The primary outcome was the need for subsequent imaging. Secondary outcomes included length of renal colic episode, days to surgery, number of emergency department visits, and number of primary care visits during the renal colic episode. RESULTS: A total of 429,060 patients were included in the final analysis. Of those, 50.5% (216,747) had a CT scan as their initial imaging modality, 19.7% (84,672) had an US, and 3.2% (13,643) had both a CT and an US on the same day. Subsequent imaging was obtained in 40.7% of those who had a CT scan as the initial imaging, compared to 42.9% in those who had an US and 43.1% who had both an US at CT on the same day. Of those who initially had an US, 38.0% went on to have at least one CT scan during their renal colic episode, including those who had a CT on the same day as the initial US, while 62.0% were able to avoid a CT scan altogether. In contrast, 16.8% had a repeat CT after an initial CT at the time of presentation. The length of the renal colic episode was slightly longer in those who had a CT first compared to US (RR 1.005 CI 1.000-1.009), however the time to surgery was less in those who had a CT first (RR 0.831 CI 0.807-0.856). Fewer emergency department and family physician visits were seen in those who had an initial CT. CONCLUSIONS: In patients presenting with renal colic in Ontario, approximately half are having a CT done as the initial imaging modality despite US being the recommended imaging modality in uncomplicated renal colic presentations. Those who have an US done first are often able to avoid subsequent CT scans. Efforts should be made to encourage the use of US in those presenting with renal colic rather than CT when clinically indicated. Source of Funding: PSI Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e686 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Danielle Jenkins More articles by this author Greg Hosier More articles by this author Marlo Whitehead More articles by this author Rebecca Griffiths More articles by this author Thomas McGregor More articles by this author D. Robert Siemens More articles by this author Expand All Advertisement PDF DownloadLoading ...

Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study

ObjectivesTo examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.DesignA register-based prospective cohort study.SettingSwedish region of Dalarna.ParticipantsParticipants...

Health and Health Care Use Strongly Associated with Cumulative Burden of Social Determinants of Health.

Understanding health outcomes and patterns of health care utilization associated with patients' cumulative social determinant of health (SDOH) risk is essential to supporting better health care. This study compared mental and physical health outcomes and health care utilization by increasing number of social needs among a clinical adult population. Surveys were sent to 6000 patients with recent visits to 7 primary care clinics in Portland, Oregon in 2018. The final study sample included respondents who matched to medical claims data, N = 1748. The authors used a modified logistic regression model to estimate risk ratios for the relationship between cumulative SDOH factors and self-reported chronic conditions, and a 2-part model to estimate the effects of cumulative SDOH risk on health care utilization. Increased SDOH need was associated with increasing likelihood of worse self-reported health outcomes, especially mental health. Compared with those with no SDOH need, having 1-2 SDOH need(s) (adjusted risk ratio [aRR] 1.25; 95% confidence interval [CI]: 1.06-1.46) and 3 or more SDOH needs (aRR 1.45; 95% CI: 1.22-1.73) had a greater risk of reporting any behavioral health condition. However, the number of SDOH had a graded but inverse impact on use of mental health care services where fewer visits were observed among those using care. Having SDOH was associated with increased likelihood of having an emergency department visit and increased number of primary care visits. This study demonstrates the compounding impact of SDOH on health and health care use. This highlights the importance of collecting SDOH, including the total number of SDOH needs, when considering a patient's health and health care.

Outcomes of a randomized quality improvement trial for high-risk Veterans in year two.

The Veterans Health Administration (VHA) conducted a randomized quality improvement evaluation to determine whether augmenting patient-centered medical homes with Primary care Intensive Management (PIM) decreased utilization of acute care and health care costs among patients at high risk for hospitalization. PIM was cost-neutral in the first year; we analyzed changes in utilization and costs in the second year. VHA administrative data for five demonstration sites from August 2013 to March 2019. Administrative data extracted from VHA's Corporate Data Warehouse. Veterans with a risk of 90-day hospitalization in the top 10th percentile and recent hospitalization or emergency department (ED) visit were randomly assigned to usual primary care vs primary care augmented by PIM. PIM included interdisciplinary teams, comprehensive patient assessment, intensive case management, and care coordination services. We compared the change in mean VHA inpatient and outpatient utilization and costs (including PIM expenses) per patient for the 12-month period before randomization and 13-24 months after randomization for PIM vs usual care using difference-in-differences. Both PIM patients (n=1902) and usual care patients (n=1882) had a mean of 5.6 chronic conditions. PIM patients had a greater number of primary care visits compared to those in usual care (mean 4.6 visits/patient/year vs 3.7 visits/patient/year, p< 0.05), but ED visits (p= 0.45) and hospitalizations (p= 0.95) were not significantly different. We found a small relative increase in outpatient costs among PIM patients compared to those in usual care (mean difference + $928/patient/year, p= 0.053), but no significant differences in mean inpatient costs (+$245/patient/year, p= 0.97). Total mean health care costs were similar between the two groups during the second year (mean difference + $1479/patient/year, p= 0.73). Approaches that target patients solely based on the high risk of hospitalization are unlikely to reduce acute care use or total costs in VHA, which already offers patient-centered medical homes.

Primary care visits increase utilization of evidence-based preventative health measures

BackgroundPrimary care visits can serve many purposes and potentially influence health behaviors. Although previous studies suggest that increasing primary care provider numbers may be beneficial, the mechanism responsible for the association is unclear, and have not linked primary care access to specific preventative interventions. We investigated the association between the number of times patients accessed their primary care provider team and the likelihood they received selected preventative health interventions.MethodsPatients with complete data sets from Sanford Health were categorized based on the number of primary care visits they received in a specified time period and the preventative health interventions they received. Patient characteristics were used in a propensity analysis to control for variables. Relative risks and 95% confidence intervals were calculated to estimate the likelihood of obtaining preventative measures based on number of primary care visits compared with patients who had no primary care visits during the specified time period.ResultsThe likelihood of a patient receiving three specified preventative interventions was increased by 127% for vaccination, 122% for colonoscopy, and 75% for mammography if the patient had ≥ 1 primary care visit per year. More primary care visits correlated with increasing frequency of vaccinations, but increased primary care visits beyond one did not correlate with increasing frequency of mammography or colonoscopy.ConclusionsOne or more primary care visits per year is associated with increased likelihood of specific evidence-based preventative care interventions that improve longitudinal health outcomes and decrease healthcare costs. Increasing efforts to track and increase the number of primary care visits by clinics and health systems may improve patient compliance with select preventative measures.

HCV testing: Order and completion rates among baby boomers obtaining care from seven health systems in Florida, 2015–2017

Many U.S. residents infected with hepatitis C virus (HCV) are baby boomers (born 1945–1965), who remain undiagnosed. Past CDC and USPSTF guidelines recommended one-time HCV testing for all baby boomers, with newer guidelines recommending universal screening for all adults. This retrospective cohort study examined electronic medical records for patient visits from 2015 to 2017 within the OneFlorida Data Trust and University of South Florida Health system. We assessed percentages of HCV tests ordered and completed across four age groups (those born before 1945, 1945–1965, 1966–1985, and after 1985). In 2019, we used logistic regression to examine factors associated with HCV test ordering and completion among baby boomers, including age, race, sex, number of primary care visits, HIV status, hepatitis diagnosis, and liver cancer history. All age groups had low rates of HCV test orders. 4.4% of baby boomers had a test ordered in 2015, and 6.7% in 2016. Of those, 94.5% and 89.7% completed testing, respectively. All other races/ethnicities had lower likelihood of testing completion than Whites (Blacks (aOR 0.82, 95%, CI 0.75–0.91); Asians (0.69, 0.52–0.92); Hispanics (0.29, 0.26–0.32)), although test orders were higher for Asians (1.48, 1.37–1.61) and Blacks (1.78, 1.73–1.82). Tests ordered (11.42, 10.94–11.92) and completed (2.25, 1.94–2.60) were more likely among those with hepatitis history. Test orders were more likely for HIV-positive patients (3.68, 3.45–3.93), but completion was less likely (0.67, 0.57–0.78). Interventions are needed to increase testing rates so that HCV infections are treated early, mitigating HCV-related morbidity and mortality, especially related to liver cancer.

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

BackgroundAcute myocardial infarction (AMI) is associated with greater utilization of healthcare resources and financial expenditure.ObjectivesTo evaluate temporal trends in healthcare resource utilization and costs following AMI throughout 2003–2015.MethodsAMI patients who survived the first year following hospitalization in a tertiary medical center (Soroka University Medical Center) throughout 2002–2012 were included and followed until 2015. Length of the in-hospital stay (LOS), emergency department (ED), primary care, outpatient consulting clinic visits and other ambulatory services, and their costs, were evaluated and compared annually over time.ResultsOverall 8047 patients qualified for the current study; mean age 65.0 (SD = 13.6) years, 30.3% women. During follow-up, LOS and the number of primary care visits has decreased significantly. However, ED and consultant visits as well as ambulatory-services utilization has increased. Total costs have decreased throughout this period. Multivariate analysis, adjusted for potential confounders, showed as significant trend of decrease in LOS and ambulatory-services utilization, yet an increase in ED visits with no change in total costs.ConclusionsDespite a decline in utilization of most healthcare services throughout the investigated decade, healthcare expenditure has not changed. Further evaluation of the cost-effectiveness of long-term resource allocation following AMI is warranted. Nevertheless, we believe more intense ambulatory follow-up focusing on secondary prevention and early detection, as well as high-quality outpatient chest pain unit are warranted.

Abstract TMP77: Predictors of Readmission After Stroke in a Cohort of Privately Insured Patients

Introduction: Reducing readmission rate is a healthcare priority. The aim of this project is to examine factors associated with readmission after stroke in a privately insured cohort. Methods: Our organization is a health insurance provider as well as a healthcare provider. We retrospectively identified members of our insurance plan who discharged from one of our family of hospitals (one comprehensive stroke center, one primary stroke center, and two stroke ready hospitals) 2014-2018 with a stroke diagnosis. Using insurance claims, we captured all readmissions and ER visits in the 30 days after discharge. Using the same data, we were also able to identify primary care visits in the year preceding and the month following the index stroke. The impact of primary care was examined in a univariate analysis and a multivariate analysis adjusting for age, sex, race, stroke type, and length of stay (LOS). Results: We identified 1177 patients after excluding those who were not members of our insurance plan and those who had a planned admission such as to inpatient rehab (mean age 71±15 years; 53% women; 17% non-white). Stroke types were 72% ischemic stroke; 12% TIA; 7% ICH; 4% SAH. Most common discharge destination was home 68% followed by skilled nursing facility 27%. Overall 30-day all-cause readmission rate was 31% (21% inpatient admission, 8% ER visit, and 2% both). In an unadjusted model, there was a significant association between number of primary care visits and probability of readmission (OR 0.60 [95% CI 0.50-0.72]; p&lt;0.0001). This association remained significant in the multivariate analysis (OR 0.73 [95% CI 0.58-0.91]; p=0.005). Other variables independently associated with readmission include age, LOS, and ischemic type of stroke. There was no association between readmission and sex or race and no interaction between primary care and sex nor between primary care and race. Conclusion: Established primary care is protective from stroke readmission. In high risk patients (older age with ischemic stroke and prolonged length of stay), efforts should be made to arrange for primary care sooner than later.