Patient Health Service Use Research Articles

Out-of-pocket costs for patients diagnosed with high-grade glioma and their carers

Abstract Background This study aimed to describe the out-of-pocket costs incurred by patients diagnosed with high-grade glioma and their carers in the standard care arm of the Care-IS trial in the six to eight months following their diagnosis. Methods Carers completed monthly cost surveys detailing the out-of-pocket costs incurred by patients and carers over a six-month period. Seventy carers reported out-of-pocket costs at baseline (within two months following patient diagnosis), and a maximum of 50% of participants reported costs in any subsequent month. Costs were adjusted to 2023 AUD and reported as medians with interquartile range. Demographic factors were assessed to determine if any were significantly associated with being in the first or fourth quartile of total out-of-pocket costs at baseline. Results Median monthly costs for patient-carer dyads were highest at baseline ($535(IQR:$170-$930)), and two months post-recruitment ($314 (IQR:$150-$772)). The largest contributors to patient-carer costs were patient health service use and patient medications. Patient and carer health service use and medication costs varied over time. The median health service use and medication out-of-pocket costs for patients and carers were mostly below $100 per month, however, there was large variance in the upper 75th percentile for these cost categories. No factors were significantly associated with higher baseline out-of-pocket costs. Conclusion A HGG diagnosis has a significant and sustained financial impact on people who are diagnosed and their carers. Patients experience significant additional costs relating to their diagnosis and travel to receive care, and their carers also continue to experience sustained costs whilst managing the additional tasks associated with informal caregiving.

Telemonitoring in Heart Failure - A Single Center Experience.

ResumoFundamentoA evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente.ObjetivosEste estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência.MétodosEste é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo.ResultadosUm total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas.ConclusõesEste estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.

Unmet need for mental health services in indolent lymphoma: age differences over one-year post-diagnosis

This study examined distress and mental health service use in patients with newly diagnosed indolent lymphoma over the first-year post-diagnosis, as well as differences by age. Patients with indolent lymphoma completed online self-report measure of distress and whether they accessed mental health services (Yes/No) every four months for a total of four surveys. The baseline sample consisted of 74 patients; 41.9% were age 65 years and older, 24.3% endorsed elevated distress, and 16.2% accessed mental health services. Across time, less than half (36.4–46.7%) of distressed patients accessed mental health services. In patients younger than 65 years, a greater proportion of distressed than non-distressed patients accessed mental health services. However, distress was not associated with mental health service use in older adults. Future research should evaluate issues driving distress and access to mental health care in patients with indolent lymphomas, including age-based approaches.

Preventive Medical Services Use Among Community Mental Health Patients With Severe Mental Illness

This study examines predictors of reduced preventive health service use in patients with severe mental illness by examining psychiatric diagnoses and demographic factors. Of 387 patients approached in 4 community mental health clinics regarding their preventive health services use from January 2005 to May 2007, 234 (60.5%) were interviewed. Of those participants interviewed, 221 had a DSM-IV-TR diagnosis of (1) primary psychotic disorder (schizophrenia or schizoaffective disorder), (2) bipolar disorder, or (3) recurrent major depressive disorder. Psychiatric disorders and demographic factors that predicted high service utilization were analyzed using analysis of variance and χ² tests. In the linear predictive model, use of preventive services was not statistically different among the 3 diagnostic groups. Participants with primary psychotic disorder used a similar number of preventive services compared to those with bipolar disorder and major depression. Women used more services than men (P < .01), and individuals with health insurance used more than uninsured participants (P < .001). Male gender and not having medical insurance were predictive of lower preventive health service use in this sample of patients with severe mental illness. Further research is needed to replicate these findings and to improve use of preventive health services in people with severe mental illness.

Baseline Differences and Trajectories of Change for Deceased, Placed, and Community Residing Alzheimer Disease Patients

This study identifies predictors of placement or death in a large ethnically/racially diverse sample of moderately impaired Alzheimer disease patients residing in the community. Patients and caregivers were followed for 18 months with 4 assessments at 6-month intervals. Multinomial regression was used to identify caregiver and patient baseline characteristics and changes over time as predictors of patient placement in a long-term care facility (n=180), patient death (not preceded by placement, n=187), or remaining in the community at home (n=583). Our findings reveal important differences between death and placement when compared with continued home care. Both death and placement are significantly associated with increased activities of daily living limitations (Exp(B)=1.285, P=0.017; Exp(B)=0.1.202, P=0.038, for death and placement, compared with home care, respectively), having a nonspouse caregiver [Exp(B)=0.325, P=0.026; Exp(B)=0.386, P=0.050, for death and placement, respectively], and being a male patient [Exp(B)=0.367, P=0.003; Exp(B)=0.439, P=0.016, for death and placement, respectively]. Death and placement differ with respect to health service use, race, and group assignment. Whites are more likely to be placed rather than remain at home when compared with African American [Ex(B)=0.520, P=0.028] or Hispanic [Exp(B)=0.338, P<0.005] patients, whereas being assigned to the control condition as opposed to active treatment [Exp(B)=0.515, P=0.008], having a male caregiver [Exp(B)=0.482, P=0.043], and increasing patient health service use [Exp(B)=1.105, P=0.015] are associated with increased mortality. Placed and deceased patients are further differentiated from each other by the fact that caregivers of placed patients report an increase in being bothered by memory problems when compared with caregivers of deceased patients [Exp(B)=0.577, P=0.006]. Patients who are placed, died, or remain at home have unique trajectories, which vary as a function of the reference group used for comparison. Increasing bother with memory problems is uniquely associated with placement relative to death while increasing health service use in the form of physician contacts and nurses visits is uniquely associated with death among community residing Alzheimer disease patients.

Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis

To compare the ability of 3 database-derived comorbidity scores, the Charlson Score, Elixhauser method, and RxRisk-V, in predicting health service use among individuals with osteoarthritis (OA). The study population comprised 306 patients who were under care for OA in the Veterans Affairs (VA) health care system. Comorbidity scores were calculated using 1 year of data from VA inpatient and outpatient databases (Charlson Score, Elixhauser method), as well as pharmacy data (RxRisk-V). Model selection was used to identify the best comorbidity index for predicting 3 health service use variables: number of physician visits, number of prescriptions used, and hospitalization probability. Specifically, Akaike's Information Criterion (AIC) was used to determine the best model for each health service outcome variable. Model fit was also evaluated. All 3 comorbidity indices were significant predictors of each health service outcome (P < 0.01). However, based on AIC values, models using the RxRisk-V and Elixhauser indices as predictor variables were better than models using the Charlson Score. The model using the RxRisk-V index as a predictor was the best for the outcome of prescription medication use, and the model with the Elixhauser index was the best for the outcome of physician visits. The Rx-Risk-V and Elixhauser are suitable comorbidity measures for examining health services use among patients with OA. Both indices are derived from administrative databases and can efficiently capture comorbidity among large patient populations.

P01.22 Predictors of chronicity and health service use in patients presenting unexplained physical symptoms

P01.22 Predictors of chronicity and health service use in patients presenting unexplained physical symptoms

Social networks and mental health service utilisation--a literature review.

Social networks have been shown to be smaller in individuals with severe mental illness than in the general population. Patients' social networks and social support may impact on their utilisation of psychiatric services. This literature review focuses on social networks, social support and mental health service use in patients with mental illness. Most studies suggest that smaller social networks or less social support are associated with more frequent hospitalisation. Qualitative aspects of the social network are also related to the risk of hospitalisation. The relationship between social networks and other types of service use is not established.