Utilization Patterns Research Articles

Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team

Background and Objectives: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. Materials and Methods: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020–31 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. Results: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. Conclusions: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments.

Trajectory Analysis of Healthcare Use Before and After Gastrointestinal Cancer Surgery.

Frailty correlates with worse post-operative outcomes and higher surgical costs, but the long-term impact on healthcare utilization remains ill-defined. We sought to evaluate patterns of healthcare utilization pre- and post-surgery among patients with gastrointestinal cancer and characterize the association with frailty. Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the 2005-2020 SEER-Medicare database. Frailty was assessed using the claims-based frailty index. Group-based trajectory modelling identified clusters of patients with discrete patterns of healthcare utilization. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty. Among 66,684 beneficiaries, four distinct utilization trajectories based on data from 12 months before and after surgery were identified. Following a surge in utilization during the month of surgery, most patients reverted to pre-surgery baseline utilization (low: n=6588, 9.9%; moderate: n=17,627, 26.4%; high: n=29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgery precipitated a transition from a "low" pre-surgery utilization state to a "high" utilization state post-surgery. Frail patients were more likely to be among those individuals who transitioned to high utilizers (low: 4.2% vs. vs. transition: 12.6% vs. high: 7.5%; p<0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: OR 4.90, 95%CI 4.49-5.35; p<0.001). Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare utilization after surgical resection. Preoperative predictive models may help differentiate different health care utilization trajectories to help tailor care for patients in the postoperative period.

Prescriber Phenotypes: Variability in Topical Rosacea Treatment Patterns among United States Dermatologists

Background/Objectives: Aggregate prescribing behavior for inflammatory lesions of rosacea has been described, but individual physician behavior has not been characterized. This study aims to assess the modern state of topical rosacea drug selection by analyzing prescribing patterns among individual dermatologists. Methods: We assessed utilization patterns of four topical papulopustular rosacea agents in 2021 Medicare Part-D data. K-means cluster analysis identified prescriber phenotypes based on the proportion of claims for each drug by physician. Results: Cluster analysis identified four prescriber phenotypes for topical rosacea agents, with the majority favoring metronidazole. In each of the other clusters, metronidazole was co-prescribed alongside the primary agent. Significant predictors of phenotype included patient ages, patient risk scores, and a group practice setting. Conclusions: The study reveals nonuniform prescribing patterns for topical papulopustular rosacea treatments among U.S. dermatologists. While aggregate data indicate diverse drug utilization, cluster analysis suggests that individual prescribers tend to use a limited selection of agents.

Non-used cryopreserved sperm among oncological patients: extra-long-term follow-up and analysis.

To investigate factors influencing long-term utilization and disposal patterns of cryopreserved semen straws in oncological patients. This retrospective study included all men who cryopreserved semen due to cancer between October 1993 and December 2021. To assess non-used cryopreserved sperm straws, we investigated the following parameters: cryopreserved semen and usage for fertility treatments versus disposal, summarized by total non-used cases. A Kaplan-Meier curve was used to describe last usage and disposal requests over a 15-year analysis. A Log-rank test was applied to compare between age and paternal status categories. The cohort consisted of 445 patients. Of these, 55 patients utilized thawed semen for fertility treatments, and 65 opted for disposals, leaving 325 patients who neither used nor disposed of their cryopreserved straws. Our findings revealed a distinct pattern based on age, with the youngest age group (< 25 years) exhibiting significantly lower utilization and disposal rates compared to older patient groups. Additionally, men without children exhibited significantly fewer disposal requests compared to fathers. The median cryopreserved straws were 10 (interquartile range, 6 to 17), while the median used straws were only 2 (interquartile range, 2 to 6). Our study brings attention to the additional and needless burden of preservation from both patient and preserved straw perspectives. Implementing a policy based on a cost-effective approach, incorporating time and straw limits, and considering demographic characteristics, could enhance efficiency and necessitate patient consent before preservation.

Insights into artificial waterhole utilization patterns by elephants and rhinos: Lessons from a South African Nature Reserve.

Artificial water provisioning is a common practice in southern African nature reserves, where different game species exhibit preferences for specific waterhole types. The movement patterns and behaviour of elephants and rhinos are closely linked to water availability, with these mega-herbivores noticeably influencing the environment and other species they interact with at waterholes. Since there is limited research on this topic, understanding preferences for different types of artificial waterholes is crucial, particularly during periods of water scarcity. This knowledge enables reserve managers to effectively manage the numbers and types of waterholes. In this study, we investigate artificial waterhole selection and preferences by elephants and rhinos in the Olifants West Nature Reserve, South Africa. The study area featured various waterhole types, including earth dams, concrete pans, reservoirs, and troughs. By employing camera traps, we analysed visitation frequency, timing of visits, and factors influencing visit frequency. Our findings revealed distinct preferences for specific waterhole types among different social groupings of the study species. Breeding herds of elephants predominantly utilized reservoirs and occasionally visited troughs, while bachelor herds favoured earth dams. Black rhinos showed a preference for earth dams, whereas white rhinos selected troughs and earth dams, with bachelor groups favouring troughs and female rhinos favouring earth dams. The outcomes of this study have significant implications for the development of comprehensive conservation plans in areas where these species reside, and for potential release sites.

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study

BackgroundRespiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease.MethodsThis retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV.ResultsOut of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 − 1,261) and full-term infants ($ 606; 95% CI: 583–630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk–shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics.ConclusionOur findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden.

Using Resource Utilization in Spine Healthcare to Complement Patient-Reported Outcome Measurements in Assessing Surgical Success

ObjectivePatient-reported outcome measures (PROMs) are utilized to assess surgical success but are limited by data collection, response bias, and subjectivity. The large volume of digital healthcare data offers a new method to utilize healthcare utilization as a longitudinal, individualized, and objective proxy for health needs among surgical patients. This study aimed to design and evaluate a novel resource utilization in spine healthcare (RUSH) clustering method that complements PROMs in evaluating post-operative patient outcomes. MethodsThis retrospective cross-sectional study conducted at a large, tertiary healthcare system included all adult patients undergoing cervical or lumbar surgery between 2014 to 2020 with at least 3 months follow-up. Post-operative healthcare utilization was analyzed using clinic visits, inpatient encounters, telephone encounters, MyChart messages, opioid use, physical therapy, injections, and imaging. Latent profile analysis determined RUSH clusters and changes in PROM Information System Physical Health (PROMIS-PH) scores pre- and 12-months post-operation. ResultsThis study included 5,602 surgeries (mean age 61.3 ± 13.1, 49.9% female). Four RUSH groups were identified: low utilizers (21.5%), moderate utilizers without advanced imaging (34.7%), moderate utilizers with advanced imaging (10.7%), and high utilizers (33.1%,). Utilization patterns varied by surgery type, with lower-utilization patterns among non-fusion procedures and a consistent sub-population of high utilizers across all surgery types. High RUSH utilizers had the lowest pre-operative PROMIS-PH scores and the worst average postoperative change. ConclusionsRUSH clustering provides a novel, data-driven approach to measure surgical success, complementing traditional PROMs, and leveraging big data to monitor and respond to surgical outcomes.

The Most Common Side Effects, Concerns and Discontinuation Patterns of Oral Contraceptive Pills Among Polish Women: A Cross-Sectional Study.

Over the decade, variety and effectiveness of contraception methods have greatly improved, resulting in increased popularity of oral contraceptive pills (OCPs). However, hormonal contraception carries the risk of multiple side effects. The lack of sufficient knowledge often leads to the development of health concerns, which can affect patient's adherence. The aim of our research was to describe a side effect profile of OCPs and assess the most frequent concerns and discontinuation reasons in Polish women. The survey included questions regarding OCPs utilization patterns, side effects, health concerns and attitudes of the responders. This cross-sectional study was based on a survey, which was distributed online and open from 29 April to 15 May 2022. The survey included questions regarding OCPs utilization patterns, side effects, health concerns and attitudes of the responders. Out of 1699 respondents, the current OCPs intake was reported by two thirds of women and 22% had a history of using them in the past. Seventy-nine percent of all OCPs users experienced adverse effects while 9% reported having concerns about safety and potential adverse effects. Decreased libido and weight gain were the most significant reasons for ceasing hormonal contraception. Moreover, the most common concerns and the most unfavorable side effects varied in different age groups. The occurrence of anxiety depended on age and education. Healthcare professionals prescribing OCPs should provide their patients with comprehensive counseling. Understanding and addressing concerns of young women can improve their compliance and reduce the number of unintended pregnancies.

Anaerobe-targeted antibiotic therapy in the neonatal intensive care unit.

Anaerobe-targeted antibiotic (ATA) therapy may adversely impact the developing neonatal microbiome. We describe utilization patterns, potential indications, and related outcomes of ATA therapy in neonatal intensive care units across the US over 13 years. While overall antibiotic use decreased, ATA use was unchanged. Potentially associated indications were inconsistent.

Disparities in infectious disease-related health care utilization between Medicaid-enrolled American Indians and non-Hispanic Whites-Lessons from the first 16 months of coronavirus disease 2019 and a decade of flu seasons.

To understand why American Indian and Alaskan Native (AIAN) populations have had exceptionally high COVID-19 mortality, we compare patterns of healthcare utilization and outcomes for two serious infectious respiratory diseases-Influenza-like-illness (ILI) and coronavirus disease 2019 (COVID-19)-between American Indian and Alaskan Native (AIAN) populations (as identified in Medicaid data) and non-Hispanic Whites over the 2009-2021 period. We select all people under the age of 65 years identified as non-Hispanic White or AIAN in the New York State Medicaid claims data between 2009 and 2021. We analyze data across 10 ILI cohorts (between September 2009 and August 2020) and 4 COVID-19 cohorts (March-June 2020, July-September 2020, October-December 2020, and January-June 2021). We examine mortality and utilization rates using logistic regressions, adjusting for demographic characteristics, prior chronic conditions, and geographic location (including residence near a reservation). We stratify the analysis by rural vs. nonrural counties. We use the New York State Medicaid claims data for the analysis. We find that even among Medicaid beneficiaries, who are similar in socioeconomic status and identical in health insurance coverage, AIAN populations have much lower rates of use of outpatient services and much higher rates of acute (inpatient and emergency room) service utilization for both ILI and COVID-19 than non-Hispanic Whites. Prior to COVID-19, demographic and health status-adjusted all-cause mortality rates, including from ILI, were lower among American Indians than among non-Hispanic Whites on New York State Medicaid, but this pattern reversed during the COVID-19 pandemic. Both findings are driven by nonrural counties. We did not observe significant differences in all-cause mortality and acute service utilization comparing AIAN to non-Hispanic Whites in rural areas. The utilization and mortality disparities we identify within the Medicaid population highlight the need to move beyond insurance in addressing poor health outcomes in the American Indian population.

Differential fatty acids utilization across life stages in a Vespa species.

Dietary fatty acids (FAs) are essential macronutrients affecting animal fitness, growth, and development. While the degree of saturation of FAs usually determines the level of absorption and allocation within the body, the utilization of dietary FAs across the life stages of individuals remains unknown. We used three different 13C labeled FAs, with a different saturation level (linoleic acid (18:2), oleic acid (18:1), and palmitic acid (16:0)), to investigate the absorption and allocation of dietary FAs across the life stages of the Oriental hornet. Our results show that only larvae utilized all tested FAs as metabolic fuel, with palmitic acid being oxidized at the highest rate. Oleic and palmitic acids were predominantly incorporated into larval tissues, while oleic acid dominated pupal tissues. In contrast, linoleic and oleic acids were predominantly incorporated into adult tissues. These findings highlight a life stage-dependent shift in certain FAs utilization, with palmitic acid mostly utilized in early stages and linoleic acid in adulthood, while oleic acid remained consistently utilized across all life stages. This study emphasizes the importance of considering FA saturation and life stage dynamics in understanding FA utilization patterns.

Computed tomography referral guidelines adherence in Europe: insights from a seven-country audit.

Ensuring appropriate computed tomography (CT) utilization optimizes patient care while minimizing radiation exposure. Decision support tools show promise for standardizing appropriateness. In the current study, we aimed to assess CT appropriateness rates using the European Society of Radiology (ESR) iGuide criteria across seven European countries. Additional objectives were to identify factors associated with appropriateness variability and examine recommended alternative exams. As part of the European Commission-funded EU-JUST-CT project, 6734 anonymized CT referrals were audited across 125 centers in Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia. In each country, two blinded radiologists independently scored each exam's appropriateness using the ESR iGuide and noted any recommended alternatives based on presented indications. Arbitration was used in case auditors disagreed. Associations between appropriateness rate and institution type, patient's age and sex, inpatient/outpatient patient status, anatomical area, and referring physician's specialty were statistically examined within each country. The average appropriateness rate was 75%, ranging from 58% in Greece to 86% in Denmark. Higher rates were associated with public hospitals, inpatient settings, and referrals from specialists. Variability in appropriateness existed by country and anatomical area, patient age, and gender. Common alternative exam recommendations included magnetic resonance imaging, X-ray, and ultrasound. This multi-country evaluation found that even when using a standardized imaging guideline, significant variations in CT appropriateness persist, ranging from 58% to 86% across the participating countries. The study provided valuable insights into real-world utilization patterns and identified opportunities to optimize practices and reduce clinical and demographic disparities in CT use. Question Largest multinational study (7 EU countries, 6734 CT referrals) assessed real-world CT appropriateness using ESR iGuide, enabling cross-system comparisons. Findings Significant variability in appropriateness rates across institution type, patient status, age, gender, exam area, and physician specialty, highlighted the opportunities to optimize practices based on local factors. Clinical relevance International collaboration on imaging guidelines and decision support can maximize CT benefits while optimizing radiation exposure; ongoing research is crucial for refining evidence-based guidelines globally.

Pilot Study to Evaluate Patients’ Understanding of Key Terms and Aspects of Antimicrobial Use in a Rural Province in South Africa Findings and Implications

Abstract Introduction: Antimicrobial resistance (AMR) is a global concern, necessitating the understanding of utilisation patterns and their rationale. Pilot studies have been conducted in a rural province in South Africa to determine the extent of self-purchasing of antibiotics by patients from independent and chain pharmacies. It is imperative to understand the extent of knowledge and concerns of patients regarding the key aspects of antibiotic use and AMR, and potential language barriers, when pharmacists and their assistants are discussing the key aspects with patients. Consequently, the aim was to pre-test a patient questionnaire translated in three native languages building on the findings from the English language pilot. Materials and Methods: The English patient questionnaire (Parts 1 and 2) was translated to Sepedi, Tshivenda and Xitsonga. In total 30 patients were interviewed (5/language for Part 1 and Part 2 respectively) when leaving 10 chain and independent pharmacies. This was followed by interviews with patients to evaluate their understanding of questions and key concepts. Results: Eleven of 15 patients interviewed for Part 1 received antibiotics, including 8 without a prescription. Only independent pharmacies (8/10) dispensed antibiotics without prescriptions. Interviews revealed concerns about antibiotic knowledge and AMR and that certain terms including ‘antibiotic’ and ‘AMR’ posed challenges with patient understanding of the purpose of antibiotics. For instance, one patient self-purchased antibiotics for ‘cleansing’ of sexually transmitted infections. The questionnaires in the native languages were subsequently revised so that explanations for terms, including ‘antibiotic’ and ‘AMR’ will be provided in the main study. Conclusion: Similar to the previous pilot studies, self-purchasing of antibiotics was observed among independent pharmacies, although at varying rates, with similar indications. Continued health literacy education for pharmacists and patients, especially with native language communication, are needed to address current challenges and will be explored in the main study.

Respiratory phenotype and health care utilization patterns by adults with sickle cell disease

AbstractAdults with sickle cell disease (SCD) and asthma have increased mortality and health care utilization; however, there are individuals with respiratory symptoms (including cough and wheeze) without asthma. These individuals may have similar patterns of increased mortality and health care utilization. To characterize the association between respiratory phenotype and health care utilization by adults with SCD. Cross-sectional study of adults with SCD presenting for emergency and inpatient hospital care from 2012 to 2014 in Florida, Iowa, and New York using state-level health care utilization databases. Outcomes of interest include all-cause, SCD-related, painful episode, and acute chest syndrome–related care. Respiratory phenotype was defined as SCD + asthma, SCD + respiratory symptoms, and SCD + none. We built multivariable logistic regression and negative binomial regression models to evaluate the association adjusting for demographics, social determinant of health proxies, year of care, and state. Of 29 952 identified individuals, 3.4% had intermittent respiratory symptoms, and a larger proportion (15.6%) had asthma. There was a high rate of inpatient hospitalizations (43%) and ED visits (60%). Individuals with asthma had a higher annual risk of inpatient hospitalizations (48% vs 37%) but lower annual risk of an ED visit (62% vs 86%) than individuals with intermittent respiratory symptoms. The pattern of increased health care utilization among individuals with intermittent respiratory symptoms was consistent across each utilization type. In this large cohort of adults with SCD, we identified some with intermittent respiratory symptoms who had significantly increased health care utilization. This warrants further evaluation to understand potential etiologies and interventions.

Medical misinformation in social media: Representations of gastrointestinal disorders on a short video platform

Background and Objectives: Short video platforms have become one of the most common methods for disseminating medical information on social media. We analysed gastrointestinal (GI)-related content on TikTok, focusing on the creators’ background, patterns of content utilisation and overall content quality and understandability, using validated metrics to quantify the degree of misinformation. Methods: Twelve hashtags related to common GI conditions on TikTok and the 20 most engaging posts associated with each hashtag were selected for review. The ‘most engaging’ status was determined by the application’s internal algorithm. Six GI board-certified physicians evaluated the videos using two validated instruments: DISCERN quality criteria and Patient Education Materials Assessment Tool (PEMAT-A/V) survey. Results: In total, 253 videos were reviewed with 18.6 billion likes, 191,000 comments, 935,000 saves and 927,000 shares. IBS hashtag had the greatest number of views (2.2 billion), while videos on haemorrhoids had the most likes (4.3 million), comments (59,000) and shares (288,000). Most videos 177/253 (70%) were created by non-healthcare workers. The median video quality was 2/5 on DISCERN Likert-type scale with 23/75 DISCERN score. Of 186 videos, 114 (61.3%) were rated ‘very poor’; 58/186 (31.2%) ‘poor’, 13/186 (7%) ‘fair’ and only one video (0.5%) was rated ‘excellent’ on DISCERN grading system. The median PEMAT-A/V scores were 7/12 (73.9%) for understandability and 1/3 (33.3%) for actionability. Conclusion: Our study highlights significant public interest in common GI disorders. However, most posts lacked substantive information and did not have verifiable sources.

Socioeconomic and demographic factors predictive of same day access utilization in outpatient radiation oncology.

Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization. From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization. On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR]=3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR]=4.05, 95% CI: 1.72-9.11). While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious. Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed. Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable. Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.

Association between lifetime criminal legal involvement and acute healthcare utilization in middle-aged and older US adults, 2015-2019.

Five decades into the era of mass incarceration, a growing number of older adults have experienced criminal legal involvement (CLI) in their lifetime. Studies have shown that prior incarceration is associated with substantial disease burden, but little is known about the distinct needs and utilization patterns of middle-aged and older adults with lifetime CLI compared to those without. Using a nationally representative data set, we tested the association between lifetime CLI exposure and use of acute care services among middle-aged and older adults. Our sample included 44,007 US adults (25,074 middle-aged-50-64 years; 18,709 older- ≥65 years) who participated in the National Survey of Drug Use and Health (2015-2019). The data is publicly available. Our independent variable was lifetime CLI. Using separate negative binomial regression models for middle-aged and older adults, we tested the association between lifetime CLI and acute healthcare utilization (ED visits and nights spent inpatient) controlling for relevant sociodemographic covariates. For middle-aged respondents, 19.1% reported lifetime CLI; for older adults, the rate of exposure was 9.6%. In multivariate models, CLI was associated with increased ED visits in middle-aged adults (IRR 1.18, 95% CI 1.06-1.31) but not older adults (IRR 0.99, 95% CI 0.85-1.16). CLI was associated with increased nights hospitalized in both groups (middle-aged: IRR 1.33, 95% CI 1.08-1.62; older adults: IRR 1.26, 95% CI 1.01, 1.57). Middle-aged and older adults with lifetime CLI experience higher rates of acute care utilization than their peers with no lifetime CLI, even after adjustment for confounders. As the cohort of adults from the era of mass incarceration ages, understanding the mechanisms by which lifetime CLI impacts health outcomes is crucial in designing interventions to improve outcomes and reduce unnecessary acute healthcare utilization.

Evaluation of rimegepant utilization patterns and patient characteristics among new users: a United States administrative claims-based study

Objective To assess tablet utilization patterns and describe pre-treatment characteristics among new users of rimegepant. Background Rimegepant is the only oral calcitonin gene-related peptide antagonist approved in the United States for both the acute and preventive treatment of migraine. Methods We conducted a retrospective cohort study of people with migraine who initiated treatment with rimegepant using two US commercial claims databases (MarketScan and Optum). Patients (≥18 years old) with migraine who newly initiated rimegepant were included. Patients were stratified into two groups representing acute (quantity = 8) and prevention (quantity = 15 or 16) use cohorts. Baseline characteristics and medication use history were assessed on index and during the 365-day pre-index period. Rimegepant utilization periods were calculated based on days supplied and varying approaches to define use periods. Tablet quantity per 30 days was reported separately for both acute and prevention cohorts. Results In MarketScan, a total of 14,037 rimegepant users were identified; 11,195 (79.8%) in the acute group and 1,880 (13.4%) in the prevention group. Rimegepant utilization for acute use was 4.9 ± 2.1 tablets per 30 days and for preventive use was 13.1 ± 7.7 tablets per 30 days. There was high baseline prevalence of triptan contraindications, warnings, and high cardiovascular risk, with a combined 46.2% meeting one or more of these criteria. Acute medication overuse was also common (25.1%) prior to rimegepant initiation. Results were consistent in the Optum database. Conclusion Our analysis provides the first real-world data available on tablet utilization and characteristics of new users of rimegepant.

Patterns of healthcare utilization according to health equity determinants during the first year of the pandemic at Johns Hopkins Medicine.

Rapid telehealth adoption happened at the onset of the coronavirus disease 2019 (COVID-19) pandemic, resulting in a move from in-person predominant to telehealth predominant care delivery. Later, in person visits rebounded with telehealth options remaining. This study aimed to assess differences in healthcare utilization during this changing landscape in terms of health equity determinants. This was an observational cohort study of Johns Hopkins Medicine (JHM) patients. We analyzed utilization of video, telephone, and in-person patient-provider visits by eligible patients between March 16, 2019 and December 31, 2020. Percent changes in average weekly patient-provider visits from pre-pandemic (March 16, 2019-June 30, 2019) to early 2020 pandemic (March 16, 2020-June 30, 2020) and from pre-pandemic (July 1, 2019-December 31, 2019) to late 2020 pandemic (July 1, 2020-December 31, 2020). We used a quantile cut off technique to describe disproportionately smaller or greater drops in visits during the first year of the pandemic among health equity determinant groups and according to visit specialty, when compared to the total population. There was a 39% drop in patient-provider visits from the pre-pandemic to the early 2020 pandemic period, and a 24% drop from pre-pandemic to the late 2020 pandemic period. We discovered 21 groups according to health equity determinates and visit departments with patterns of disproportionately smaller or greater drops in visits during the first year of the pandemic, when compared to the total population: Pattern 1 -smaller drop in visits early and late 2020 (age 45-64, Medicare insurance, high poverty and high unemployment; mental health and medical specialty visits -P < .001); Pattern 2 -greater drop in visits early 2020 only (age 65-84; OB/GYN and surgical specialty visits-P < .001); Pattern 3 -greater drop in visits early and late 2020 (age 0-5, age 6-17, age 85+, Asian race, Hispanic or Latino ethnicity, private insurance-P < .001); and Pattern 4-smaller drop in visits in early 2020 when compared to late 2020. The age 18-44 group showed a smaller drop in visits early 2020 and then visit levels similar to the total population late 2020. Primary care visits were similar to the total population early 2020 and then a smaller drop in visits late 2020 (P < .001). Our study provides evidence of health equity determinant groups having disproportionally smaller or greater drops in visits during the first year of the pandemic. The observed differences may have been influenced by changing telehealth offerings during the first year of the pandemic. Groups with disproportionately smaller drops in visits early 2020 (Pattern #1 and age 18-44 group in Pattern #4), suggests more success with adopting telehealth among those groups. Whereas groups with disproportionately greater drops in visits early 2020 (Pattern #2 and Pattern #3), suggests less success with telehealth adoption. For Pattern #4, more clarification is needed on how changes in telehealth offerings contributed to the downward trend in visits observed from early to late 2020. We describe 4 main patterns to characterize groups with disproportionately smaller or greater drops in visits during the first year of the pandemic. While this work did not specifically study vulnerable populations, these patterns set the stage for further studies of such groups.