Personal Health Care Practices Research Articles

Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States

The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.

Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden Among Elderly Medicare Beneficiaries.

To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95% confidence interval, 1.13-1.97) compared with those without ADRD. ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

Perceived Effects of Occupational Hazards on Farmers' Productivity in Kwara State, Nigeria.

This study investigated the perceived effects of occupational hazards on farmers' productivity in Kwara State, Nigeria. A total of 160 respondents were selected using a multi-stage random sampling technique. Descriptive statistical techniques such as frequency count, percentages as well as Pearson Product Moment correlation analysis for empirical analysis were used. The results show common agricultural production to include maize, yam and cassava. The results also revealed prevalent occupational hazards that include cut/injury from farm tools, malaria due to mosquito bite, and general body pain. The findings further revealed that injury from farm tools and general body pain had high effects on agricultural productivity. The Pearson Product Moment Correlation analysis showed no significant relationship (P≤0.05) between selected socio-economic characteristics with the perceived effects of occupational hazards on productivity. Based on the findings, the study concludes that occupational (farming) hazards, most especially general body pain, had negative effects on agricultural productivity. The study recommends that government and relevant agencies should encourage farmers by providing for them protective equipment at subsidized cost through extension agents who will train farmers on their use. Also, public health agents should educate farmers on personal health care practices in order to ensure good health status of farmers.

Informal health care practices of residents: "curbside" consultation and self-diagnosis and treatment.

The authors explore the experiences of residents with respect to informal care related to personal health, including "curbside consultation," self-diagnosis, and self-prescription-self-care practices that run counter to ethical guidelines in medicine. Residents at one medical school completed a written survey regarding their personal health care practices, including their experiences in seeking or providing informal consultation, self-diagnosis, and self-prescribing. The authors obtained frequency data and analyzed responses via cross-tabulation. They used logistic regression models to assess the association of reported informal care practices and potential confounders, such as age, gender, and training program. One hundred and fifty-five residents volunteered (71 % response rate). Most respondents had sought health care formally (70 %), and more had sought informal care in the previous 12 months (80 %). Of those who had pursued informal care, 90 % endorsed having requested a physical exam, a laboratory test, or a medication prescription from an attending, resident, or medical student. Respondents (28 %) commonly endorsed prescribing medication for themselves. Most respondents (90 %) reported being approached for informal care at least once in the previous year, including 84 % who were approached for prescriptions and 22 % who were approached by attending physicians. Main reasons endorsed for informal care seeking related to busy schedules and to cost and confidentiality advantages. Psychiatry residents reported using both formal and informal channels for personal health care, and 31 % acknowledged prescribing medications for themselves. Informal care was a common practice among the residents in this study. Residents reported time constraints as the greatest influence on informal care seeking, rather than reasons found in previous studies related to cost and quality of care, protection of confidentiality, or prevention of embarrassment. The effects of informal care practices involving resident physicians warrant additional study.

Doctors' personal health care choices: a cross-sectional survey in a mixed public/private setting.

BackgroundAmong Western countries, it has been found that physicians tend to manage their own illnesses and tend not have their own independent family physicians. This is recognized as a significant issue for both physicians and, by extension, the patients under their care, resulting in initiatives seeking to address this. Physicians' personal health care practices in Asia have yet to be documented.MethodsAn anonymous cross-sectional postal questionnaire survey was conducted in Hong Kong, China. All 9570 medical practitioners in Hong Kong registered with the Hong Kong Medical Council in 2003 were surveyed. Chi-square tests and logistic regression models were applied.ResultsThere were 4198 respondents to the survey; a response rate of 44%. Two-thirds of respondents took care of themselves when they were last ill, with 62% of these self-medicating with prescription medication. Physicians who were graduates of Hong Kong medical schools, those working in general practice and non-members of the Hong Kong College of Family Physicians were more likely to do so. Physician specialty was found to be the most influential reason in the choice of caregiver by those who had ever consulted another medical practitioner. Only 14% chose consultation with a FM/GP with younger physians and non-Hong Kong medical graduates having a higher likelihood of doing so. Seventy percent of all respondents believed that having their own personal physician was unnecessary.ConclusionSimilar to the practice of colleagues in other countries, a large proportion of Hong Kong physicians self-manage their illnesses, take self-obtained prescription drugs and believe they do not need a personal physician. Future strategies to benefit the medical care of Hong Kong physicians will have to take these practices and beliefs into consideration.

The Knowledge, Attitudes, Personal Health Care and Patient Care Practices of the University of Medicine and Dentistry of New Jersey Faculty Members Regarding Weight Management

To understand how knowledge, attitudes and personal health care practices affect health care professionals’ (HCPs’) patient care practices regarding weight management.

Crohn’s disease: does race matter?

OBJECTIVE: The severity of Crohn’s disease (CD) has been reported to be greater in blacks than in whites. This possible disparity may be due, in part, to differences between these groups in health care utilization and accessibility. To explore these issues, we conducted a multicenter survey of patients with CD. METHODS: One-hundred and forty-five blacks with CD, recruited from four teaching hospitals and five private practices, and identified by medical record review or ICD-9 code, were enrolled and matched to 407 whites with CD (by age, gender, and practice type [teaching vs private practice setting]). Participants were interviewed regarding medical history, health status, personal health care practices during the preceding 5 yr, and beliefs regarding health care in the general population. RESULTS: Blacks and whites were similar with respect to age of CD onset, lag in time to diagnosis, and number of gastrointestinal (GI)-related hospitalizations and surgeries. Medication usage patterns were also similar in the two groups. Quality of life, measured by SF-36, was lower in all categories for blacks, compared with whites. Blacks were more likely to have had to stop work ( p < 0.01) and have lost more work days ( p < 0.01) than were whites. Whites were more likely to have health insurance and be able to identify a regular provider than were blacks. Blacks were more likely to report the following: receiving Medicaid; difficulty affording health care; delaying appointments due to financial concerns; difficulty traveling to their provider’s office; and experiencing unreasonable delays at their provider’s office. After adjusting for potential confounding variables, we found no differences between the groups, except for the number of days of work lost because of CD. CONCLUSIONS: These data suggest that black and white patients have similar reported disease presentations and course, and contrast with prior reports suggesting a more severe disease course among black patients. Although the disease itself appears similar, there were numerous reported differences between the races in health care utilization practices and in disease impact upon daily activities. We suggest that apparent disparities in CD according to race are actually due to social and economic factors, and not to the disease itself.

Current Status of Personal Health Care Practices among Adult Women in Okinawa. Problems with Health Care in Japan and Necessity of Psycho-Social Action.

The helth promotion policy in Japan was based on 3 key health determinants: nutrition, exercise, and adequate rest. In this policy, health promotion concentrates on the physical aspects only. However, the WHO charter stresses the importance of social and mental determinants as well. In an attempt to determine awareness of people towards health determinants, we surveyed adult women using a simple questionnaire, asking "How do you take care of your health?" and "Please list your answers in your own words in order of recall ." In 1995, the questionnaire was given to 100 randomly selected adult women, aged 25-39, and 73 women responded, mentioning 3.7 items per person on average. In all 273 items that were mentioned, 46 independent or mutually nonoverlapped items were identified . Three key determinants occupied 74.0% of the total. This may indicate that these 3 were already adopted to all the people of Japan for their health care. All the responded items were classified into 8 health determinants: nutrition, exercise, adequate rest, psycho-social action, hygienic action, reqular daily activitiy, physiological demand, and health education. The frequency rate of the items in psycho-social action accounted for 14%, though they were not involved in official public health recommendations. The above results may help to stress the importance of public organizations to instigate a psycho-social health promotion policy to increase public awareness in Japan.

Chaparral-Associated Hepatotoxicity

Personal health care practices that may include the use of dietary supplements are common in the United States. Products marketed as dietary supplements are diverse and may include botanicals, vitamins, and/or minerals. Chaparral (Larrea tridentata) is a botanical dietary supplement made from a desert shrub and used for its antioxidant properties. Several reports of chaparral-associated hepatitis have been published since 1990, but a complete picture of the clinical presentation is still unclear. We reviewed the 18 case reports of adverse events associated with the ingestion of chaparral reported to the Food and Drug Administration between 1992 and 1994. These reports were from health care professionals, state health departments, and individual consumers. Of 18 reports of illnesses associated with the ingestion of chaparral, there was evidence of hepatotoxicity in 13 cases. Clinical presentation, characterized as jaundice with a marked increase in serum liver chemistry values, occurred 3 to 52 weeks after the ingestion of chaparral, and it resolved 1 to 17 weeks after most individuals stopped their intake of chaparral. The predominant pattern of liver injury was characterized as toxic or drug-induced cholestatic hepatitis; in 4 individuals, there was progression to cirrhosis; and in 2 individuals, there was acute fulminant liver failure that required liver transplants. These data indicate that the use of chaparral may be associated with acute to chronic irreversible liver damage with fulminant hepatic failure, and they underscore the potential for certain dietary supplement ingredients to cause toxic effects on the liver. Health professionals should be encouraged to inquire routinely about the use of dietary supplements and other products, to be alert to potential adverse effects that may be associated with these products, and, finally, to report any serious adverse events associated with these products through the MEDWatch Program of the Food and Drug Administration.

Putting chronic illness ‘in place’. Women immigrants' accounts of their health care

This paper discusses the ways in which first generation Canadian women of Vancouver's Chinese and South Asian communities manage their chronic illness. The study reported was concerned with the women's experiences of health care encounters in hospitals and clinics, and their subsequent incorporation or modification of biomedical knowledge as they managed the day-to-day consequences of their illness. The paper presents a critique of culturalist explanations of personal health care practices, through an ethnographic account of the women's institutional and occupational emplacement and their racialized experience of place. In the study women's accounts of their illness and its management indicated a search for the alleviation of symptoms that involved a plurality of illness management strategies. The women's health care practices were mediated by local social networks and a distribution of non-medical resources rooted in the process of ‘place’, in addition to specific barriers to the use of biomedical techniques. The study suggests that inquiry into problems of health care for minority population groups needs to go beyond a narrow focus on biomedical services, and analysis must be wary of attributing primacy to untheorized concepts of culture, ethnicity or ‘race’ in explanation.

Health-protective behaviors of rural black elderly women.

This article introduces the concept of health-protective behavior and examines the practices and attitudes that shape health care behaviors among rural black elderly women. Data for this study were collected from a sample of 407 black elderly women (ages 60 to 98) who resided in a rural community in North Carolina. Personal interviews collected information on personal health care practices, health self-perception, health beliefs.

Child Rearing Methods and Children's Health Behavior

A pattern of child rearing was found to be associated with better health care practices by children than a pattern of child rearing. The methods included substantial use of reasons and information, rewards, and granting of autonomy. Based on these findings and a review of previous research, the higher level of health practices of children reared by than of those reared by methods is interpreted as an expression of the differential effectiveness of these contrasting child rearing approaches in developing the child's resources and capacities for coping and taking care of himself. THIS paper examines the relationship between methods of child rearing used by parents and their children's personal health care practices. The child rearing methods to be examined are the tendency to grant autonomy or to control, the extent to which reasons and information are supplied, and the tendency to reward good behavior or to punish misbehavior. It was hypothesized that children whose parents encouraged autonomy and responsibility, supplied reasons and information, and rewarded good behavior to a greater extent than they punished misbehavior would have better health practices than children whose parents made little attempt to develop informed, independent performance by the child, and who emphasized punishment to enforce behavior standards. The first group of methods are consistent with a developmental approach to child rearing in that they focus on developing in the child the capacities needed to care for himself. The second group are labelled here disciplinary methods because they focus on obtaining unquestioning obedience to the parents' specifications. The distinction made here is rooted in that made by Duvall (1946) between the developmental approach to motherhood that