Preventive Health Care Utilization Research Articles

The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials.

BackgroundAdverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events.ObjectiveTo update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only.MethodsSix major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model.ResultsFrom 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable.ConclusionPharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization.

PURPOSE:To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization.DESIGN:A cross-sectional study.SUBJECTS AND SETTING:A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively.METHODS:The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates.RESULTS:Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being readmitted and visiting the ER due to ostomy complications after the first month of hospital discharge and up to 18 months postdischarge (odds ratio [OR] = 0.45; 95% confidence interval [CI], 0.27-0.73; and OR = 0.37; 95% CI, 0.22-0.64, respectively).CONCLUSIONS:Findings suggest that enrolling patients in the postdischarge ostomy support program provides an effective approach to reducing preventable healthcare utilization.

Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: A single center study

Study objectiveThe use of neuromuscular blockade agents (NMBA), had been associated with significant residual post-operative paralysis and morbidity. There is a lack of clinical evidence on incidence of postoperative complications within the post-anesthesia care unit (PACU) in patients exposed to intraoperative NMBA's. This study aims to estimate the incidence of post-operative complications associated with use of NMBAs and assessing its association with healthcare resource utilization. DesignRetrospective cohort. SettingPost-anesthesia care unit in tertiary care center. PatientsAdults having non-cardiac surgery and receiving NMBAs between April-2005 and December-2013 MeasurementsWe assessed: 1) incidences of major and minor PACU complications, 2) incidence of any postoperative complication in patients receiving a NMBA reversal (neostigmine) vs. without. 3) We secondarily assessed the relationship between PACU complications and use of healthcare resources. Main resultsThe incidence of any major complications was 2.1% and that of any minor complication was 35.2%. ICU admission rate was 1.3% in patients without any complications, versus 5.2% in patients with any minor and 30.6% in patients with any major complication. ICU length of stay was prolonged in patients with any major (52.1±203h), compared to patients with any minor (6.2±64h) and with no complications (1.7±28h). Patients who received a NMBA and neostigmine, compared to without neostigmine, had a lower incidence of any major complication (1.7% vs. 6.05%), rate of re-intubation (0.8% vs. 4.6%) and unplanned ICU admission (0.8% vs. 3.2%). ConclusionsThis study documents that incidence of major PACU complications after non-cardiac surgery was 2.1%, with the most frequent complications being re-intubation and ICU admission. Patients receiving NMBA reversal were at a lower risk of re-intubation and unplanned ICU admission, justifying routine use of reversals. Complete NMBA reversals are crucial in reducing preventable patient harm and healthcare utilization.

Preventive dental care among Medicaid-enrolled senior adults: from community to nursing facility residence.

The primary objective of this study was to determine whether the utilization rate of preventive oral health care services while senior adults were community-dwelling differed from the rate after those same senior adults were admitted to nursing facilities. A secondary objective was to evaluate other significant predictors of receipt of preventive oral health procedures after nursing facility entry. Iowa Medicaid claims from 2007-2014 were accessed for adults who were 68+ years upon entry to a nursing facility and continuously enrolled in Medicaid for at least three years before and at least two years after admission (n = 874). Univariate, bivariate and multivariable analyses were conducted. During the five years that subjects were followed, 52.8% never received a dental exam and 75.9% never received a dental hygiene procedure. More Medicaid-enrolled senior adults received ≥1 preventive dental procedure in the two years while residing in a nursing facility compared to the three years before entry. In multivariable analyses, the strongest predictor of preventive oral health care utilization after entry was the receipt of preventive oral health services before entry (p < 0.01). The strongest predictor of receipt of dental procedures in the two years after nursing facility entry was the receipt of dental procedures in the three years before entry while community-dwelling. This underscores the importance of the senior adult establishing a source of dental care while community-dwelling.

CAREGIVER SUPPORT AFTER HOSPITAL DISCHARGE: THE DUKE ELDER FAMILY CAREGIVER TRAINING (DEFT) PROGRAM

The decline in functional reserves and comorbidities complicate the recovery of older adults following a hospital discharge. Consequently, the assistance of family and friends (caregivers) while convalescing at home is particularly needed. The Duke Elder Family Caregiver Training (DEFT) Center offers a model for an academic-medical-community partnership for integrated caregiver support after hospital discharge. Under the leadership of the Duke School of Nursing, caregivers referred by Duke Hospital providers receive education and training in home care from Duke learners in Nursing, Medicine, Physical Therapy programs. Video technology is used for real-time observation of skills and communication at home. The DEFT collaborates with community-based agencies for resources and activation of lay volunteers for instrumental support. The DEFT aims to increase caregiver preparation for home care reduce preventable health care utilization among patients, and increase competence among learners in interprofessional care and care transitions. Preliminary data will be discussed in the presentation.

Sociodemographic and access-related correlates of health-care utilization among African American injection drug users: The BESURE study

ABSTRACTPersons who inject drugs (PWID) may have less access to, and utilization of, health-care services, and African American PWID may be less likely than other racial groups to utilize health care in the United States. The present study evaluated the prevalence of health-care utilization (HCU) among a cohort of African American PWID in Baltimore. Data were from the 2012 Baltimore National HIV Behavioral Surveillance study. Participants were adult PWID and recruited using respondent-driven sampling (RDS). They completed a comprehensive sociobehavioral survey and voluntary HIV test with trained study interviewers. Analyses included descriptive and bivariate statistics to examine the prevalence of HCU, defined as seeing a health-care provider in the past year. Poisson regression assessed correlates of HCU. Participants were 61% male; 23% self-reported HIV seropositivity. Nearly 90% reported unemployment and/or disability; HCU prevalence was 85%. Significant negative correlates of HCU included age and higher injection frequency; positive correlates included previous incarceration and moderate financial stability. Interaction analyses showed unemployed publicly insured individuals had 30% higher HCU than unemployed and uninsured individuals (χ2 = 2.52; p < .05). There is a need to improve health-care utilization among PWID. High prevalence of disability was still found, despite insurance coverage and access to care in this population. While the recent Affordable Care Act has increased health-care coverage and access, our results suggest that is only a first step to improving health outcomes among PWID; targeted intervention to integrate these individuals is still needed.

Parent and Adolescent Views on Barriers to Adolescent Preventive Health Care Utilization

To determine adolescent and parent views of barriers to annual adolescent preventive care. A nationally recruited cross-sectional study of adolescents between ages 13 and 18 years, and parents of adolescents from different families, were recruited. The primary outcome was self-report of preventive care in the last 12 months. Demographic, family health discussions, physical/emotional health importance, and preventive care barriers were gathered from adolescents and parents. The majority of the sample (500 adolescents and 504 parents in different families) reported a primary care visit within 12 months (parents = 78.7%; adolescents = 66.9%). Adolescent participants identified more barriers than parents (parents = 0.69; adolescents = 1.42). Adolescent who reported having discussions with parents about health (aOR 1.57, 95% CI 1.26-1.98) and seeing a subspecialist provider (aOR 3.72, CI 1.21-11.47) were more likely to report preventive visits. Barriers for parents and adolescents include the belief that an appointment is only needed when a child is sick (parent aOR 0.21, CI 0.08-0.61; adolescent aOR 0.29, CI 0.17-0.51) and family cannot afford cost (parent aOR 0.34, CI 0.15-0.81; adolescent aOR 0.50, CI 0.26-0.97). Barriers for parents include the child sees a specialist (aOR 0.26, CI 0.08-0.88) and their child does not need a checkup (aOR 0.12, CI 0.05-0.34). Lastly, a barrier for adolescents was parents never schedule preventive visits (aOR 0.31, CI 0.17-0.58). The Affordable Care Act has the potential to limit preventive care barriers. The results of the current study find there are parental and adolescent issues regarding preventive services that should be addressed.

Utilization of Preventive Health Care in Adults and Children With Eczema.

Chronic disease is a barrier to delivery of preventive health care and health maintenance. However, health behaviors of adults and children with eczema, a chronic skin disorder, have not been examined. This study examined associations of eczema with vaccination, disease screening, health maintenance, and healthcare utilization. This study investigated 34,613 adults and 13,298 children from the 2012 National Health Interview Survey, a prospective questionnaire-based study. Data were analyzed between August 2014 and January 2015. Adult eczema was associated with higher odds of vaccination for tetanus (OR [95% CI]=1.37 [1.22, 1.54]); influenza (1.23 [1.10, 1.37]); hepatitis A (1.21 [1.04, 1.41]) and B (1.21 [1.07, 1.35]); human papilloma virus (1.66 [1.32, 2.08]); and pneumonia (1.35 [1.19, 1.54]), but not herpes zoster virus (1.07 [0.87, 1.31]). Adult eczema was associated with increased measurement of blood glucose (1.29 [1.16, 1.44]); cholesterol (1.19 [1.06, 1.34]); blood pressure (1.84 [1.56, 2.08]); and HIV infection (1.50 [1.34, 1.70]), but not Pap smears (1.11 [0.95, 1.30]); colon cancer screening (p=0.17); or mammograms (p=0.63). Adults with eczema were more likely to interact with general doctors, mid-level providers, mental health professionals, eye doctors, podiatrists, chiropractors, therapists, obstetrician/gynecologists, and other specialists (p≤0.01). Childhood eczema was associated with higher rates of vaccination for influenza (p<0.0002); well child checkups (p=0.002); and interaction with most types of healthcare providers (p≤0.01). Many associations remained significant in multivariate models controlling for sociodemographics and healthcare interaction frequency. Eczema in adults and children is associated with greater utilization of preventive health care and health maintenance, but not cancer screening.

A Multilevel Logit Estimation on the Determinants of Utilization of Preventive Health Care and Healthy Lifestyle Practice in China.

The purpose of this study is to provide policy implications by estimating the individual and community level determinants of preventive health-care utilization in China based upon data from the China Health and Nutrition Survey. Two different frameworks, a human capital model and a psychological-behavioral model, are tested using a multilevel logit estimation. The results demonstrate different patterns for medical and nonmedical preventive activities. There is a strong correlation between having medical insurance and utilizing preventive health services. For the usage of medical-related preventive health care (MP), age, gender, education, urban residence, and medical insurance are strong predictors. High income did not provide much of an increase in the usage level of MP, but the lack of income was a huge obstacle for low-income people to overcome. Community variation in number of facilities accounted for about one third of the total variation in the utilization of MP. The utilization of MP in China remains dependent upon the individual's social-economic conditions.

Breast and Cervical Cancer Related Practices of Female Doctors and Nurses Working at a University Hospital in Turkey.

Breast and cervical cancers are among the most frequent and most fatal cancers in women. Life span of patients may be increased and quality of life improved through early diagnosis and treatment. This investigation was performed in order to determine knowledge and practices of female health personnel working at a university hospital regarding breast and cervical cancers. This descriptive investigation was performed in Erciyes University Hospitals in 2014. A total of 524 female health personnel were included in the study. Data were collected through a questionnaire of 36 questions prepared by the researchers. The Chi square test and logistic regression were used for statistical analyses. The mean age of the study group was 32.8±6.9 years, 18.3% being doctors and 81.7% nurses. Of the study group, 60.5% stated that they performed self breast-examination, 4.4% underwent HPV testing, 26.3% thought about taking an HPV test, 34.7% of those who are 40 years and over had mammography regularly and 19.5% of those who were married had a Pap smear conducted regularly. Most important causes of not performing the methods for early diagnosis of breast and cervical cancers are "forget and neglect". It was concluded that female doctors and nurses do not pay sufficient attention to screening programs for breast and cervical cancers. The importance of early diagnosis and treatment should be emphasized during the undergraduate education and in-service training programs. Health condition of personnel and their utilization of preventive health care should be followed by occupational physicians.

Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial.

Changes in health care delivery create opportunities to improve systems to better meet the needs of low-income families while achieving quality benchmarks. Families of healthy newborns receiving primary care at a single large urban safety-net hospital participated. Intervention families were randomly assigned a family specialist who provided support until the 6-month routine health care visit. The Developmental Understanding and Legal Collaboration for Everyone (DULCE) intervention is based on the Strengthening Families approach and incorporated components of the Healthy Steps and Medical-Legal Partnership models. Medical record reviews determined use of preventive and emergency care. Surveys conducted at baseline, postintervention (6 months), and follow-up (12 months) were used to determine hardship and attainment of concrete supports. Three hundred thirty families participated in the study. At baseline, 73% of families reported economic hardships. Intervention parents had an average of 14 contacts with the family specialist, and 5 hours of total contact time. Intervention infants were more likely to have completed their 6-month immunization schedule by age 7 months (77% vs 63%, P < .005) and by 8 months (88% vs 77%, P < .01). Intervention infants were more likely to have 5 or more routine preventive care visits by age 1 year (78% vs 67%, P < .01) and were less likely to have visited the emergency department by age 6 months (37% vs 49.7%, P < .03). The DULCE intervention accelerated access to concrete resources (P = .029). Assignment to the Project DULCE intervention led to improvements in preventive health care delivery and utilization and accelerated access to concrete supports among low-income families.

Factors associated with free adult preventive health care utilization among physically disabled people in Taiwan: nationwide population-based study.

BackgroundFew previous studies have specifically addressed the health care utilization situation of the physically disabled. This study aimed to investigate the utilization of free adult preventive health care for physically disabled people and its’ affecting factors.MethodsThe data was obtained from three nationwide databases from 2006 to 2008. This study comprised 329,264 physically disabled people in Taiwan above the age of 40 who had eligible health checks during 2008. We employed descriptive statistics to analyze the use and rate of free preventive health care use by physically disabled adults. Logistic regression analysis was used to explore the factors that affect physically disabled adults’ use of free adult preventive health care.Results16.37% of the physically disabled adults used free adult preventive health care. Women (17.66%), married (17.16%), a junior high education level (17.89%), and mildly disabled adults (18.77%) had the highest use rate among various participant subgroups. The variables that significantly influenced the use of free adult preventive health care by the physically disabled included gender, age, education, marital status, urbanization of the residence areas, monthly payroll, aboriginal status, catastrophic illnesses status, relevant chronic diseases, and severity of disability.ConclusionsPhysically disabled using preventive health care tend to be low. Governments should use the media to reinforce propagation and education of these services to specific, low-utilization groups, and encourage doctors to actively provide preventive health care to communities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0610-5) contains supplementary material, which is available to authorized users.

Abstract P315: Association of Marital Status with Health Care Use among Hispanic/Latino Adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background: Sociocultural factors have been linked to health care seeking among Latino adults. A supportive social context may encourage proactive steps leading to health maintenance, including healthcare seeking. Objective: To explore the cross-sectional association of marital status with annual health care provider visits among Hispanic/Latino adults ages 18-74 with and without chronic diseases. Methods: Participants from HCHS/SOL Sociocultural Ancillary Study with measures of social support, marital status, and health care use were included in the analysis (n=3,401). Marital status was self-reported. Health care use was defined as whether the participant saw a health care provider in the past twelve months. Weighted multiple logistic regression models were used to examine the associations of marital status with healthcare use, after adjusting for covariates. Results: On average, participants were 40 years old , 83% were currently married, and 73% had at least one health care provider visit in the past twelve months. Analyses were stratified by gender and the findings were null in men, therefore only the findings in women are reported. Among Hispanic/ Latino women with chronic diseases, individuals who were married were more likely to have an annual health care provider visit than those who had never married. However, this association no longer remained significant after adjustment. Among Latino women without chronic diseases, individuals who were married were less likely to have an annual health care provider visit than those who were never married. Conclusion: Marital status is associated with health care use among Hispanic/Latino women without chronic diseases. Future research should assess whether marianismo, a culture specific gender role characterized by self-sacrifice and prioritization of familial needs, influences marital status’ association with preventive health care utilization among Latino women.

A Longitudinal Model of the Dynamics between Hmos’ Consumer-Friendliness and Preventive Health Care Utilization

This study aims at replicating and extending Xiao and Savage's (2008) research to understand the multidimensional aspect of HMOs distinguished by HMOs’ consumer-friendliness, and their relationship to consumers’ preventive care utilization. This study develops a dynamic model to consider both concurrent and time lagging effects of HMOs’ consumer-friendliness. Our data analysis discloses similar relationship patterns as revealed by Xiao and Savage. Additionally, our findings reveal the time-series changes of the influence of HMOs’ consumer-friendliness that either the effects of early experienced HMOs’ consumer-friendliness wear out totally or HMOs’ consumer-friendly characteristics on the concurrent term contain most of the explanatory power.

Impact of Arizona’s SB 1070 Immigration Law on Utilization of Health Care and Public Assistance Among Mexican-Origin Adolescent Mothers and Their Mother Figures

We examined the impact of Arizona's "Supporting Our Law Enforcement and Safe Neighborhoods Act" (SB 1070, enacted July 29, 2010) on the utilization of preventive health care and public assistance among Mexican-origin families. Data came from 142 adolescent mothers and 137 mother figures who participated in a quasi-experimental, ongoing longitudinal study of the health and development of Mexican-origin adolescent mothers and their infants (4 waves; March 2007-December 2011). We used general estimating equations to determine whether utilization of preventive health care and public assistance differed before versus after SB 1070's enactment. Adolescents reported declines in use of public assistance and were less likely to take their baby to the doctor; compared with older adolescents, younger adolescents were less likely to use preventive health care after SB 1070. Mother figures were less likely to use public assistance after SB 1070 if they were born in the United States and if their post-SB 1070 interview was closer to the law's enactment. Findings suggest that immigration policies such as SB 1070 may contribute to decreases in use of preventive health care and public assistance among high-risk populations.

Associations of the type of childcare with reported preventive medical and dental care utilization for 1‐ to 5‐year‐old children in the United States

Despite that the majority of US children use nonparental childcare (NPC), research examining its effects on children's preventive healthcare utilization is lacking. Our aim was to contrast NPC against parental childcare in terms of preventive medical and dental care utilization. Associations of childcare and healthcare utilization were evaluated using the 2007 National Survey of Children's Health, a telephone interview of parent-reported children's health (22,773 children ages 1- to 5-year old). The type of childcare was categorized as parental care, center-based care (CBC), nonrelative home care (NRHC), relative care (RCC), and mixed care (MCC). The outcome measures were preventive medical care (≥ 1 physical examination/well child check-up visit) and preventive dental care (≥ 1 check-ups/dental cleanings visit) during the past 12 months. Overall, 94.7% of 1- to 5-year-old children received preventive medical care, while only 53.6% received preventive dental care. The highest odds for preventive medical care was for 1- to 2-year-old children utilizing CBC [Odds Ratio (OR) = 2.85, 95% CI = 1.11-7.30] and for 3- to 5-year-old children utilizing MCC (OR = 2.00, 95% CI = 1.23-3.26) followed by CBC (OR = 1.66, 95% CI = 1.13-2.42). Considering preventive dental care, a statistically significant increase occurred for 1- to 2-year-old children with CBC (OR = 1.93, 95% CI = 1.62-2.30), and none occurred for any NPC above the parental childcare rates for 3- to 5-year-old children. Childcare use, particularly center-based care, may provide a means to raise preventive healthcare utilization for young children. Future regulations, as well as policy and program development, should consider promoting childcare settings as a means to improve preventive health care utilization.

Maternal Autonomy and Child Health Care Utilization in India

The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child's primary immunization status (indicative of preventive health care use) and treatment seeking for child's acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child's acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children.

Access to Private and Confidential Health Care Among Secondary School Students in New Zealand

Private and confidential health care is an important indicator of the quality of health care for adolescents. The objective of this study was to determine the prevalence of health care utilization and private and confidential health care among a nationally representative population of high school students. A two-stage cluster sample of 9,107 students (grades 8-12, response rate 73%) from 96 New Zealand high schools (response rate 84%) participated in a 2007 health survey using Internet tablets. Questions included when and where they had accessed health care, if their health care provider had explained that their health care was confidential, and if they had been seen in private by their health care provider. Although 83% of students had accessed health care in the previous 12 months, only 27% of students reported receiving private and confidential health care. Students who had accessed health care from a school-based health center (adjusted relative risk [95% confidence interval] 1.54 [1.42-1.66]) or family planning/sexual health clinics (adjusted relative risk = 2.1 [1.9-2.26]) were more likely to report receiving private and confidential health care compared with students who had not accessed health care from these settings. While most young people access health care from their family doctor or general practitioner's clinic, rates of private and confidential health care were low suggesting that opportunities to adequately explore and respond to important yet sensitive topics are compromised in primary care settings.

The ecology of medical care in Taiwan

Background In regular administrative statistics for medical services, utilization data are usually presented as aggregate data and lack an individual perspective. The aim of this study was to provide an overview of medical care utilization in Taiwan using a long-established analytical framework, the so-called ecology model. Methods Claims data for a cohort of one million people from the National Health Insurance (NHI) Research Database were used to estimate the yearly and monthly prevalence of health care utilization in Taiwan in 2005. Analyses were extended to different types of healthcare settings and were stratified by age and sex. Results are presented per 1000 of the population. Results Per 1000 people, 74 did not utilize any NHI services during the year. In a month, 503 people on average utilized at least once NHI service of any kind, 329 visited a physician’s clinic (Western medicine), 152 visited a hospital-based outpatient clinic, 19 visited an emergency department, 10 were hospitalized and 3 were hospitalized in an academic medical center. Women were more likely to utilize NHI services than men (274/504 vs. 229/496 in a month). In a month on average, 40.3% (146/362) of young people, 52.2% (166/318) of middle-aged people, 53.3% (121/227) of children and 75.0% (70/93) of elderly people utilized NHI services. Over the whole year, 22.0% (21/93) of elderly people were hospitalized and nearly one-third of them were hospitalized in academic medical centers. Conclusion People in Taiwan utilized NHI services frequently and tended to seek medical help in hospitals. Although these features might reflect the higher availability and accessibility of medical care within the NHI in Taiwan, the possibility of overuse deserves further attention.

Cross-border utilization of health care: evidence from a population-based study in south Texas.

To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.-Mexico border region.