Self-reported Health Care Use Research Articles

Testing an Evidence-Based Self-Help Program for Infertility-Related Distress: Protocol for a Randomized Controlled Trial.

Infertility-the inability to achieve pregnancy despite ≥12 months of focused attempts to conceive-is experienced by 1 in 6 couples. Women typically carry a disproportionate share of the psychological burden associated with infertility, experiencing poor quality of life, and 30%-40% experiencing depressive mood or anxiety. Unfortunately, currently available psychological interventions targeting infertility-related distress are associated with modest effects. Our team, in collaboration with patient advisors, has designed a self-help intervention for infertility-related distress involving 7 weekly 10-minute videos addressing the cognitive, behavioral, and interpersonal challenges associated with infertility, delivered through a mobile app. A feasibility study suggests that it is well accepted and highly effective in reducing symptoms of anxiety and depressed mood among distressed individuals dealing with infertility. This study represents the next step in this line of research: a fully powered randomized controlled trial comparing the intervention to a waitlist control group. We will recruit 170 individuals struggling to become pregnant in Canada or the United States to be randomized to our 7-week self-help program or a treatment-as-usual condition. The primary outcome will be fertility quality of life, while secondary outcomes will include depressive symptoms, anxious symptoms, and relationship quality, assessed before and after the program as well as biweekly for 16 weeks following completion of the program. Self-reported health care use and the presence of diagnosed mood and anxiety disorders, assessed through a structured psychiatric interview, will also be assessed immediately following the intervention and at the 16-week follow-up assessment. Treatment adherence and retention will also be recorded throughout the intervention. Multilevel modeling will compare the intervention arm to the treatment-as-usual condition in terms of all continuous outcomes across the 9 measurement points. Logistic regression will be used to assess the occurrence of mood and anxiety disorders in the 2 treatment arms at the posttreatment assessment as well as at the 16-week follow-up. Sensitivity analyses will examine potential treatment moderators: membership in the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) communities, baseline fertility quality of life, cultural background, disability status, and pursuit of conception through medical intervention. We expect our intervention to be more effective than treatment-as-usual in improving all mental health parameters assessed and decreasing health care use related to both mental and reproductive health. Effects are expected to be larger with decreasing baseline quality of life and equally effective regardless of membership in the LGBTQIA+ communities, cultural background, or disability status. If our intervention is successful, this would suggest that it should be scaled up and made publicly available. The availability of this program would fill an important gap in light of the high rates of psychopathology among those experiencing infertility and considering the current lack of effective psychotherapy approaches for infertility. Clinicaltrials.gov NCT06006936; https://classic.clinicaltrials.gov/ct2/show/NCT06006936. PRR1-10.2196/52662.

Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention in people with inflammatory arthritis: study protocol of the Physiotherapy WORKs trial

BackgroundAlthough reduced work ability is a substantial problem among people with inflammatory arthritis (IA), work ability is an underexposed area in clinical practice. Evidence on vocational interventions in IA is limited, but favourable results of delivery by a physiotherapist (PT) warrant the need for further research. Therefore, we aim to evaluate the (cost-)effectiveness of a multimodal, PT-led, vocational intervention in (self-)employed people with IA compared to usual care.MethodsThis randomized controlled trial will include 140 people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) who are (self-)employed and have reduced work ability (Work Ability Index – Single Item Scale (WAS) ≤ 7/10) and/or RA/axSpA related sick leave (≤ 6 months). Participants will be randomized 1:1 to the intervention or control condition (usual care). The intervention, delivered by primary care PTs, will be personalized to each patient, consisting of 10 to 21 sessions over 12 months. The intervention will be multimodal, comprising of 1) exercise therapy and a physical activity plan, 2) education/self-management support, 3) work-roadmap to guide participants in finding relevant other care, with optionally 4) online self-management course and 5) workplace examination. Assessments will be performed at baseline and after 3, 6, and 12 months. The primary outcome measure of effectiveness is work ability, as measured with the WAS at 12 months. For the cost-effectiveness analysis, the EuroQol (EQ-5D-5L), self-reported healthcare use, sick leave and productivity while at work will be used to estimate the trial based cost-utility from a societal perspective. A process evaluation, including assessments of adherence and treatment fidelity, will be undertaken using the registrations of the PTs and semi-structured interviews at 12 months follow-up in a random sample of the intervention group.DiscussionThe results of this study will provide insights in the (cost-)effectiveness of a multimodal, PT-led, vocational intervention in people with IA and a reduced work ability.Trial registrationThis study is registered in the International Clinical Trial Registry Platform (ICTRP) under number NL9343.

A Scalable Program for Improving Physical Activity in Older People with Dementia Including Culturally and Linguistically Diverse (CALD) Groups Who Receive Home Support: A Feasibility Study

Home care clients with dementia/cognitive impairment are typically functionally dependent and physically inactive. We pilot-tested a co-designed physical exercise program for its feasibility, safety, adherence and potential for benefits on physical activity, physical function, healthcare use and falls. Trained community care support workers delivered a 12-week home exercise program to clients with dementia/cognitive impairment, once weekly for 15 min during care shifts, supplemented by carers' supervision of exercises for 30 min, three times weekly. A physiotherapist provided fortnightly phone support to ensure safety and exercise progression. Baseline and Week 12 assessments using validated scales for physical activity, physical function, daily living independence, falls efficacy, quality of life, self-reported healthcare use, falls and sleep quality were undertaken. Differences were examined with regression analyses. Care support workers (n = 26) and client/carer dyads (n = 26 and 80.8% culturally and linguistically diverse) participated. Participants recorded adverse events/falls and exercises in dairies. Fifteen dyads completed the program. No falls/adverse events occurred with the exercises. The adherence rates against targets for exercise time completed and days in which exercise were undertaken for support workers were 137%/79.6%, and for client/carer dyads were 82%/104.8%, respectively. Physical activity participation, physical function and falls efficacy significantly improved at Week 12 compared to baseline. The feasibility, safety and adherence of the co-designed physical exercise program were demonstrated. Strategies to minimise dropouts in future effectiveness studies are required.

POPULATION TRENDS IN HEALTHCARE USE BY MEXICAN ADULTS AGED 60 AND OLDER WITH AND WITHOUT COGNITIVE IMPAIRMENT

Abstract Government policies that have greatly expanded health insurance coverage in Mexico have taken place in the context of rapid population aging and an increasing number of older adults living with cognitive impairment. We used data from the Mexican Health and Aging Study to investigate population-level trends in self-reported healthcare use by cognitive status in 2001, 2012, 2015, and 2018. Healthcare measures included having an outpatient procedure, any doctor visits, staying >1 nights in the hospital, and screenings for high cholesterol, diabetes, and hypertension. All outcomes were dichotomized as yes/no. The sample sizes included 6179 (2001), 8924 (2012), 9429 (2015), and 8916 (2018) participants aged 60 and older who completed a direct interview (total N=33,448). Participants with cognitive impairment were identified using five cognitive assessments (2001 n=1000; 2012 n=1273; 2015 n=1467; 2018 n=1372). Generalized estimating equations that adjusted for demographic characteristics and self-reported health conditions were used. The adjusted odds of having spent >1 night in the hospital, outpatient procedures, any doctor visits, and preventive screenings were significantly higher in 2012, 2015, and 2018 than in 2001 regardless of cognitive status. Overall, participants with cognitive impairment had significantly higher adjusted odds for >1 nights in the hospital (OR=1.31, 95% CI=1.20-1.42), but significantly lower odds for any doctor visits (OR=0.81, 95% CI=0.75-0.88), outpatient procedures (OR=0.70, 95% CI=0.57-0.85), and preventive screenings for high cholesterol (OR=0.75, 95% CI=-.70-0.81), diabetes (OR=0.78, 95% CI=0.72-0.85), and hypertension (OR=0.76, 95% CI=0.70-0.82). These results are important to understanding the healthcare needs of Mexico’s growing older adult population.

ETHNORACIAL DIFFERENCES IN HOME HEALTHCARE USE: FINDINGS FROM THE NATIONAL HEALTH AND RETIREMENT STUDY

Abstract This study seeks to identify ethnoracial differences in self-reported home health care (HHC) use among older adults. To do so, we examined 8,817 people aged 65 and older from the 2016 wave of the Health and Retirement Study (HRS), a nationally representative survey of older adults in the U.S. The dependent variable was whether HRS participants reported any HHC service use in the past two years. The primary independent variable was ethnoracial grouping, which included non-Hispanic White, non-Hispanic Black, and Hispanic groups. Multivariable logistic regressions stratified by ethnoracial grouping identified correlates of HHC use. We found that HHC use was more prevalent among non-Hispanic Blacks (14.9%) than in non-Hispanic Whites (10.1%) or Hispanics (10.7%). For all ethnoracial groups, increasing age, dementia, activities of daily living impairment, medical comorbidity (except for Hispanics), and hospitalization (in the past two years) were associated with an increased likelihood of HHC use. In addition, we identified ethnoracial differences in the correlates of HHC use. Among non-Hispanic Whites, more formal education and Medicaid insurance were associated with a higher likelihood of using HHC. For non-Hispanic Blacks, residing in rural areas was associated with a decreased likelihood of HHC use, whereas being single and living alone were associated with an increased likelihood of HHC use. This study thereby identified notable ethnoracial differences in the correlates of HHC use among older adults.

Amitriptyline at low-dose and titrated for irritable bowel syndrome as second-line treatment (The ATLANTIS trial): protocol for a randomised double-blind placebo-controlled trial in primary care

BackgroundIrritable bowel syndrome (IBS) is a common functional bowel disorder that has a considerable impact on patient quality of life and substantial societal and health care resource costs. Current treatments are often ineffective. Tricyclic antidepressants have shown promise in secondary care populations but their effectiveness in a primary care setting remains unclear.MethodsATLANTIS is a randomised, multi-centre, parallel-group, two-arm, double-blind, placebo-controlled trial of low-dose amitriptyline as a second-line treatment for IBS in primary care. Participants will be invited by letter, or recruited opportunistically, from general practices in three regions of England (West Yorkshire, Wessex, and West of England) and screened for eligibility. A total of 518 adult patients with IBS, who are symptomatic despite first-line therapies, will be randomised 1:1 to amitriptyline or identical placebo for 6 months. Treatment will commence at a dose of 10 mg (or one placebo tablet) daily at night, with dose titration up to a maximum of 30 mg at night, depending on side effects and response to treatment. Participant-reported assessments will be conducted at baseline and 3, 6, and 12 months post-randomisation. The primary objective is to determine the effectiveness of amitriptyline, compared with placebo, in improving participant-reported global symptoms of IBS at 6 months (using the IBS Severity Scoring System). Secondary outcomes include relief of IBS symptoms, effect on IBS-associated somatic symptoms (Patient Health Questionnaire-12), anxiety and depression (Hospital Anxiety and Depression Scale), ability to work and participate in other activities (Work and Social Adjustment Scale), acceptability and tolerability of treatment, self-reported health care use, health-related quality of life (EQ-5D-3L), and cost-effectiveness. A nested, qualitative study will explore patient and general practitioner experiences of treatments and trial participation, including acceptability, adherence, unanticipated effects, and implications for wider use of amitriptyline for IBS in primary care.DiscussionDetermining the clinical and cost-effectiveness of low-dose amitriptyline as a second-line treatment for IBS in primary care will provide robust evidence to inform management decisions.Trial registrationISRCTN ISRCTN48075063. Registered on 7th June 2019.

Body mass index, waist circumference, waist-to-hip ratio, and body fat in relation to health care use in the Canadian Longitudinal Study on Aging.

Obesity is associated with increased health care use (HCU), but it is unclear whether this is consistent across all measures of adiposity. The objectives were to compare obesity defined by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and percent body fat (%BF), and to estimate their associations with HCU. Baseline data from 30,092 participants aged 45-85 years from the Canadian Longitudinal Study on Aging were included. Measures of adiposity were recorded by trained staff and obesity was defined as BMI ≥ 30.0 kg/m2 for all participants and WC ≥ 88 cm and ≥102 cm, WHR ≥ 0.85 and ≥0.90, and %BF > 35% and >25% (measured using dual energy x-ray absorptiometry) for females and males, respectively. Self-reported HCU in the past 12 months was collected for any contact with a general practitioner, specialist, emergency department, and hospitalization. Pearson correlation coefficients (r) compared each measure to %BF-defined obesity, the reference standard. Relative risks (RR) and risk differences (RD) adjusted for age, sex, education, income, urban/rural, marital status, smoking status, and alcohol use were calculated, and results were age- and sex-stratified. Obesity prevalence varied by measure: BMI (29%), WC (42%), WHR (62%), and %BF (73%). BMI and WC were highly correlated with %BF (r ≥ 0.70), while WHR demonstrated a weaker relationship with %BF, with differences by sex (r = 0.29 and r = 0.46 in females and males, respectively). There were significantly increased RR and RD for all measures and health care services, for example, WC-defined obesity was associated with an increased risk of hospitalization (RR: 1.40, 95% CI: 1.28-1.54 and RD per 100: 2.6, 95% CI:1.9-3.3). Age-stratified results revealed that older adult groups with obesity demonstrated weak or no associations with HCU. All measures of adiposity were positively associated with increased HCU although obesity may not be a strong predictor of HCU in older adults.

Validation of the FIMA Questionnaire for Health-Related Resource Use Against Medical Claims Data: The Role Played by Length of Recall Period

Self-reported health care use of 1,552 participants was validated against medical claims data. Reliability was measured by intraclass correlation coefficient (ICC), sensitivity, specificity, and Cohen's Kappa. Linear regression models were used to investigate the association between validity and individual characteristics, health state, recall period (3, 6, or 12 months), or frequency of resource use. On average, participants were 74 years old; 95% rated the questionnaire as easy. The number of physician contacts was underestimated depending on recall period by 9 to 28% and the ICC was moderate (3/6/12 months, ICC 0.46/0.48/0.55), whereas contacts with physiotherapists were remembered quite well (ICC>0.75). Remembering the number of days in rehabilitation and hospital differed by recall periods (3/6/12 months); rehabilitation ICC=0.88/0.51/0.87; hospital ICC=0.69/0.88/0.66. Very good reliability of self-reported long-term care insurance benefits was found for all recall periods (Kappa>0.90) while agreement in self-reported medical aid was poor (Kappa<0.30); agreement in intake of medication was good (Kappa>0.40). The chance of agreement between self-reports and claims data significantly decreased with the number of contacts. Individuals with better health had a significantly higher chance of reporting contacts with physiotherapists accurately. The FIMA largely demonstrated good reliability. The FIMA is a coherent and valid instrument to collect health-related resource use in health economic studies in an elderly population.

Longitudinal association between panic disorder and health care costs in older adults.

To analyze whether probable panic disorder (PD) is associated with health care costs in older age over time. Data regarding individuals aged 65 and over were derived from two waves of the ESTHER cohort study (nt1 = 2,348, nt2 = 2,090). Probable PD was assessed using the panic screening module from the Patient Health Questionnaire. Health care costs were obtained through monetary valuation of self-reported health care use data. Fixed effects regressions analyzed the association between transitions in probable PD status and change in health care costs, while adjusting for potential confounders. On a descriptive level, study participants with a positive PD screening displayed higher three-month health care costs compared to those without (incremental costs: € 259 for t1 , € 1,544 for t2 ). Transitions in probable PD were associated with an approximate increase of 65% in outpatient health care costs (β = 0.50, p < .05). There was no significant association between probable PD transition and change in any other cost category. Using longitudinal data, our results highlight the economic consequences of probable PD in older adults. Future research should address whether reducing PD in older adults may reduce the associated economic burden and analyze underlying mechanisms.

Effects of Mental Health on the Costs of Care for Chronic Illnesses.

The study examined whether comorbid low mental health functioning inflates the cost of treating a chronic disease. Data were from the 2015 Medical Expenditure Panel Survey (N=33,893). Costs were estimated from medical records and self-reported health care use. The mental component summary (MCS) score of the 12-item Short Form (SF-12) was used as a measure of mental health status. A general linear model estimated costs with fixed effects for chronic disease (present or absent) and mental health functioning (lowest, middle, and highest MCS score tertiles indicating low, middle, and high levels of mental health functioning, respectively). The SF-12 physical component summary score was a covariate. Eight conditions (arthritis, chronic obstructive pulmonary disease [COPD], high cholesterol, cancer, diabetes, stroke, coronary heart disease, and asthma) were analyzed separately. For each analysis, presence or absence of the chronic condition had a strong impact on cost. Lower mental health functioning also had a significant impact on cost. However, the interaction between mental health functioning and chronic disease diagnoses was statistically significant for only three conditions and accounted for only a small variation in cost. Sensitivity analyses using MCS score as a continuous variable, using a log10 transformation of the cost variable, and focusing only on persons with scores on the extreme low end did not significantly alter the conclusions. Contrary to expectation, the combination of poor mental functioning and chronic disease diagnosis did not have a strong synergistic effect on cost. Mental and general medical conditions appear to have independent effects on health care costs.

Self-reported use of family physician, chiropractor and physiotherapy services among adult Canadians with chronic back disorders: an observational study

BackgroundChronic back disorders (CBD) are prevalent, costly, and among the most common reasons for seeking primary care; however, little is known regarding the comparative use of family physician, chiropractic, and physiotherapy services among people with CBD in Canada. Elucidating these differences may identify potential gaps in access to care and inform the development of strategies to improve access. The research objectives were to investigate patterns of health care use and to profile factors associated with self-reported use of family physicians, chiropractors, and physiotherapists among adult Canadians with CBD.MethodsThe combined 2009 and 2010 Canadian Community Health Surveys conducted by Statistics Canada were used to investigate self-reported health care use among adults with CBD. This complex survey employs population weights and bootstrapping to be representative of the Canadian population. Following descriptive analyses, we used multiple logistic regression to profile self-reported health care use while statistically controlling for possible confounding effects.ResultsThe majority of adult respondents with CBD sought care only with a family physician (53.8%), with 20.9% and 16.2% seeking care with combined family physician/chiropractor or family physician/physiotherapist, respectively. Few respondents sought care only with a chiropractor (2.5%) or physiotherapist (1.0%). After adjustment, differential patterns of utilization (p < 0.05) were evident between provider groups with respect to age, gender, socioeconomic status, rural/urban residence, functional limitations, and presence of co-morbidities.ConclusionsThis research highlights potential inequities in access to physiotherapists and chiropractors in relation to family physicians among adult Canadians with CBD, particularly among lower socioeconomic status and rural/remote populations.

Obesity and Disparities in Human Papillomavirus Vaccination for U.S. Adolescent Girls and Young Women.

Obesity is recognized as a barrier to receiving women's preventive health services, including cervical and breast cancer screening. Little is known about whether obesity is associated with a lower incidence of human papillomavirus (HPV) vaccination, another important preventive care service for adolescent girls and young women. The objective of this study was to determine if adolescent girls and young women with obesity are less likely to receive HPV vaccination compared with individuals with normal weight. We examined whether HPV vaccination was associated with obesity status in women aged 9-30years surveyed from 2009 to 2016 by the U.S. National Health and Nutrition Examination Survey. Results from logistic and linear regression models were adjusted for age, race, income, insurance status, self-reported health, and health care use, accounting for the weighted survey design. The final cohort included 5,517 women. Overall, 32.9% of participants reported vaccination, with a mean age at vaccination of 15.8years. Adolescent girls and young women with obesity were less likely to report vaccination; the adjusted odds ratio of vaccination was 0.79 (p=.01) compared with normal weight women. Among those vaccinated, the age at vaccination was significantly older for women with obesity, 16.3years compared with 15.2years (p=.002), but there was no difference in the completion of the vaccination series rate by obesity. Adolescent girls and young women with obesity were less likely to report HPV vaccination and, if they were vaccinated, received the vaccination at a later age.

International comparison in walkable environments and hospital burden in type 2 diabetes patients

IntroductionWhile some comparative work has provided evidence for a universally positive impact of built environment features that promote physical activity, less is known about chronic diseases and hospitalization among different social contexts and health care systems. Parallel international linkage efforts present an opportunity to study health impacts of the built environment.&#x0D; Objectives and ApproachThis study compares the impact of neighbourhood environments on health outcomes for patients with type 2 diabetes (T2D) in two countries. Neighborhood-level measures for walkable environments were derived for Canada and Wales using Geographic Information Systems. Hospitalization admissions from routine data sources and linked survey data responses (from the Welsh Health Survey and Canadian Community Health Survey) allow for the generation of population-based descriptive statistics on socio-demographic information, self-reported health, diagnostic patterns, and health care use. We examine the feasibility of investigating contextual differences in walkable environments, T2D, and hospitalization between Wales and Canada.&#x0D; ResultsData linkage in respective privacy protecting safe havens in the Canada Research Data Centre Network (CRDCN) and the Wales Secure Anonymised Information Linkage (SAIL) Databank show promise for a comparative study, enabling parallel modelling of environmental and socio-demographic factors with hospitalization data. Both the Canadian and Welsh surveys ask respondents about their current diabetes status, allowing us to compare hospitalization rates and neighborhood effects of those who report having diabetes with the those who do not. Moreover, the linking of survey responses and similarity in geographic scale permitted consistent measurement of walkable environments across countries. Key administrative variables have been identified relating to health and behaviors, such as socio-demographic information, smoking status, and body mass index, and hospitalization metrics in both countries are commensurable.&#x0D; Conclusion/ImplicationsThe generation of comparable linked datasets, built environment indicators and comparative research for T2D patients will have wider implications for international assessment of the impacts of environment on chronic diseases, and the hospital burden associated with these conditions.

Shared Telemedicine Appointments in Young Adults with T1D—An Economic Evaluation of the CoYoT1 Trial

Background: Young adults with type 1 diabetes (T1D) experience significant difficulties adhering to glucose control standards. An innovative care model - shared medical appointments through home telemedicine - was recently examined and found to improve patient attendance and diabetes care engagement. Objective: To evaluate within-trial cost-effectiveness of the intervention in Colorado Young adults with T1D (CoYoT1) aged 18-25. Methods: In the prospective pilot trial, patients self-selected into the CoYoT1 or usual care groups. We collected baseline, 6, and 12 months data on patients’ self-reported healthcare use and trial medical care time related to group and/or individual visits. Results: The health-related utility in the control group declined to a greater extent than the CoYoT1 group (p=0.04), but QALYs did not differ between the groups (p=0.5). We also found significantly lower direct, indirect, and total costs during the trial (CoYoT1: $2,341 vs. control: $6,935) (all p &amp;lt;0.01). The benefits were mainly due to CoYoT1 patients having fewer hospitalizations (p=0.09) and fewer primary care visits that occurred outside the trial (p=0.01), although the CoYoT1 group ($199) had higher annual costs of trial medical care time than controls ($84). Conclusion: With long-term implementation, the CoYoT1 intervention may help patients to maintain a higher quality of life and save overall healthcare costs. Disclosure W. Wan: None. R. Skandari: None. A. Nathan: None. P. Zarei: None. M.W. Reid: None. J. Raymond: None. E. Huang: None.

Do transdermal opioids reduce healthcare use in an Australian rural pain population? A comparison with oral opioids

To determine whether transdermal (TD) opioids reduce healthcare contacts when compared with oral opioids in a rural population with chronic noncancer pain (CNCP). An observational longitudinal study to measure the changes in self-reported healthcare use by the route of opioid administration over time (monthly for 1 year). Subjects were opioid-treated CNCP patients from North West Tasmania. The subjects completed the monthly datasheets by recording all healthcare contacts and the routes of opioid administration. The outcome measures of mean monthly healthcare contacts (MHCs) by the routes of opioid administration were analyzed using generalized estimating equations with robust standard errors. The details of 10,564 healthcare contacts from 198 subjects were obtained during the study. General practitioner (GP) mean MHCs were 2.01 (95% confidence intervals [CI] = 1.58-2.45) for oral opioids and significantly (p = 0.02) lower by 0.38 (95% CI = -0.70 to -0.05) contacts for TD opioids. Pharmacy mean MHCs were 2.44 (95% CI = 1.88-3.00) for oral opioids and unchanged (p = 0.86) by -0.04 (95% CI = -0.44-0.37) for TD opioids. Total mean MHCs with oral opioid use were 5.98 (95% CI = 4.93-7.03). With TD opioid use, this was nonsignificantly lower (p = 0.12) by 0.62 (95% CI = -1.40-0.15) contacts. The use of TD opioid preparations, with their prolonged analgesic effect, may reduce total healthcare activity and significantly reduce GP contact. This may particularly benefit a rural population where there is a relative shortage of doctors.

Accuracy of Self-Reported Health Care Use in a Population-Based Sample of Homeless Adults.

To assess the accuracy of self-reported ambulatory care visits, emergency department (ED) encounters, and overnight hospitalizations in a population-based sample of homeless adults. Self-report survey data and administrative health care utilization databases. Self-reported health care use in the past 12months was compared to administrative encounter records among 1,163 homeless adults recruited in 2004-2005 from shelters and meal programs in Toronto, Ontario. Self-reported health care use was assessed using a structured face-to-face survey. Each participant was linked to administrative databases using a unique personal health number or their first name, last name, sex, and date of birth. The sensitivity of self-report for ambulatory care visits, ED encounters, and overnight hospitalizations was 89, 80, and 73 percent, respectively; specificity was 37, 83, and 91 percent. The mean difference between self-reported and documented number of encounters in the past 12months was +1.6 for ambulatory care visits (95 percent CI=0.4, 2.8), -0.6 for ED encounters (95 percent CI=-0.8, -0.4), and 0.0 for hospitalizations (95 percent CI=0.0, 0.1). Adults experiencing homelessness are quite accurate reporters of their use of health care, especially for ED encounters and hospitalizations.

Corrigendum

This article refers to:Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa

Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa

BackgroundSouth Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain.ObjectiveTo measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older.MethodsThe Study on Global Ageing and Adult Health (SAGE), in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry.ResultsFour hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0–46.6) followed by hypertension (31.2%; 95% CI 26.8–35.9) and diabetes (6.1%; 95% CI 4.1–8.9). All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist–hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported higher use of the health facilities also reported lower levels of functioning and quality of life.ConclusionSelf-reported chronic health conditions, especially hypertension, had a high prevalence in this population and were strongly associated with higher levels of health care use. The primary health care system in South Africa will need to provide care for people with non-communicable diseases.

Concordance between self-reports and archival records of physician visits: A case–control study comparing individuals with and without alcohol use disorders in the community

ObjectiveThe accuracy of self-reported healthcare use among individuals with alcohol use disorders (AUD) has been questioned. The present study attempts to compare the accuracy of self-reported physician visits for individuals who differ with respect to their history of AUDs. MethodsOur data source was a 14-year follow-up of individuals interviewed at the St. Louis site of the 1981–1983 Epidemiologic Catchment Area Study (ECA). We used a case–control design (n=237) to compare the accuracy of self-reports among ECA participants with stably diagnosed AUDs (cases; n=75) to two comparison groups: those with problem/very heavy drinking (n=81) and those unaffected by alcohol (n=81). Intraclass correlation coefficients (ICC) described the concordance between self-reports and archival records of physician visits in the prior six months. We used multinomial logistic regression to identify characteristics associated with under-reporting and over-reporting, and zero-truncated Poisson regression to identify characteristics associated with discordance severity. ResultsSelf-reports of cases had substantial concordance with physician records (ICC=0.74, CI=0.61–0.83). As compared to cases, those with problem/very heavy drinking had a significantly higher ICC, and those who were unaffected by alcohol had a significantly lower ICC. However, differences in concordance disappeared when using regression models that adjusted for factors known to affect the accuracy of self-reported healthcare use. Utilization frequency was a strong predictor of inaccurate reporting. ConclusionsThese findings suggest AUD status may not independently affect the accuracy of self-reports. Counts of physician visits for those with AUD may be considered accurate when utilization frequency is low.

Good General Health In Survivors of Childhood AML Treated with Chemotherapy Only: A NOPHO-AML Study.

AbstractAbstract 1076 Background.More than 60% of children with acute myeloid leukemia (AML) become long-term survivors and most are cured with chemotherapy only. With this improvement, the late mortality and morbidity after the very intensive treatment deserve attention. Previous studies have reported late effects after childhood AML, but most side effects were probably caused by cranial irradiation or hematopoietic stem cell transplantation (HSCT). Limited data exist about the long-term mortality, morbidity, and social outcomes in AML survivors treated with chemotherapy only. The objectives of this study were to report the occurrence of late mortality and compare the self-reported health care use and health experience, lifestyle behavior, and social outcomes of AML survivors with those of their sibling controls. Methods.Children treated for AML according to the Nordic protocols NOPHO-AML-84, -88, and -93, and alive by 30 June 2007 were identified in the NOPHO-AML database. We excluded patients with myeloid leukemia of Down syndrome, Fanconi anemia, preceding myelodysplastic syndrome, therapy-related AML, patients receiving allogeneic or autologous HSCT, and patients who had experienced a relapse or had a secondary malignancy. A total of 102 (74%) of the 138 eligible AML survivors accepted the invitation for a physical and paraclinical examination and completed a questionnaire concerning health and social status. One sibling per patient was invited to complete a similar questionnaire which was accepted by 85 (91%) of 93 eligible siblings. Results.The median follow-up was 11 (range 4–25) years after diagnosis. Five-year AML survivors' overall survival rate was 94% at 20 years after diagnosis (95% confidence interval; 84–98%). Four children died more than five years after end of treatment; one from sequelae of initial cerebral bleeding, two from side effects of treatment including one with hearth failure, and one from secondary malignancy. AML survivors had no increased rate of hospitalization compared with sibling controls but more received prescription drugs, especially for asthma (23% vs. 9%, p=0.03). Self-reported health experience was excellent or very good in 77% and comparable with that of siblings (Table). The rate of current smokers was similar in the two groups (23% vs. 24%). Sixty-seven percent of the AML survivors >20 years of age and 73% of their siblings reported to be undertaking or having completed an education, defined as vocational training or academic education lasting at least three years (p=0.8). Among those >20 years of age, the frequency of marriage or cohabitation did not differ between AML survivors and siblings (39% vs. 37%). Conclusions.Children treated on NOPHO-AML protocols without HSCT and surviving at least five years after diagnosis had a very low mortality rate. Their self-reported health was good, and health care use was limited and comparable to that of sibling controls, but they were more often receiving prescription drugs for minor illnesses. Most AML survivors seemed to have coped well with their transition into adulthood, and they reported educational achievement, employment and marital status comparable to those of their sibling controls.TableSelf-reported health in AML survivors (age >10 years) and their siblings.Health statusAML survivorsSiblingsn=86%n=71%Excellent/very good66775577Good12141217Fair/poor8946 Disclosures:No relevant conflicts of interest to declare.