Patient Service Use Research Articles

Experience implementing distress screening using the National Comprehensive Cancer Network distress thermometer at an urban safety‐net hospital

Table 1: Regression analyses predicting support service use in patients starting treatment after DT implementation (N = 1430). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

PTU-124 The Treatment Needs of Patients with Gastrointestinal Disorders in Tertiary Functional Versus Pooled Psychology Clinics

Introduction Psychological and physical co-morbidity is associated with poorer outcomes and higher service use for patients with gastrointestinal (GI) disorders. This study aimed to evaluate the treatment needs of patients with GI disorders in tertiary functional versus pooled GI psychology clinics. Methods 67 patients (49 females; mean age 42; range 17–86) completed questionnaires on accessing a tertiary functional (n = 36) and pooled (all causes) GI psychology clinic (n = 31). The Gastrointestinal Symptom Rating Scale (GSRS), Work and Social Adjustment Scale (WSAS), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Questionnaire (GAD-7) and Visceral Sensitivity Index (VSI) were completed. Mann-Whitney U-test was used for comparison of samples. Results Severity across measures was high amongst both samples. 31% of tertiary functional patients (n = 35) and 37% of pooled GI psychology (n = 30) patients scored within the ‘severe range’ for all three areas of need; GI symptom severity, functional impairment and distress. 67% of patients within the tertiary clinic were above cut off for clinically significant distress compared with 90% in the pooled GI psychology clinic. No significant differences were found between the two groups of patients for GI symptom severity (U = 527, p = 0.697), functional impairment (U = 532, p = 0.951), GI-specific distress (U = 502.5, p = 0.949) or depression (U = 403, p = 0.078). Patients seen within the GI Psychology clinic scored significantly higher for generalised anxiety (U = 350, p = 0.014). Conclusion Clinically significant high levels of GI symptom severity, functional impairment and psychological distress were reported across the samples. This was expected as referral indication to the pooled GI psychology clinic, but surprisingly high in the tertiary functional clinic. This supports developing integrated psychological services within this GI sub–speciality to provide interventions for health-related distress. Generalised anxiety was significantly higher within the pooled psychology sample. Future studies may determine whether GI patients with less overt anxiety, but nonetheless significant psychological needs, are at risk of under-referral to psychology. Use of questionnaires may identify psychological co-morbidity within gastroenterology services to triage appropriate and timely referrals for psychological therapy. Disclosure of Interest None Declared

DEPRESSION AND ANXIETY: IMPACT ON SERVICE USE IN PATIENTS WITH ADVANCED CHRONIC OBSTRUCTIVE PULMONARY DISEASE

IntroductionThere is a high prevalence of anxiety and depression among people with Chronic Obstructive Pulmonary Disease (COPD). Anxiety and depression are associated with negative health outcomes and increased service use, particularly hospital admissions. Other demographic and health variables are also significant in this relationship. However, less is known about the nature of these relationships when COPD is advanced.Aim:To identify the relationship between anxiety and depression and service use in patients with advanced COPD, and the role of demographic and health variables.Methods:A population-based cohort of patients with advanced COPD recruited to the mixed–method Living with Breathlessness Study completed the Hospital Anxiety and Depression Scale (HADS) and reported hospital and community service use and experiences. Patient demographics and health variables were also collected. Quantitative analyses will explore relationships between anxiety and depression, service use, and demographic and health variables. Purposively sampled qualitative data analysed using a framework approach.Results235 patients recruited: mean age 71.6 (SD 10.3); 61% male; mean MMRC dyspnea scale 3.68 (SD 1.040); mean CAT score 23.4 9 (SD7.5). Anxiety and depression scores (HADS) were higher than population norms. Relationships between anxiety and depression, service use, demographic and health variables will be reported quantitatively and qualitatively.Conclusion(s)This analysis will provide new evidence on psychological health and service use in patients with advanced COPD. As part of an ongoing longitudinal study this data will inform trajectories of change in patient psychological health and service use to enable responsive service planning.

Improving cardiovascular disease management in Australia: NPS MedicineWise

To determine the impact of four NPS MedicineWise programs targeting quality use of medicines in cardiovascular management in primary care. Interrupted time-series analysis using the Department of Veterans' Affairs (DVA) claims dataset from 1 January 2002 to 31 August 2010. We examined the use of antithrombotics in people with atrial fibrillation and in those who had had a stroke, and the use of echocardiography and spironolactone in the population with heart failure. All veterans and their dependants in Australia who had received cardiovascular medicines or health services related to the targeted intervention. NPS MedicineWise national programs to improve cardiovascular management in primary care, which included prescriber feedback, academic detailing, case studies and audits as well as printed educational materials. Changes in medication and health service use before and after the interventions. All national programs were positively associated with significant improvements in related prescribing or test request practice. The interventions to improve the use of antithrombotics resulted in a 1.27% (95% CI, 1.26%-1.28%) and 0.63% (95% CI, 0.62%-0.64%) relative increase in the use of aspirin or warfarin in the population with atrial fibrillation 6 and 12 months after the program, respectively, and in a 1.51% (95% CI, 1.49%-1.53%) relative increase in the use of aspirin as monotherapy for secondary stroke prevention 12 months after the intervention. The heart failure programs resulted in a 3.69% (95% CI, 3.67%-3.71%) relative increase in the use of low-dose spironolactone and a 4.31% (95% CI, 4.27%-4.35%) relative increase in the use of echocardiogram tests 12 months after the intervention. NPS MedicineWise programs were effective in achieving positive changes in medicine and health service use for patients with cardiovascular diseases.

AB1395 Switching from adalimumab to other disease-modifying antirheumatic drugs without apparent medical reasons in rheumatoid arthritis: Impact on health care service use

BackgroundPatients with rheumatoid arthritis (RA) stabilized on adalimumab (ADA) might be incentivized to switch from ADA to a different therapy with a lesser copayment even without apparent intolerance or lack...

Predictors of service use of patients with co-morbid mental health and substance use disorders across seven European sites

The purpose of this study was to identify factors which predict service use over time in patients with co-morbid mental health and substance use disorders (dual diagnosis). Three hundred and fifty-two patients with dual diagnosis were recruited from acute psychiatric inpatient units at seven European sites. At baseline and 9 months follow-up, socio-demographic and clinical information, as well as information concerning the use of treatment services was collected. Predictors for use of psychiatric and substance misuse services at follow-up were studied using multinomial logistic regression models. At follow-up, patients with dual diagnosis used psychiatric services significantly more than substance use services. The main predictor of service use at follow-up is influenced by the study site and not by psychopathology. More networking and signposting are needed especially for substance misuse services. Service provision and planning can improve access of vulnerable populations even when psychopathology improves.

Function assertive community treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness

Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a different pattern of psychiatric service consumption compared to traditional services, which should result in different costing parameters than care as usual (CAU). South-Limburg FACT patients, identified through the local psychiatric case register, were matched with patients from a non-FACT control region in the North of the Netherlands (NN). Matching was accomplished using propensity scoring including, among others, total and outpatient care consumption. Assessment, as an important ingredient of FACT, was the point of departure of the present analysis. FACT patients, compared to CAU, had five more outpatient contacts after the index date. Cost-effectiveness was difficult to assess. Implementation of FACT results in measurable changes in mental health care use.

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

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

Preventive Psychiatric Admission for Patients With Borderline Personality Disorder: A Pilot Study

The purpose of this study was to establish the preliminary effects of preventive psychiatric admission of patients with severe borderline personality disorder (BPD) on the rate of agreement over treatment, patient service use, and patient views on the intervention. A retrospective pre-post test design with quantitative measures and qualitative interviews was used. Agreement over treatment increased substantially and significantly, and services use decreased substantially, yet not significantly. Patients were highly content with the intervention. Preliminary results indicate that preventive admissions may be easy to use and cost effective with severe BPD patients in mainstream psychiatric services, but more research into the intervention is needed.

Medical and Supportive Care Among People with ALS in the Months Before Death or Tracheostomy

People with amyotrophic lateral sclerosis (ALS) who choose tracheostomy demonstrate a strong and mostly consistent attachment to life from the point of diagnosis. It is unclear if these patients also use medical and health services to a greater degree than patients who decide against tracheostomy. In this research, patients with a high likelihood of dying over six months (forced vital capacity < 50% predicted) were followed monthly until death or tracheostomy with long-term mechanical ventilation (LTMV). Patient service use was measured by caregiver reports of 1) ALS-specific prosthetic devices, 2) allied health or medical services, 3) legal preparation for medical care or the end of life, and 4) medical care episodes. Caregivers also reported all patient prescription medications. At follow-up, 57 patients died and 14 elected to have tracheostomy and LTMV. Patients who opted for LTMV were younger and had higher household incomes. They were significantly more likely to use nasal ventilation, paid home care, and family or personal counseling over follow-up, and they were also more likely to remain on medications. The proactive orientation to health and desire to live despite severe disability reported for people choosing LTMV thus extends as well to more intensive use of medical and supportive care in the months before tracheostomy. A challenging task for clinicians is to acknowledge this strong desire to live while providing appropriate expectations for life after tracheostomy.

Under one roof? A population-based survey of patient use and preference for sexual health services

AimTo compare patterns of population service use and preference in areas with and without one-stop shop services.BackgroundA number of strategy documents have recommended adopting a more integrated approach to sexual health service provision. One proposed model of integration is one-stop shops, where services for contraception and sexually transmitted infections are provided under the same roof. Currently, the potential impact of one-stop shop services on patient service use and preference is unclear, particularly at a population level.MethodThree different models of one-stop shop were studied: a dedicated young persons’ service, a specialist mainstream service, and an enhanced general practice. In each model, the one-stop shop site was matched to two control sites with traditional service provision. Random samples of male and female patients were selected from general practices close to either the one-stop shop or control sites. These patients received a postal survey asking about their use or preference for services for six sexual health needs. One-stop shop and control samples were compared using multivariate logistic regression.FindingsOf the 14 387 patients surveyed, 3101 (21.6%) responded. In the young persons’ model, few significant differences were found in service use or preference between those living in one-stop shop and control site areas. In the specialist services model, women in the one-stop shop area were significantly more likely to cite specialist services for emergency contraception and abortion advice, when compared to those served by non-integrated control services. In the general practice model, respondents in the one-stop shop area were significantly more likely to cite general practice for all six sexual health needs. Overall, general practice was the preferred service provider cited for all sexual health needs, except condoms and pregnancy tests. These findings are discussed in terms of their implications for the provision of integrated sexual health services. In addition, key methodological issues and future research possibilities are identified.

Intervention to reduce emergency medical service use in patients with chronic psychotic disorders

In this study 240 older patients with schizophrenia were randomly assigned to either a behavioural skills-based treatment approach, or a time-equivalent attention control condition. The behavioural intervention comprised 24 weekly group-based sessions aimed at teaching participants everyday functional skills such as medication management. The control condition was also 24 weekly group-based sessions but based on a support group method, whereby participants would talk amongst themselves to solve current problems but with no input from the group facilitators.

Reducing emergency medical service use in patients with chronic psychotic disorders: Results from the FAST intervention study

Patients with schizophrenia have disproportionately high rates of emergency medical service use, likely contributing to the high cost this illness places on society. The aim of this study was to examine the impact of a theory-based, behavioral intervention on immediate and long-term use of emergency medical services. Older patients with schizophrenia ( n=240) were randomized to receive either a behavioral, skills-building intervention known as Functional Adaptation and Skills Training (FAST) or a time-equivalent attention-control condition (AC). Logistic regression analyses indicated that AC participants were nearly twice as likely to use emergency medical services in general (OR=2.54; p=0.02) and emergency psychiatric services in particular (OR=3.69; p=0.05) during the active intervention phase of the study. However, there were no differences between the interventions in terms of emergency service use during the long-term follow-up phase of the study (i.e., 6–18 months post-baseline). The FAST intervention appears efficacious for reducing the short-term risk of using emergency medical services. However, the long-term efficacy of the FAST intervention appears less clear. Future studies may want to provide more powerful maintenance sessions to encourage continued use of skills in patients’ real-world settings.

Service Use for Patients with Adjustment Disorder and Short Term Treatment: A Brief Report

Objective: To examine adjustment disorder by describing service utilization patterns for patients from a managed behavioral health organization (MBHO), and by comparing clinical outcomes for those who completed treatment within 6 months versus those who continued beyond 6 months. Methods: Administrative claims data from 2001 through 2003 were merged with survey data (at baseline, 6 weeks, and 6 months post-intake) and retrospectively analyzed for 211 MHBO patients with an exclusive diagnosis of adjustment disorder. Results: Fifty-four percent (n = 115) were in treatment for up to 6 months, 46% (n = 96) were in treatment up to 12 months or longer, with 20% (n = 19) treated continuously for two years. Despite similarities in demographics, clinician-types, and clinical symptoms at baseline, patients treated for 12 months or longer had significantly worse outcomes and higher costs. Conclusions: Short-term outpatient services for adjustment disorder may not be the norm among MBHO-covered patients and some may necessitate further evaluation and clinical care.

Components and Correlates of Family Burden in Schizophrenia

Components and Correlates of Family Burden in Schizophrenia

Telemonitoring of Medication Adherence in Patients with Schizophrenia

Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of resources. The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and service use in patients with schizophrenia. A total of 108 schizophrenia patients were randomized into three equal groups according to the approaches used to assess medication adherence; self-report, pill counting, and telemonitoring. Telementoring was achieved through an innovative new platform called @HOME. This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking. Patient's adherence was observed over an 8-week period, during which patient's clinical status and service use were recorded. In comparison to the other two groups, patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments. The @HOME platform was highly acceptable by patients, caregivers, and professionals, and required minimal training for implementation. The results of the study suggest that the use of telemonitoring in psychiatric settings was both feasible and acceptable and may be associated with significant clinical and service related benefits.

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

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

Substance use and schizophrenia: effects on symptoms, social functioning and service use.

Studies examining the effects of substance use in patients with schizophrenia have produced conflicting results. To examine the effects of comorbid substance use on symptoms, social functioning and service use in patients with schizophrenia. Patients (n=316) with and without substance use problems from three centres participating in the Scottish Comorbidity Study were compared, using research interviews and case note review, on measures of symptoms, social functioning and service use. Patients with substance use problems were younger, more likely to be male and had shorter duration of illness. They had more police contact and increased self-reported needs, but otherwise showed few differences when compared with those without such problems. The presence of problem substance use had only modest impact on service use, symptoms or social functioning for this group of patients with schizophrenia. This has important implications for service development to meet the perceived needs of this group.

Dying of lung cancer or cardiac failure: prospective qualitative interview study of patients and their carers in the community

Objective: To compare the illness trajectories, needs, and service use of patients with cancer and those with advanced non-malignant disease.Design: Qualitative interviews every three months for up to one year...

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

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