Utilization Of Services Research Articles

Impact of the COVID-19 pandemic on mortality and health services utilization costs of patients diagnosed with lung cancer

IntroductionHealthcare service disruptions due to the COVID-19 pandemic may have caused worse health outcomes and resulted in more expensive treatments for patients diagnosed with lung cancer in Alberta, Canada. MethodsA population-based retrospective cohort design was used to compare 1-year survival, mortality, and health services utilization costs of patients diagnosed with lung cancer pre- (March 17th, 2018 to March 16th, 2019), intra- (March 17th, 2020 to March 16th, 2021), and post-pandemic (March 17th, 2021 to March 16th, 2022). Kaplan-Meier curves and Cox regressions were used for estimating survival and hazard ratios. General linear models with gamma family and log link were used for estimating health services utilization costs. All costs were converted to 2024 Canadian dollars (CA$1~US$0.74). ResultsIn total, 2332, 2271, and 2408 individual patients were diagnosed with lung cancer in the pre-, intra-, and post-COVID, respectively. The survival at 365 days after diagnosis was 50%, 49%, and 51% for patients diagnosed with lung cancer pre-, intra-, and post-pandemic, respectively. Multivariate Cox regressions showed that patients diagnosed intra- and post-pandemic had a significantly (15% and 10%) higher probability of death at 1 year after diagnosis as compared to those diagnosed pre-pandemic (intra- vs. pre- HR=1.15, p=0.001 and post- vs. pre- HR=1.10, p=0.023). Patients diagnosed with lung cancer intra-pandemic had the highest health services utilization cost ($59.000) per patient per year, followed by post-pandemic ($55,510) and pre-pandemic ($51,640). Compared to pre-pandemic, the health services utilization cost intra-pandemic was 15.3% ($7,859) higher and post-pandemic was 7.5% ($3,887) higher. Although significantly higher than pre-, post-pandemic patients had a lower hazard ratio and health services utilization cost compared to intra-pandemic. ConclusionsLung cancer patients diagnosed during COVID-19 pandemic had significantly increased mortality and health services utilization costs compared to pre-pandemic, however, these impacts improved right post-pandemic.

Impact of discontinuing disease-modifying therapies on health care utilization among midlife patients with multiple sclerosis in the United States.

Multiple sclerosis (MS) is a lifelong progressive neurological disease treated primarily with disease-modifying therapies (DMTs). Disease activity tends to decline as patients age. Midlife represents a crossroads where the risks of DMT may outweigh the benefits, prompting providers to consider DMT discontinuation to reduce treatment burden. However, real-world evidence on the impact of DMT discontinuation among midlife patients is lacking. To evaluate the association between DMT discontinuation and health care utilization among midlife patients with MS. Midlife patients with MS who received an injectable or oral DMT between 2001 and 2018 were identified from the MarketScan commercial claims database. DMT discontinuation, defined as a treatment gap exceeding 90 days in days supply, was the independent variable. Patients who discontinued DMTs had their index date set as the last gap day, whereas index dates for those who continued DMTs were matched based on the time distribution of index dates of discontinuers. Inpatient hospitalizations (all-cause, MS-related, and non-MS-related), emergency department (ED) visits (all-cause, MS-related, and non-MS-related), and relapse-related hospitalizations and outpatient visits were independently evaluated during the 365-day follow-up. Patients were observed until the occurrence of an event (depending on the model), deviation from the treatment group, disenrollment, death, end of follow-up, or data unavailability. Stabilized inverse probability of treatment weighting (sIPTW) was employed to balance the 2 groups. The associations between DMT discontinuation and each utilization outcome were estimated using Cox proportional hazard regression models with sIPTW. Of 149,721 midlife patients with MS, 22.8% discontinued DMTs and 77.2% continued DMTs. Patients who discontinued DMTs had a higher cumulative incidence for all utilization outcomes during the 365-day follow-up than those who continued DMTs. Cox regression showed that DMT discontinuation was associated with a 10.3% and 24.9% higher rate of all-cause and non-MS-related inpatient hospitalizations, respectively, with no significant association found for MS-related hospitalizations. Patients discontinuing DMTs exhibited higher utilization rates for ED visits, with an increase of 21.3% for all-cause, 23.0% for MS-related, and 20.9% for non-MS-related visits compared with those who continued DMTs. We also observed a 15.9% and 52.1% higher rate of relapse-related hospitalizations and outpatient visits associated with DMT discontinuation, respectively. This study revealed that DMT discontinuation was associated with higher health care services utilization among midlife patients with MS, especially relapse-related outpatient visits. DMT discontinuation during midlife may be premature, and DMTs may still be necessary to reduce health care utilization.

Healthcare Service Utilization and Related Costs. A Comparison of the Situation of Persons With Spinal Cord Injury to the General Population.

The aim of the study is to investigate healthcare utilization and related costs in spinal cord injury compared to the Swiss population, addressing gaps in understanding this vulnerable group's needs. We analyzed healthcare utilization across age groups using data from the Swiss Health Survey and the Swiss Community Survey. Employing count models, Zero-Inflated Negative Binomial, and Poisson regressions, we estimated the adjusted healthcare visits across different age groups in the sample. Persons with spinal cord injury use 11 times more healthcare services than the healthy population and 4 times more than persons with other chronic health conditions. Notably, service providers for persons with spinal cord injury include physiotherapists, nursing services, general practitioners, and specialists. The high frequency of usage of persons with spinal cord injury translates into high costs, which is 3 times higher than in the general healthy population. These patterns become more evident as persons with spinal cord injury age, where nursing care and rehabilitation services become the most demanded services. Our findings show the multiple healthcare needs of people with spinal cord injury, which makes them a high-needs, high-cost group. This characteristic underscores the importance of preventive measures to reduce the incidence of spinal cord injury in older adults.

Take Care of the Patient: Pharmacists Should Advocate for Overdose Prevention Centers (OPC) as Harm Reduction.

Overdose prevention centers (OPCs) are places where people can bring previously obtained substances to use under the supervision of trained healthcare professionals who are prepared to intervene in the event of an overdose. Healthcare professionals, counselors and peer support provide services including naloxone distribution, provision of sterile injection equipment, counseling services, referrals to necessary providers, and above all, a safe and compassionate space for people to get the care they need. This is a method of harm reduction that has been used globally for decades and is now gaining traction in the United States. Pharmacists play a vital role in harm reduction for patients, and they should support the legalization and establishment of overdose prevention centers across the country to extend this essential service. A compelling body of evidence shows that overdose prevention centers reduce overdose deaths, emergency department visits for overdoses, wounds relating to injection drug use and reduce emergency medical service utilization in the area surrounding the centers. They also reduce drug use and discarded hazardous drug paraphernalia in public areas. Overdose prevention centers also provide wrap-around services that aid in holistic care of the person, including referrals to inpatient substance use treatment, detoxification, primary care, transportation and housing. It is the responsibility of pharmacists to advocate for the needs of patients, and overdose prevention centers will provide an effective avenue for pharmacists to deliver counseling and medication management services as part of care of the individual.

Emergency department visits, inpatient hospitalizations, and non-fatal and fatal drug overdoses during COVID-19 among Veterans with opioid use disorder.

The COVID-19 pandemic had dramatic adverse impacts on people with opioid use disorder (OUD), as evidenced by significant disruptions to care and unprecedented increases in drug overdoses. In this study, we evaluated the impacts of COVID-19 on utilization of emergency and inpatient care, and fatal and non-fatal overdoses among veterans with OUD. We used Veterans Health Administration (VHA) electronic medical record and mortality data to compare emergency department (ED) visits, inpatient hospitalizations, and fatal and non-fatal overdoses between a pandemic-exposed cohort of veterans with OUD observed both pre- and post-pandemic onset (n = 53,803; observed January 2019-March 2021) to a matched pre-pandemic control group (n = 53,803; observed October 2017-December 2019). Compared to pre-pandemic trends, there were significant decreases in the odds of ED and inpatient admissions and total number of ED and inpatient admissions during COVID-19. There was a significant decrease in the odds of having a recorded non-fatal overdose. The odds of overdose death increased during the pandemic compared to pre-pandemic trends. We observed significant decreases in the utilization of ED and inpatient care services, and fewer non-fatal overdoses, post-pandemic onset. Healthcare disruptions limiting access to emergency and inpatient care could account for the lower number of recorded non-fatal overdoses, potentially reflecting an underestimate of risk. In contrast, fatal overdoses increased during the pandemic compared to pre-pandemic trends. Lower utilization of emergency and inpatient care, and higher rates of fatal overdoses during the pandemic, suggest an exacerbation of unmet treatment need post-pandemic onset.

Implementation of KYC Principles for Indonesian Payment Services Provider

Payment Services Providing is a bright yet simple business to run for it requires a merely reliable system to execute transactions among banks as well as other entities. Nevertheless, these services are also utilized by criminals such as terrorists and/or money launderers. This paper is aimed to discuss the complex yet necessary execution of Know Your Customers Principle for a PSP. This is a library research to collect and analyze secondary data covering law and business literature published within 5 years as well as any legislation concerning PSPs. The research concluded that KYC Principles are mandatory for PSP with activities to manage funds such as in the form of e-wallet. Secondly, KYC Principles are not mandatory for PSPs with only activities as payment aggregator, billing provider and/or remittance services provider. At this point, it is suggested firstly to complete the regulations concerning KYC Principles for Indonesian PSPs. Secondly, utilization of KYC Services requires advanced technology concerning the way to obtain customers data as well as its storage and access availability.

Assessment of brand awareness and marketing techniques of health services by users of primary health centres in Indonesia

Community health centres are of great importance in the context of disease prevention and health promotion. Nevertheless, the number of individuals who utilise health centres for preventive care is significantly lower than those who seek treatment for existing illnesses. The objective of this study was to provide insights into innovative marketing strategies and brand awareness to enhance the utilisation of primary health services. A cross-sectional study was conducted with a randomly selected sample of 249 respondents who visited the health centre in 2023. The results of the survey indicated that the majority 62% of respondents had been informed about the healthy people mall innovation programme by the health centres. The most prevalent method of communication regarding the healthy people mall innovation program was through direct promotion by health centre health workers, as reported by 39% of respondents. This indicates that direct promotion remains a pivotal strategy for introducing the healthy people mall initiative. The healthy people mall plays a crucial role in prompting individuals to prioritize their healthcare services.

The Influence of Experience Value, Destination Image, Destination Service Utility on Tourist Loyalty with Tourist Engagement as an Intervening Variable and Heritage Value as a Moderating Variable in Tourist Villages on the Island of Java.

This research is expected to contribute to a deeper understanding of the dynamics of tourist loyalty in the context of tourist villages in Java, by considering various factors that influence it, such as Experience Value, Destination Image, Destination Service Utility, Tourist Loyalty, Tourist Engagement, and Heritage Value as Variable Intervening. This research model was analyzed using SmartPLS. Data were collected by distributing surveys to 230 tourists visiting tourist villages in Java Island. The data collection technique used a sample non- probability. The results of the study indicate that most of the hypotheses proposed are accepted, it is proven that there are eight hypotheses that are proven to have a significant direct relationship between variables, and three hypotheses do not have a significant relationship. The research model tested only shows the influence of variables that support sustainable growth, with these eight variables. Further research is expected to develop with other variables such as tourism village management, tourism village improvement strategies, tourism village development. This study proves that tourism villages can use research results to identify opportunities and threats that may arise from factors Destination Service Utility, in improving tourism development.

Male partners’ involvement in antenatal care and its associated factors in West-central Ethiopia

BackgroundMale partner involvement in antenatal care is a key factor that cannot be ignored in the quest for improvement in maternal health and is recommended as an essential intervention to improve maternal and neonatal health outcomes. However, little attention has been given to male partners’ involvement in maternity care, particularly in developing countries.ObjectiveThis study aimed to assess male partners’ involvement in antenatal care and its associated factors among male partners whose wives gave birth within the last one-year in Bichena town, Westcentral, Ethiopia, 2019.MethodsA community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019, in Bichena town, among 406 male partners. The data was collected by a simple random sampling technique and analyzed using the Statistical Package of the Social Science 23.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant.ResultsIn this study, 53.4% [95% CI: 48.3- 58.1%] of male partners had high involvement in antenatal care. The age group of 20–29 years [AOR = 2.14, 95% CI = 1.04–4.38], having primary, secondary, and diploma and above educational level [AOR = 2.04, 95% CI = 1.02–4.07], [AOR = 3.02, 95% CI = 1.49–6.11] and [AOR = 4.03, 95% CI = 2.06–7.89] respectively, ≤ 10 years marriage length [AOR = 2.92, 95% CI = 1.46–5.87], good knowledge of the services provided in antenatal care [AOR = 2.68, 95%, CI = 1.62–4.42], good awareness of the danger signs of pregnancy [AOR = 1.77, 95 CI = 1.10–2.85], favorable attitude towards antenatal care [AOR = 2.62, 95% CI = 1.64–4.19], travel less than 15 min to reach a nearby health facility [AOR = 3.43, 95% CI = 1.54–7.65] and making decision together to seek care in health facility [AOR = 2.44, 95% CI = 1.19–5.03] were associated with male partners involvement in antenatal care.ConclusionsMale partners' involvement in antenatal care was encouraging in the study area compared to previous studies done in Ethiopia. We suggest strengthening awareness among male partners about their shared responsibility during pregnancy. Male partners should be invited to attend the antenatal care. Policymakers and healthcare planners should design programs and plans that will encourage male partners’ involvement in maternal healthcare services utilization.

Determinants Influencing Utilization of Antenatal Care Services in Tabora Region, Tabora Municipality, Tanzania

This study examines the determinants influencing the utilization of antenatal care services (ANC) in in Tabora region with a particular focus on Tabora Municipality, Tanzania. The study used both quantitative and qualitative methods to analyze the problem. The study uses primary and secondary data obtained from the field. Tools used for data collection were questionnaires, interviews, and observation. This study employed a cross-sectional research design. This design was preferred because the design allowed the collection of data from different groups of respondents at one point at a time. Similarly, the design had a greater degree of accuracy and precision in the data collected and used for statistical description and interpretation. The study found that there was low utilization of antenatal care services in Tabora Municipality. The study revealed that the low utilization of ANC in Tabora Municipality can be solved by addressing the determinants that are responsible for the low use of ANC services. The study identified a number of determinants that influence ANC visits such as spousal involvement in antenatal clinics, the attitudes of health service professionals, clinic opening days for the antenatal care services by client satisfaction and integrated approach to antenatal care services. The determinants that affect the use of ANC visits are not only many and complex, but they play different roles in different situations. The study revealed that men and the whole community should be included in the ANC campaign so that they understand more about potential risks for pregnant women. This would increase the level of ANC use and thus reduce the high incidence of maternal and neonatal death in Tanzania including the Tabora region that results from poor utilization of ANC services. Also, this study adds knowledge to health service providers in understanding the determinants that limit pregnant women’s utilization of antenatal services finding ways to improve the services and encourage women to utilize ANC services. The study findings will enable programme planners, policymakers, implementers and managers to come up with strategies for interventions that will enable pregnant women to start seeking and utilizing ANC services early in pregnancy and to have fewer pregnancy complications that lead to maternal and neonatal deaths

Factors associated with utilization of oral health services among adults aged 18–70 years in Lira district, Northern Uganda: a community based cross-sectional study

BackgroundUtilization of oral health services is a global public health challenge. Low- and middle-income countries are disproportionately affected. Uganda is one of the low- and middle-income countries where only 4% of the population has access to oral health services. Northern Uganda is one of the regions in the country with limited information about oral health utilization.ObjectiveTo assess factors associated with utilization of oral health services among adults aged 18–70 years in Lira district, Northern Uganda.MethodsThis was a quantitative cross-sectional study conducted in Lira District. Multistage sampling was used to select 576 respondents. Data was collected using a researcher-administered structured questionnaire that was adopted, modified, and pretested. Data was analyzed at three levels, including univariate, bivariate, and multivariate at 0.05 significance level.ResultsOf the 634 respondents, 576 responded, giving a 90.9% response rate. Results show that utilization of oral health services was 20.5% (118) among adults aged 18–70 years in 6 months. Predictors of utilization of oral services among this age group are: having not attended any formal education (AOR = 0.2, 95%CI 0.06–0.62), having poor attitudes towards oral health services (AOR = 0.55, 95%CI 0.34–0.89), having cultural influence on the utilization of the oral health services (AOR = 4.84, 95% CI 2.77–8.43), accessing the services from private not-for-profit facilities (AOR = 4.67, 95% CI 1.79–12.16), being un sure of the availability of the equipment used (AOR = 0.42, 95% CI 0.18–0.9), and availability of friendly services (AOR = 2.53, 95% CI 1.12–5.50).Conclusions and recommendationsUtilization of oral health services is low in Lira district, with only 2 in 10 of the adults aged 18-70years of age utilizing oral health services in 6 months. To improve utilization, targeted health education campaigns should address cultural barriers and attitudes, while ensuring that public health facilities are better equipped and provide more user-friendly services.

Impact of the COVID-19 pandemic on university students' psychological distress, well-being, and utilization of mental health services in the United States: populations at greatest risk.

The COVID-19 pandemic led to major disruptions in the lives of university students, which is a population that is already at a greater risk of mental health concerns. Little is known about how the pandemic impacted distress and mental health services utilization among university students across the United States. Using survey data from the National College Health Assessment, both before the COVID-19 pandemic (pre-March 2020, n = 88,986) and during the pandemic (Spring 2021, n = 96,489), the present study examined mental health symptoms and utilization of mental health services among undergraduate students attending four-year universities in the United States. There were notable increases in measures of psychological distress and reductions in well-being from before the pandemic to during the pandemic. However, overall utilization rates of mental health services slightly decreased from pre-pandemic to during the pandemic. Predictors of severe psychological distress included those who experienced loneliness, COVID-19 related stressors, and loss of a loved one from COVID-19. COVID-related stressors and loneliness were associated with higher utilization rates of mental health services, while well-being and resilience were associated with lower utilization rates. Analyses revealed that several demographic groups were at an elevated risk for severe psychological distress, including non-binary, female, and sexual minority students, and especially those who identify as both non-binary and non-heterosexual. Results indicated that students of color, especially female students of color, were less likely to receive mental health services. Future research is needed to increase our understanding of the barriers to mental health service use among high-risk university students.

Assessing the change in prevalence and characteristics of canadians utilizing chiropractic services across two time periods 2001–2010 and 2015–2018: a population-based repeated cross-sectional study

BackgroundDespite increases in musculoskeletal disorders (MSD) in Canada, evidence suggests utilization of chiropractic services has remained relatively stable over time. Understanding the extent to which chiropractors are consulted and factors associated with their utilization may suggest factors related to accessing care. We assessed the change in prevalence and characteristics of Canadians seeking chiropractic care across two time periods 2001–2010 and 2015–2018.MethodsWe used national cross-sectional data from seven cycles of the Canadian Community Health Survey between 2001 and 2018. The survey included Canadians aged 12 years and older living in private dwellings in all provinces and territories. National annual weighted prevalence and age-standardized weighted prevalence (and 95% confidence intervals) of chiropractic utilization were calculated. We calculated prevalence of chiropractic utilization stratified by demographic, socioeconomic, lifestyle and health-related variables. Crude linear trends and change in prevalence from 2001 to 2010 were assessed using linear regression models.ResultsThe national annual prevalence of Canadians consulting a chiropractor in the previous 12 months slightly increased from 11.0% (95% CI 10.8, 11.3) in 2001 to 11.4% (95%CI 11.1, 11.7) in 2010, and in those reporting receiving regular health care from a chiropractor from 7.5% (95%CI 7.2, 7.7) in 2015 to 7.9% (95%CI 7.7, 8.2) in 2018. Prevalence of utilization varied by province, highest in the Western provinces but lowest in Atlantic provinces. The age-specific prevalence of chiropractic utilization was highest in those aged 35–49 years and remained stable over time, except for slight increase in those aged 65–79 years. A higher percentage of Canadians identifying as white, Canadian-born, in the highest quintile of household income, overweight, physically active and in excellent health reported seeking chiropractic services. The most common reported chronic conditions measured in the survey among Canadians consulting chiropractors were chronic back problems, arthritis, fibromyalgia and headaches.ConclusionThe national prevalence of utilization of chiropractic services among Canadians slightly increased over time but varied by province and respondents’ socioeconomic and health characteristics. Chronic back problems were the most common reported chronic condition. This comprehensive population-based study on chiropractic utilization in Canada can be used to inform decisions concerning health human resources and access to rehabilitation care for MSD.

From triage to treatment

Background: The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, leading to changes in presentation types, service utilization, and admission rates to emergency departments (ED). This study examines changes in ED visit patterns and triage misclassifications during the pandemic in Alberta, Canada. Methods: We conducted a retrospective population-level time-series analysis of all patients who presented to 12 EDs in the Edmonton Alberta Zone between March 3, 2019, and March 3, 2022. Routinely collected electronic health record data were analyzed and with primary categories of reporting including Canadian Triage Acuity Scale (CTAS), age, Canadian Emergency Department Information System (CEDIS) presenting complaint, admission status, triage misclassifications, and time markers for patient care. Results: 1.24 million cases from 12 hospitals were included. When we compare the patterns of presentation to the pre-pandemic period, we found a relative increase of 12.5% in EMS volumes, a 43.2% relative reduction in the proportion of patients presenting to tertiary EDs, 17.2% relative reduction in the number of patients under the age of 18, and a global increase in acuity with the highest relative increase 19.7% coming from patients in the highest acuity level: CTAS 1. Complaint distributions during these periods demonstrated that mental health, substance use, and environmental complaints experienced 15.5%, 22.4%, and 26.7% relative increases in volume, respectively; pediatric specific complaints experienced a 56.5% relative reduction. By the end of the study period, patients spent an average of 59 minutes longer in the ED compared to the pre-pandemic period. The proportion of patients triaged using Epic increased from 7.8% of all patients triaged in the pre-pandemic period to over 66.1% during the pandemic, and there was a 22.9% and 24.2% relative reduction in high-risk triage misclassifications (22.9%) and pain related triage misclassifications (24.2%) by the end of the period compared to the before the pandemic. Conclusion: Our study adds to the pandemic-related emergency care knowledge base by describing ED visit trends, changes in presenting complaint categories and time markers for patient care over a big-data pre and post pandemic dataset. Nursing-specific ED quality indicators that have not been previously described over a three-year duration between March 3rd 2019 and March 3rd 2022. are also presented. Our study findings have significant implications for healthcare professionals and policymakers in understanding both the impact of the pandemic on ED care delivery as well as future pandemic and post-pandemic ED operations.

Utilization of cervical cancer screening services among women aged 18 to 59 years in Laikipia East Sub-County, Kenya

INTRODUCTION Cervical cancer, a preventable disease, continues to be the leading cause of death resulting from cancers in Kenya. Despite free cervical cancer screening services in all government hospitals in Laikipia County, the screening uptake remains low at 19% compared to the WHO target of 70%. Hence, understanding the barriers and facilitators is important in informing targeted interventions. MATERIALS AND METHODS A mixed-method cross-sectional study was done in Laikipia East Sub-County, Kenya, between July and August 2022. The participants were women aged between 18 to 59 years. Data was collected on demographic factors and cervical cancer screening utilization. Also, qualitative data was collected using 5 FGDs and 6 KIIs to get more insights. Chi-square tests and odds ratios were calculated using STATA version 15 to assess associations and determine the level of significance. RESULTS Out of the 272 participants, 32.4% (n=88) had ever screened for cervical cancer. The logistic regression analysis indicates that as women age, their likelihood of undergoing screening increases, particularly for those aged 50-59, who show a tenfold higher likelihood of screening [ OR 10.40 (3.20-33.82), p-value &lt;0.001]. Conversely, unemployment is associated with a reduced likelihood of screening [OR 0.42 (0.18-0.99), p-value 0.047] while individuals earning 50-200 USD per month exhibit an increased likelihood [OR 2.25 (1.30-3.87) p-value 0.004]. However, religion, marital status, and education level factors do not show a significant association with the utilization of cervical cancer screening as indicated by p-values of 0.735, 0.069, and 0.765, respectively. CONCLUSION AND RECOMMENDATIONS Laikipia county government offers free cervical cancer screening in all government-run facilities but many, especially those aged 25-49, lack awareness. It is vital to boost awareness through community education on cervical cancer causes and prevention, emphasizing screening as preventive. Affordable treatment is also crucial for community reassurance post-diagnosis.

Emergency Medical Services and Police Utilization for Pediatric Mental and Behavioral Health Concerns Within a Large Hospital System.

This study aimed to compare emergency medical services (EMS) and police utilization trends, epidemiology, and emergency department (ED) outcomes between pediatric patients with mental or behavioral health (MBH) emergencies and those with non-MBH concerns transported to a large children's hospital system. This was a retrospective cohort study of patients aged 5 to 18 years transported via EMS and police to two EDs affiliated with a children's hospital from January 2012 through December 2020. Data were abstracted from electronic hospital records. Encounters for MBH emergencies were identified using diagnostic codes and chief complaints. Trends of EMS and police transports of patients with MBH emergencies were examined. Patient demographics and ED outcomes were compared between children presenting with MBH emergencies and those with non-MBH concerns. During the 9-year study period, out of 40,663 transports to the EDs, 36,137 (89%) arrived via EMS, and 4,526 (11%) arrived via police. A total of 10,250 (28.4%) EMS transports were for MBH emergencies. The volume of patients transported by EMS for MBH emergencies increased by 1.4% per year (P < 0.01) with no significant change in total EMS patient volumes. Patients with MBH emergencies transported by EMS were more likely to be older, female, of White race, and publicly insured; require restraint in the ED; and be admitted (P < 0.001). Of police transports, 4153 (91.8%) were for MBH emergencies, with no statistical change in the proportion of police transports that were for MBH emergencies. Police-transported MBH patients compared to non-MBH police-transported patients were more likely to be younger, female, and of White race (P < 0.001); 8.7% required mechanical/physical restraints in ED, 6.7% required pharmacologic restraint medications in ED, and 53% were admitted. The proportion of pediatric transports for MBH emergencies by EMS is rising and comprises the majority of police transports. Distinct from non-MBH pediatric patients transported, MBH patients necessitate significant ED resources, including ED-administered restraints and admission, highlighting their unique burden on the prehospital and ED systems.

Midwife-Led Mobile Antenatal Clinic: An Innovative Approach to Improve Utilization of Services in Pwani, Tanzania

Participating in antenatal clinics is a major determinant in reducing poor maternal and neonatal birth outcomes. We aimed to evaluate the utilization of antenatal clinic (ANC) services provided by a mobile clinic led by skilled midwives and determine the acceptability in the Pwani region, Tanzania. For a year, the mobile clinic, nicknamed “Mkunga Kitaani” and equipped with necessary tools and staff, served seven villages in the Kisarawe district that lacked health facilities. The research was conducted using a descriptive study design, incorporating both qualitative and quantitative methods. Qualitative and quantitative data were collected through 12 interviews and 214 medical records among pregnant women, respectively. The results show that approximately 17% of the women initiated ANC early, while 36% made their visit during their third trimester. Participants generally preferred the mobile clinic over traditional facilities due to its provision of comprehensive care. However, challenges such as clinic unreliability during the rainy season and limited availability of tests, including obstetric ultrasounds, were noted. Despite hurdles, the study highlighted increased ANC access and community engagement, suggesting potential for expansion to other underserved rural areas. The findings underscore the importance of innovative approaches to ANC delivery in regions with limited healthcare infrastructure.

Treatment patterns and characteristics of patients with Post-Traumatic Stress Disorder (PTSD): A retrospective claims analysis among commercially insured population.

This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity. The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD). The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent. PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence.

Young Adults with a History of Residential Youth Care: A Cohort Profile of a Hard-to-Reach Population

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study—the VINGO study—targeting young adults (22–30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021–2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults.

Utilization patterns of Chiranjeevi Swasthya Bima Yojana in Rajasthan during financial year 2023 to 2024: a cross-sectional study at a tertiary care hospital

Background: Publicly funded health insurance (PFHI) is considered a key policy tool to provide financial protection to households seeking healthcare. The state government of Rajasthan has launched Mukhya Mantri Chiranjeevi Swasthya Bima Yojana (CSBY), with a cover of 25,00,000 INR per family per year, that makes it one of the largest PFHI in world by cost-coverage. However, there is an evidence-gap on utilization patterns and consequent need of higher-rate packages in state-PFHIs. A study was designed with the objective to describe the utilization pattern of CSBY in Rajasthan. Methods: The cross-sectional study was conducted at Sawai Man Singh Hospital in Jaipur, the highest public tertiary care institute of Rajasthan. The data on CSBY hospitalisations was collected from Chiranjeevi portal for financial year 2023-2024. Summary statistics were used to describe the variables such as age and gender of beneficiaries and medical specialities and cost details of packages utilised. Results: The mean age of patients was 45.9 (±20.0) years and 62.1% were males. The top specialty by volume of admission was general medicine (14.2%) and by cumulative cost of packages utilized was cardiology (22.0%). The median cost of packages utilized per hospitalization was 12,200 INR. 96.8% of beneficiaries utilized the services at a cumulative cost of up to 1 lakh INR and only 0.01% patients utilized more than 5 lakh INR. Conclusions: The study found higher utilisation of highly-specialised services over broad-specialties and an underutilisation of higher-rate packages, demonstrating a gap in perceived need of higher-rate packages in the state.