Utilization Of Services Research Articles

Factors Associated With Medication Adherence Among Patients With Attention-Deficit/Hyperactivity Disorder (ADHD).

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common behavioral health condition that impacts 5% to 8% of children and 2.5% of adults worldwide. The symptoms of ADHD are effectively managed with medication, yet patients with ADHD may inconsistently take their medication. We assessed medication adherence among patients with ADHD and identified factors associated with medication adherence that may be utilized to optimize adherence. This is a retrospective, observational study among patients aged 4 years and older with a diagnosis of ADHD at primary care and multispecialty outpatient clinics during May 2021 to May 2023. We assessed sociodemographic characteristics, stratified by medication adherence status (Percentage of Days Covered ≥ 80%) using simple proportion, Student's t-test, and Chi-square test. We conducted univariable and multivariable logistic regression analyses to assess potential medication adherence factors, including sociodemographic characteristics, depressive symptoms, suicide risk, health service utilization, and social determinants of health (SDOH). We found 7,661 patients diagnosed with ADHD, with a mean (SD) age of 21.8 (14.8) years. The ADHD prevalence was 5.5% for patients aged 4 to 12, 4.4% for 13 to 17, and 0.8% for 18+ years old. Most patients were male (56.9%), non-Hispanic White (37.6%), and privately insured (55.1%). Among these patients, only 4,242 (55.4%) were treated with medication. Among 4,011 patients with medication adherence information, the average adherence rate was 56%, and only 1,113 patients (27.5%) met our threshold for adherence to ADHD treatment (80%). Adherence was positively associated with being adults, having more BH and PCP visits, and negatively associated with racial and ethnic minorities and more severe depressive symptoms. Only half of patients with ADHD were treated with medication. Of those treated, less than a third adhered to medication. Age, race and ethnicity, depressive symptoms, and BH and PCP visits were statistically associated with medication adherence. Healthcare providers may need to address factors such as coexisting depressive symptoms, and unmet SDOH needs to improve medication adherence among patients with ADHD. Also, patients reaching adolescence may need enhanced medication management.

Is There Value Without Context? A Survey Evaluating How Laboratory Test Results Are Presented to Patients in Canada.

Although direct reporting of laboratory test results to patients improves engagement and utilization of healthcare services, this assumes that results are presented in a manner that can be comprehended and acted upon by patients. To evaluate the practice of patient reporting across Canadian laboratories, a voluntary survey was distributed. 22 responses were received from laboratories and laboratory networks nationwide, representative of the range of Canadian laboratory and patient demographics. Despite the Connected Care for Canadians Act being passed in June 2024, one-third of respondents do not provide results to patients. Of those that do, results largely replicate physician reports and are heterogeneous between labs, with different strategies used to present data and flag abnormalities. A minority of labs suppress some testing from patient receipt, modify reports to improve patient comprehension, or provide graphs to support interpretation and trending. Laboratory professionals largely agreed that there are benefits in modifying reports to aid in patient comprehension but expressed concern that patient health literacy is currently in adequate. This may lead to increased anxiety, misinterpretation of results, follow-up questions, self-diagnosis, and undue stress until a healthcare provider could be consulted. Collaboration with patients and healthcare providers is necessary to develop guidelines on meaningful direct-to-patient reporting.

Quality of care for newly diagnosed patients with rheumatoid arthritis in South Korea: A nationwide cohort study.

This study aimed to evaluate the quality of care in newly diagnosed RA patients by analyzing conventional disease-modifying antirheumatic drugs (cDMARDs) treatment patterns and healthcare utilization using a nationwide claims database. This retrospective cohort study was conducted using the Korean Health Insurance Review and Assessment database. Study subjects were those newly diagnosed with RA (ICD-10 code M05, M06) and were prescribed a cDMARD in 2014, with follow-up until 2018. Demographic and clinical information, the level of healthcare facilities (LOH) at which the first prescription claim was made, and subsequent healthcare service utilization were collected. We also analyzed the initial pattern in cDMARD prescription and its retention rate. A total of 21,136 patients were analyzed. Diagnosis of seronegative RA (n = 14,571, 68.9%) was more common than seropositive RA. Seropositive RA was most often discovered in tertiary general hospitals (n = 2,230, 34.0%), whereas seronegative RA was most diagnosed in primary care clinics (n = 7,539, 51.7%) (P < 0.001). The most prescribed initial cDMARD was hydroxychloroquine as monotherapy (n = 9,867, 46.7%). However, methotrexate, a well-established first-line cDMARD, was prescribed in 5,447 (25.8%) patients. The discontinuation rate of cDMARD was higher in seronegative than seropositive patients (65.3% vs. 90.3%) and in patients first diagnosed in community LOH (P for trend < 0.001). The mean number of visits to any outpatient clinics (35/year) was substantially higher than that of the general population. Yet, the number of outpatient visits for RA management was only 2.8/year. The quality of care for newly diagnosed RA patients in South Korea can be improved. Further education on accurate diagnosis and effective treatment is necessary to improve the quality of care provided by other specialists and general practitioners.

"Diagnose & Adios": Multi-Perspective Insights on Formal Service Use in Dementia Family Caregivers.

Dementia family caregiving is a complex role that becomes increasingly intense and demanding over time. The utilization of home and community-based services (HCBS) can provide knowledge and skills to foster preparedness, which may protect against adverse caregiving outcomes; yet actual uptake of services remains low. The current study aims to gather multi-perspective insights underlying the disconnect between caregivers' need for-versus utilization of-HCBS using Pearlin et al.'s (1990) stress process model as a guiding theoretical framework. Five focus groups of 4-8 participants each were conducted with dementia family caregivers (n = 13) and subject matter experts (n = 17). A deductive-inductive thematic approach was used for data analysis. Three overarching concepts were identified: "Pathways to Preparedness'", 'Multi-Level Barriers', and 'Bridging the Gap.' Findings reflected caregivers" need for support in 4 core areas: (a) dementia-specific education/training; (b) competent mental health support; (c) financial/legal navigation, and (4) emergency readiness. Results revealed cross-dimensional barriers across individual-, provider-, and systemic-contexts impeding HCBS access and utilization. Personalized caregiving navigation and technology were deemed potential solutions to facilitate clearer clinical pathways between unmet needs and relevant services. Results underscore the complexity of the HCBS system in the United States and highlight the multidimensional barriers disrupting the pipeline connecting caregivers to HCBS. Findings can inform web-based behavioral interventions aiming to enhance family caregivers' knowledge of, access to, and utilization of formal services in community settings.

Development of planning of the integrated care for older people in China: a theory of change approach

BackgroundIntegrated Care for Older People (ICOPE), developed by the World Health Organization (WHO) with a global perspective, faces varying degrees of barriers to implementation, particularly in middle-and low-income countries. Therefore, as with other new public service interventions, we draw on established integrated care interventions to design a Theory of Change (ToC) model for ICOPE, and to propose methods and pathways for adapting community-based integrated care models for older people (OP) to specific contexts, thereby updating and enhancing the implementation of ICOPE.MethodsAn initial ToC for the ICOPE was drafted based on the WHO guidelines and published literature, and synthesizing the results of semi-structured interviews, group discussions. A total of 36 healthcare stakeholder experts in geriatric nursing, geriatric care and chronic disease management, rehabilitation and quality of life, and psychiatric-mental health were recruited to participate in a 5-stage ToC group workshop conducted consecutively. Each workshop has 2–3 facilitators, and lasts from 60 to 120 min. In multiple workshops, the experts discussed the causal pathway, the interventions needed to activate it, the underlying principles and assumptions, evaluated and refined them, and finally reached consensus.ResultsThe ToC design has improved the ICOPE program, identifying the resources, long-term outcomes, and impacts required for the implementation of ICOPE in a specific setting, and clarifying the specific components of the integrated care interventions, such as materials, procedures, and intervention providers. The localized, OP-centred model of integrated home care developed in our study may contribute to healthy ageing through four potential long-term outcomes: (1) reduction of unnecessary hospitalizations and increased utilization of referral services, (2) enhancement of self-care capacity to prevent, reverse, or delay the decline of intrinsic capacity in OP, (3) improvement of the quality of life of OP living at home, and (4) reduction of caregiving burdens and improvement in the level of caregiving.ConclusionThe ToC is effective in identifying key characteristics of resources, interventions, impact, and outcomes of integrated care for OP. Our ICOPE program has been strengthened by ToC, which forms an integrated care model for assessment, planning, implementation, and evaluation, adapted to a specific setting, and provides guidance for other areas in similar settings.

Co-designing Healthcare Interventions with Users: A Discrete Choice Experiment to Understand Young People's Preferences for Sexual and Reproductive Health Services in Lusaka, Zambia.

Like in many countries, coverage of sexual and reproductive health (SRH) services among adolescents and young people (AYP) aged 15-24 remains low in Zambia. Increasing coverage of SRH services requires interventions that are responsive to the needs and preferences of AYP. We conducted a discrete choice experiment (DCE) to elicit AYP's preferences for SRH service delivery in Lusaka, Zambia. A cross-sectional DCE was conducted with AYP aged 15-24 years. Consenting participants were presented with alternative SRH service delivery strategies represented by six attributes, namely: location, type of provider, type of services, service differentiation by sex, availability of edutainment, and opening hours. Multinomial logit and random parameters logit models were used to analyse the data. All variables were effect coded. A total of 423 AYP aged 15-24 years (61% female) completed the DCE. Respondents preferred SRH services that were integrated with other healthcare services (b = 0.65, p < 0.001), delivered by medical staff and peer support workers (b = 0.44, p < 0.001), and provided at a hub within a health facility (b = 0.62, p < 0.001). AYP also preferred services to be available on weekends during the daytime (b = 0.37, p < 0.001). Participants also preferred alternatives which included edutainment (b = 0.22, p < 0.001). Service differentiation by sex had little effect on the preference for SRH service delivery (b = - 0.05, p = 0.08). The coefficient for the "neither" option was negative and statistically significant (b = - 5.31, p < 0.001), implying that AYP did not favor routine SRH service delivery in an outpatient department. Efforts to increase SRH service utilization among AYP should focus on providing comprehensive SRH services that are integrated with other healthcare services. These services should be delivered by a combination of medical staff and peer supporter workers in youth-friendly spaces. Careful attention should be paid to opening times to ensure that these are convenient to AYP.

The interaction of COVID-19 and sociodemographic factors on pediatric rehabilitation service initiation

Purpose This study examined the effect of the COVID-19 (COVID) pandemic on pediatric rehabilitation referrals and service initiation. Materials and methods In a retrospective cohort study, we examined rehabilitation service utilization in 32 721 children between 2018 and 2022. Descriptive statistics compared service initiation rates by key patient characteristics during the pre-COVID/COVID periods and logistic regression estimated the changes in service initiation. Results During COVID, service initiation decreased significantly by 23% (p < 0.001), whereas referral rates remained stable. The multivariate model showed that the rate of service initiation decreased faster for children aged 13–18 years than children aged 0–2 years (−11.1 vs. −6.8 percentage points (pps)). Speech-language pathology service initiation decreased significantly more than physical therapy during COVID (−12.2 vs. −6.5 pps), and urban service initiation rates decreased more than rural rates (9.2 vs. 0.9 pps). Disparities in service initiation by race, insurance type, urban/rural location, and primary language were persistent prior to and during COVID. Conclusions Policies and procedures are needed to address disparities that existed prior to and during COVID in rehabilitation services access. It is critical to screen children for rehabilitation needs that may have gone untreated during COVID to optimize functional outcomes and quality of life.

A narrative review of mental health help-seeking and service utilization models for Black internalizing adolescents

A narrative review of mental health help-seeking and service utilization models for Black internalizing adolescents

Impact of insurance type on outpatient mental health treatment of US adults

The mental health treatment gap in the US continues to be a major public health challenge. Even individuals with health insurance face substantial barriers to care, including high costs, insufficient coverage and inaccurate provider directories. Policies to address the treatment gap require updated population-based information about whether treatment rates vary by type of insurance. The current study aimed to compare past-year outpatient mental health treatment across insurance types (private, Medicare, Medicaid, other, or none), in the household sample of non-elderly adults in the Mental and Substance Use Disorder Prevalence Study (MDPS), (n = 4,640). MDPS, fielded October 2020 through October 2022, identified 12-month prevalence of mental disorders and rates of treatment among US adults from interviews by trained clinicians using the Structured Clinical Interview for DSM-5. Logistic regressions estimated odds of treatment among participants with a past-year MDPS diagnosis across insurance types, after adjusting for age, sex, race/ethnicity, income level, diagnosis, and functional impairment. Analyses were weighted to reflect the US adult population. 60.2% of the 1,833 participants with an MDPS mental disorder received outpatient treatment in the past year. Compared to participants with private insurance, those with no insurance had lower odds of outpatient treatment (AOR = 0.37 [0.16-0.87]). Participants with Medicare had higher odds of treatment (AOR = 4.25 [1.56-11.64]), suggesting that individuals with complex and disabling illness were least likely to have treatment disruptions during the early phases of the pandemic. Differences between groups decreased as the pandemic progressed, but utilization of services only significantly increased among individuals with private insurance. Persisting mental health treatment gaps in the US vary by type of health insurance, which warrants extensive policy reforms.

Inequalities in antenatal care service utilization in Nepal: evidence from nationally representative Nepal multiple indictor cluster surveys 2014 and 2019

IntroductionAntenatal care (ANC) is essential for improving maternal and neonatal health outcomes, and its utilization is influenced by socioeconomic factors. This study aims to assess disparities in ANC service utilization by wealth, caste/ethnicity, and province among Nepalese women, using data from the nationally representative Nepal Multiple Indicator Cluster Surveys (MICS) 2014 and 2019.MethodsWe assessed the association of ANC service utilization with the household wealth index quintiles, caste/ethnicity and province using multivariable logistic and negative binomial regression models. We also measured wealth-related inequality using concentration curves and concentration indices.ResultsThe proportion of women who received four or more ANC visits increased from 60.6% in 2014 to 77.8% in 2019. However, in both 2014 and 2019, women in the highest wealth quintile were over five times more likely to receive recommended ANC visits than those in the lowest quintiles. Similarly, the expected number of ANC visits was 70% higher in 2014 and 35% higher in 2019 for women in the highest wealth quintile compared to the lowest quintile. Concentration curves showed a decrease in pro-rich inequality in ANC utilization by 2019 relative to 2014, though notable inequality remained. Geographic disparities were evident: Karnali and Madhesh provinces had significantly lower utilization of recommended ANC visits and fewer ANC visits than Koshi Province. Ethnic disparities were also prominent, with women from Dalit, Disadvantaged Janajati, and Other Madheshi caste groups being significantly less likely to complete recommended ANC visits.ConclusionOur findings reveal persistent wealth-related inequality in ANC service utilization in Nepal, with women from wealthier households, advantaged caste/ethnic groups and better-off provinces having higher odds of receiving recommended ANC visits and a higher number of ANC visits. Concerted efforts are needed to address these equity gaps in ANC service utilization, particularly for women from low-income households, disadvantaged caste/ethnic groups, and underserved provinces.

Highlighting maternal healthcare utilization in five scheduled tribes of Assam, North-East India: Determinants and strategies for improvement

ABSTRACT According to World Health Organization, “maternal health is the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the healthcare dimensions of family planning, preconception, prenatal and postnatal care in order to ensure a positive and fulfilling experience in most cases and reduce maternal morbidity and mortality in other cases.” The most vital importance of maternal and child health (MCH) care services is to improve the outcome of both mother and child by preventing maternal and child mortality. Utilization of maternal healthcare services plays a critical role in reducing maternal, infant and child mortality along with the improvement in reproductive health of women. This paper attempts to provide an in-depth analysis of the determinants of maternal healthcare services utilization among the five tribes of Assam, India. The study is significant as it highlighted the major determinants of maternal healthcare service utilization in tribal context. The data were collected from Lakhimpur, Dibrugarh, Dhemaji, Sivsagar and Tinsukia districts through primary survey conducted among the Mishings, Sonowal Kacharis, Deoris and the Hajongs. Data are collected from July 2023-January 2024. The findings reveal that women’s autonomy in decision making on taking care of her health is an important factor in getting access to healthcare services. We observed that mother’s role in financial autonomy (Taking decision on spending money on treatment), choice of delivery, preference for doctor, or the nature of treatment has an influence on her access to healthcare services.

Exploring the pattern of mental health support-seeking behaviour and related barriers among women experiencing intimate partner violence in urban slums of Bangladesh: perspectives from multiple level stakeholders.

Intimate partner violence (IPV) is a recognised global public health concern, substantially impactingwomen's well-being. While there is growing research on how IPV victim-survivors seek mental health support in the Global North, it remains understudied in the Global South, particularly for those residing in slums in low-income countries like Bangladesh. Through interviews and group discussions with different stakeholders, this study explored the mental healthcare-seeking behaviour of victim-survivors of IPV residing in urban slums, barriers to service utilisation, and recommendations to strengthen care pathways. Stakeholders perceived IPV as normalised in slums, indicating sociocultural norms and interpersonal causes as significant contributors to mental health issues and events of IPV. Seeking healthcare and moral support for IPV from local dispensaries and informal sources was common; however, IPV victim-survivors had no knowledge about mental-health-related services. Low mental health literacy and lack of financial support prevented them from seeking the necessary care. Social stigma regarding accessing mental healthcare, coupled with the absence of professional service providers and community-based services, represent critical systemic challenges. Recommendations included promoting community-level awareness of IPV and mental health issues, increasing mental healthcare services, training health workers, and fostering positive masculinities in community-based interventions. Stakeholders emphasised the need to adopt culturally relevant interventions for tackling IPV and improving mental healthcare pathways, especially for the low-income population of Bangladesh.

Subtypes and service utilization among opioid use disorder patients at a community health center: findings from a medically underserved urban area of the Northeastern United States

BackgroundOpioid use disorder often co-occurs with other mental health and substance use disorders. Identifying clusters of individuals receiving treatment for opioid use disorder based on co-diagnosed conditions, healthcare plans, and service utilization over a seven-year treatment period provides insight into service needs. Objectives included [1] characterizing the sample [2], examining subtypes of the sample using cluster analysis, and [3] identifying differences in Current Procedural Terminology by subtype to examine service utilization among identified clusters.MethodsThis study uses secondary data from the electronic medical records of a community health center in a large urban area in the Northeastern United States from 2015 to 2021. The study sample included N = 705 adults who had an opioid use disorder diagnosis as indicated by the community health center’s electronic medical records. Measures include [1] age [2], race and ethnicity [3], sex [4], healthcare plan(s) [5], co-occurring mental health disorder [6], co-occurring substance use disorder [7], co-occurring mental health disorder or substance use disorder, and [8] Current Procedural Terminology codes for behavioral health service utilization. Cluster analysis was used to examine the sample. These clusters were then analyzed for service utilization with a one-way analysis of variance.ResultsThe cluster analysis identified six clusters with an average silhouette of 0.5, indicating good clustering. These six clusters were operationalized as [1] Medicare/Medicaid healthcare plan with substance use disorder needs [2], Private pay and charity care healthcare plan with cocaine use disorder needs [3], Medicare/Medicaid and other publicly-funded healthcare plans with mood disorder needs [4], Private healthcare plan with low co-occurring disorder needs [5], Other publicly-funded healthcare plan with cannabis use disorder needs [6], Medicare/Medicaid healthcare plan with mental health disorder needs. Service utilization differed between these clusters with cluster mean differences for psychotherapy sessions (F = 8.55, p < 0.001), psychiatric sessions (F = 22.72, p < 0.001), and group therapy sessions (F = 10.76, p < 0.001).ConclusionsThis study highlights the importance of comprehensive and integrated treatment for substance use disorders and mental health disorders, particularly for those in underserved communities. Healthcare coverage, a socioeconomic factor that impacts access to care, is critical in distinguishing treatment needs and utilization.

Associated factors for the utilization of institutional delivery services in Nepal: Findings from the Nepal Demographic Health Survey, 2022.

Institutional delivery provides skilled obstetric health care, postnatal care, and essential medical timely intervention to enhance the health of mothers and children. In Nepal, the proportion of institutional deliveries has increased from 8 percent in 1996-79 percent in 2022, although it is not satisfactory. This study investigates disparities in the utilization of institutional delivery service across associated factors related to residential factors, socio-economic factors, health service-related factors, and bio-demographic factors. We used secondary data from the Demographic and Health Survey (DHS) 2022 of Nepal. It involves a sample of 1977 eligible women aged 15-49 who had given birth within two-year preceding the survey. We considered institutional delivery as an outcome variable, while residential, socio-economic, bio-demographic, and health service-related factors as independent variables. Descriptive analysis and binary logistic regression analysis for crude and adjusted odds ratios (AOR) along with 95% confidence interval (CI) were utilized. Of the total 1977 women, 1569 (79.4%) opted for institutional delivery. Women belonging to the Muslim ethnic group had lower odds (AOR:0.500, 95% CI: 0.259-0.966, p < 0.050) compared to their reference group. Similarly, the likelihood of opting for institutional delivery was significantly lower among women who required more than 30 minutes time to reach a health facility (AOR:0.626, 95% CI: 0.491-0.800, p < 0.001) and those having 6 + parity (AOR:0.080, 95% CI: 0.032-0.205, p < 0.001) compared to their reference group. In the contrary, women from Terai region (AOR:2.428, 95% CI: 1.194-4.937, p < 0.050), Bagmati Province (AOR:2.327, 95% CI: 1.179-4.593, p < 0.050), secondary and higher education level (AOR:3.161, 95% CI: 2.141-4.668, p < 0.001), richest wealth group (AOR:13.451, 95% CI: 5.231-34.589, p < 0.001), and antenatal care (ANC) visits 4 and more times (AOR:5.084, 95% CI: 2.7963-9.242, p < 0.001), were noticed more likely to choose for institutional delivery compared to their reference group, respectively. The result shows the ecological region, province, ethnic group, distance to reach health facility, parity, respondents' education level, wealth index and ANC visits, and mother's age in 5-year groups are the associated factors for the utilization of institutional delivery service in Nepal. It highlights the need for targeted interventions to enhance the utilization of institutional delivery services. Addressing socio-economic and geographical disparities, economic barriers, advancing education, promoting antenatal care visits, and ensuring nearer healthcare accessibility are crucial to achieving the equitable maternal and neonatal health care through institutional delivery in Nepal. It is concluded that more attention needs to be paid to areas where the severity persists by professionals and policymakers as well.

Analysis of influencing factors and equity in health education for mobile populations based on random forest model: evidence from the China migrants dynamic survey

BackgroundStrengthening health education is an important measure to improve the health of mobile populations and a key objective of China’s basic public health services. Existing studies demonstrate that health education affects the health of mobile populations, but insufficient attention is paid to the importance of factors that influence health education. Moreover, few studies examine how these factors contribute to health education equity among mobile populations in China. Therefore, this study aims to reveal the importance of factors affecting health education based on a comprehensive understanding of mobile populations’ overall health education status. Furthermore, the contribution of these important factors to health education equity is analyzed to inform differentiated intervention strategies, thereby providing a reference for enhancing mobile populations’ health level and achieving equal access to basic public health services.MethodsThis study utilized data from the 2018 China Migrants Dynamic Survey (CMDS), with a final sample of 103,910 participants after data cleaning. Chi-square tests were first conducted to examine differences in health education across various characteristics of the mobile population. The relative importance of influencing factors was then assessed using a random forest model, followed by key factor identification through LASSO regression. Subsequently, binary logistic regression was performed to quantify the effects of these key factors. Finally, concentration indices were calculated to identify these factors’ contributions to health education equity.ResultsThe self-assessed health status of China’s mobile population was good, with 81.89% reporting receipt of health education, while 18.11% had not received any health education. Seven key factors were identified as most influential in determining health education access among the mobile population: income, education, age, health record, scope of mobility, reason for mobility and gender. The health education concentration index of the mobile population was 0.0121, indicating a significant inequality in the utilization of health education services. Each important factor had a significant negative amplifying effect on health education equity among the mobile population.ConclusionHealth education among the mobile population requires further enhancement. Special attention should be directed toward vulnerable groups, including low-income individuals, the older adult, those with lower educational levels, and those with wider migration ranges. Moreover, the impact of key factors on health education equity among the mobile population should be carefully considered to improve health education equity.

The Correlation between Availment of Maternal Care and Receiving of Health Services through 4Ps Health Grant with the Perceived Improvement in Child and Maternal Health among Women of Reproductive Age in 4 Barangays in Tondo, Manila

The Pantawid Pamilyang Pilipino Program (4Ps) is a conditional cash transfer program of the Philippine government that seeks to reduce poverty by encouraging health and education among poor families. The present study investigated the relationship between the utilization of maternal care and routine health services through the 4Ps Health Grant and perceived improvement in maternal and child health among women of reproductive age in four barangays in Tondo, Manila. Employing a quantitative correlational design, information was gathered through systematic surveys that were distributed to beneficiaries of the 4Ps between the ages of 20 to 80 years old. Snowball sampling was utilized in order to access respondents, and information was computed utilizing Spearman's rho correlation in SPSS. Findings showed that most respondents made extensive use of health benefits, routine check-ups, and health education services. Statistical analysis revealed a weak but significant positive relationship between both maternal care availment (r = 0.199, p = 0.006) and regular health service receipt (r = 0.214, p = 0.003) with perceived improvements in maternal and child health. These results indicate that while 4Ps Health Grants can enable enhanced health-seeking behavior, underlying structural problems like limited medical infrastructure and service quality continue to prevent the program's potential. The research concludes that while the 4Ps Health Grant has a positive impact on maternal and child healthcare attitudes, improvements in accessibility, staffing, and service delivery are essential in order to ensure maximum long-term health outcomes. This study is part of an increasing body of literature on the effectiveness of conditional cash transfer schemes and provides recommendations for effective strengthening of public health policy and social welfare interventions for urban poor populations.

Utilization of Outpatient Mental Health Services During and 2 Years after the COVID-19 Pandemic.

Objective: Analyze the impact of COVID-19 on outpatient mental health (OP-MH) utilization patterns, particularly telehealth, across eight different MH conditions with a 2-year follow-up. Methods: This population-based cohort study uses a 5% random sample of Medicare beneficiaries aged ≥18 and newly diagnosed with one of the eight MH disorders: psychotic, depressive, bipolar, anxiety, trauma-related, substance-use, other MH disorders, and two or more MH disorders. Monthly OP-MH utilization patterns were compared among patients in 2020-2021 newly diagnosed in 2019 to comparable prepandemic cohorts newly diagnosed in 2017. Multiple logistic regression models were conducted to examine differences in telehealth utilization across MH conditions. Results: Across groups, patients were mostly aged 65-84 (n = 39,749 [72.4%] in 2017 and n = 40,513 [75.5%] in 2019), female (n = 33,387 [60.8%] in 2017 and n = 32,193 [60.0%] in 2019), and White (n = 48,314 [88.0%] in 2017 and n = 47,282 [88.1%] in 2019). Total OP-MH utilization dropped (a 27.5% decrease at its lowest) for all MH conditions at the pandemic's onset compared with the nonexposure group. Although utilization increased postpandemic, slight disruptions remained until the end of 2021. Telehealth visits rose from 0.5% in January 2020 to 55% in April 2020, decreasing to 18% by December 2021. Regression analysis showed that patients with psychotic, bipolar, or trauma-related, and two or more MH disorders had higher odds of telehealth usage compared with those with anxiety, while patients with substance-use disorders had lower odds. Rural residents, older adults (65+), and men had lower odds of using telehealth, with residents of the Northeast and West regions showing higher odds compared with the South. Telehealth disparity profiles were uniquely associated with different MH conditions. Conclusion and Relevance: Findings highlight the need for tailored telehealth strategies among Medicare beneficiaries to address specific demographic and geographical disparities across MH conditions.

Internet use for health information, health service utilization, and quality of care in the U.S.

BackgroundIncreased internet use for health information in the United States enhances interactions with healthcare professionals, but its effects on healthcare utilization and care quality are still being investigated. We explored the association between internet use for health information, patient-centered communication (PCC), and sociodemographic factors on the likelihood of visiting a health care provider and quality of care. We also examined if PCC mediates this association.MethodsWe conducted a secondary data analysis using the National Cancer Center Institutes (NCI) Health Information National Trends Survey (HINTS) 2018–2020. Multinomial logistic regression and path analyses assessed variable interrelationships and mediating effects.ResultsIndividuals using the internet for health information for themselves were 2.40 times more likely (P <.001) to have frequent provider visits and 1.18 times more likely (P <.022) to rate their care as very good/good compared to excellent, compared to those who did not use the internet for health information for themselves. In contrast, individuals using the internet for discussion with their providers were 2.05 times more likely (P <.001) to have increased visits, and they were 40% less likely (P <.001) to rate their care as fair/poor compared to excellent, relative to those who did not use the internet for discussions. Path analysis indicated that individuals using the internet for health information for themselves may negatively impact PCC, resulting in lower quality ratings, while those who use the internet for discussions with healthcare providers had a positive effect on PCC, leading to higher care ratings.ConclusionThis study enhances our understanding of how PCC and internet use for health information impact US healthcare. Using the internet for provider discussions positively impacts perceived care quality, highlighting PCC’s vital role.

Pediatric severe TBI in South America: Healthcare resource utilization before and during the COVID-19 pandemic.

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality worldwide. Understanding healthcare utilization during hospitalization for severe TBI across varied resource settings is crucial for informing improvements in clinical practice, patient outcomes, and for reducing TBI burden. We examined hospital services utilization among children with severe TBI in South America. This secondary analysis of data collected during the baseline period of a randomized controlled trial implementing severe TBI clinical management guidelines identified pediatric patients (<18 years) with severe TBI across 16 hospitals in Argentina, Chile, and Paraguay between September 1, 2019 and July 13, 2020. Demographics, injury characteristics, clinical presentation, intensive care unit (ICU) utilization, surgical interventions, and imaging data were collected, and descriptive statistics were calculated. Utilization differences were examined across two time periods based on the COVID-19 pandemic: prepandemic (September 1, 2019-March 10, 2020) and during the pandemic (March 11-July 13, 2020) using Student's t-tests and chi-square tests. One-hundred and sixteen patients (median age: 6.5 years) with severe TBI enrolled during the study (n = 80 prepandemic and n = 36 during the pandemic) period. There were no differences in demographic characteristics, injury mechanism, or discharge outcomes between time periods. Vasopressor use was less common during the pandemic (63.8% vs. 33.3%, p < 0.01) as were surgeries (p = 0.05). Other measures, including nutrition, mechanical ventilation, and central venous pressure monitoring were stable over time. Intracranial pressure (ICP) monitoring remained above 50% throughout. We failed to detect a pandemic effect resulting in pediatric severe TBI ICU care or hospital discharge outcome changes. Clinicians adapted successfully.

Predicting high-need high-cost pediatric hospitalized patients in China based on machine learning methods

Rapidly increasing healthcare spending globally is significantly driven by high-need, high-cost (HNHC) patients, who account for the top 5% of annual healthcare costs but over half of total expenditures. The programs targeting existing HNHC patients have shown limited long-term impact, and research predicting HNHC pediatric patients in China is limited. There is an urgent need to establish a specific, valid, and reliable prediction model using machine-learning-based methods to identify potential HNHC pediatric patients and implement proactive interventions before high costs arise. This study used a 7-year retrospective cohort dataset from two administrative databases in Shanghai, covering pediatric patients under 18 years. The machine-learning-based models were developed to predict HNHC status using logistic regression, k-nearest neighbors (KNN), random forest (RF), multi-layer perceptron (MLP), and Naive Bayes. This study divided the data from 2021–2022 into 70:30 as a training set and a test set, with the internal class balancing approach of the Synthetic Minority Over-sampling Technique (SMOTE). A grid search strategy was employed with k-fold cross-validation to optimize hyperparameters. Model performance was assessed by 5 metrics: Receiver Operating Characteristic-Area Under Curve (ROC-AUC), accuracy, sensitivity, specificity, and F1 score. The external validation from 2022–2023 data and the internal validation using different train-test ratios (80:20 and 90:10) were used to assess the robustness of the trained models. Among the 91,882 hospitalized children included in 2021, significant differences were found in socioeconomics, disease, healthcare service utilization, previous healthcare expenditure, and hospital characteristics between the HNHC and non-HNHC groups. The hospitalization costs for HNHC pediatric patients accounted for over 35% of total spending. The MLP model demonstrated the highest predictive performance (ROC-AUC: 0.872), followed by RF (0.869), KNN (0.836), and naive Bayes (0.828). The most important predictive factors included length of stay, number of hospitalizations, previous HNHC status, age, and presence of Top 20 HNHC diseases. MLP showed robustness as the most efficient model in external validation (ROC-AUC: 0.843) and internal validation using different train-test ratios (ROC-AUC: 0.826 in 80:20 ratio; 0.807 in 90:10 ratio). Machine learning models, particularly MLP, effectively predict HNHC pediatric patients, providing a basis for early identification of HNHC and proactive healthcare interventions into clinical practice. This approach can also assist policymakers and payers in optimizing healthcare resource allocation, controlling healthcare costs, and improving patient outcomes.