Subsequent Health Service Use Research Articles

Tiredness as determinant of subsequent use of health and social services among nondisabled elderly people.

To examine whether self-reported tiredness in daily activities at age 75 is an independent determinant of incident hospitalization and use of home services 5 years later. In all, 275 people participated in a prospective study in Glostrup, Denmark, when they were 75 and 80 years old. Four subgroups were created according to whether participants had been hospitalized or used home care in the year before the baseline study and whether or not they were disabled at the time. The key predictor variables were measured by two scales about tiredness in daily activities. Nondisabled individuals who felt tired in their daily activities had about twice the risk of being hospitalized and of being users of home help 5 years later. Because tiredness in daily activities is related to subsequent hospitalization and use of home help, it should be taken seriously in preventive services among elderly people.

The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study.

The purpose of this study was to prospectively assess the independent effect of hip fracture on mortalìty, hospitalization, and functional status. Among 7527 members of the Longitudinal Study of Aging who were over age 70 at baseline, 368 persons with hip fracture occurring between 1984 and 1991 were identified. Median length of follow-up was 831 days. Hip fracture was significantly related to mortality (adjusted hazards ratio [AHR] = 1.83; 95% confidence interval [CI] = 1.55, 2.16) when treated as a time-dependent covariate. This effect was concentrated in the first 6 months postfracture (AHR = 38.93, 95% CI = 29.58, 51.23, vs AHR = 1.17; 95% CI = 0.95, 1.44). Hip fracture significantly increased the likelihood of subsequent hospitalization (adjusted odds ratio = 3.31, 95% CI = 2.64, 4.15) and increased the number of subsequent episodes by 9.4%, the number of hospital days by 21.3%, and total charges by 16.3%. Hip fracture also increased the number of functional status dependencies. The health of older adults deteriorates after hip fracture, and efforts to reduce the incidence of hip fracture could lower subsequent mortality, morbidity, and health services use.

The relationship between complaint-related cognitions in referred patients with irritable bowel syndrome and subsequent health care seeking behaviour in primary care.

It is generally accepted that it is important to explore patients' beliefs and fears about the meaning of their symptoms during medical consultations. To discover how referral behaviour of GPs and attention to dysfunctional cognitions of medical specialists affect the subsequent health care seeking behaviour of patients with irritable bowel syndrome. Questionnaires were distributed to GPs and to doctors and patients at an outpatient clinic in the University Hospital of Nijmegen. The results of the present study indicate that doctors' attention to the complaint-related cognitions of IBS-patients is also related to a reduced use of medical health services in primary care. On the other hand, when referred IBS-patients continue to attribute their complaints to a somatic abnormality even after such an abnormality has been ruled out through extensive physical examinations, the subsequent use of medical health services in primary care is likely to increase. Moreover, GPs' referral behaviour appears to strengthen these dysfunctional somatic attributions in IBS-patients. These unfavorable consequences might be avoided by handling cognitions and anxiety more specifically during medical consultations in primary as well as secondary care.

The determinants of health services utilization in southern Iraq: a household interview survey.

A household survey was conducted in 1982-83 in a sample of 324 households served by five health centres in two different areas of Southern Iraq. Information from each household was collected on socioeconomic factors, access to curative health services, sickness within the previous four weeks and the subsequent use of health services. Thirty seven per cent of people reported some sickness during the four-week recall period, giving an average of 40 episodes per 100 people per four weeks. The average consultation rate was 33 per 100 people and the annual estimated rate was 4.3 consultations per person per year. There was an average of 82 consultations per 100 sickness episodes with the highest rates for infectious and parasitic diseases (111) and hypertension and heart diseases (108), and the lowest for eye and ear diseases (52). The most important factors affecting utilization were level of perceived sickness in the household and the distance to the nearest health centre. Household income did not appear to be an important factor except for attendance at private clinics. The study suggests that the overall rate of utilization is sufficient for curative services but that now it is the quality of this care that needs to be examined.