Total Health Care Use Research Articles

High health care use prior to elective surgery for osteoarthritis is associated with poor postoperative outcomes: A Canadian population-based cohort study.

The characterization and influence of preoperative health care use on quality-of-care indicators (e.g., readmissions) has received limited attention in populations with musculoskeletal disorders. The purpose of this study was to characterize preoperative health care use and examine its effect on quality-of-care indicators among patients undergoing elective surgery for osteoarthritis. Data on health care use for 124,750 patients with elective surgery for osteoarthritis in Ontario, Canada, from April 1, 2015 to March 31, 2018 were linked across health administrative databases. Using total health care use one-year previous to surgery, patients were grouped from low to very high users. We used Poisson regression models to estimate rate ratios, while examining the relationship between preoperative health care use and quality-of-care indicators (e.g., extended length of stay, complications, and 90-day hospital readmissions). We controlled for covariates (age, sex, neighborhood income, rural/urban residence, comorbidities, and surgical anatomical site). We found a statistically significant trend of increasing worse outcomes by health care use gradients that persisted after controlling for patient demographics and comorbidities. Findings were consistent across surgical anatomical sites. Moreover, very high users have relatively large numbers of visits to non-musculoskeletal specialists. Our findings highlight that information on patients' preoperative health care use, together with other risk factors (such as comorbidities), could help decision-making when benchmarking or reimbursing hospitals caring for complex patients undergoing surgery for osteoarthritis.

Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study

To investigate the relationship between preterm birth and hospital / out-of-hospital care and costs over the first five years of life. Birth data from a population-based cohort of 631,532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalisations, primary and secondary care, and the use of medicines. We analysed the distribution of healthcare use and public healthcare costs for infants that survived at least five years, comparing the outcomes of extremely preterm (< 28 weeks' gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks). A linear regression model was used to investigate the effect of preterm birth on these outcomes, controlling for important confounders including pregnancy and birth complications, neonatal morbidity, survival, and maternal socioeconomic characteristics. Preterm birth has a statistically significant and economically relevant effect on healthcare use and costs in the first five years of life. Compared with a term infant, preterm infants born 32-36 weeks, 28-32 weeks, and < 28 weeks, respectively, had an average: 7.0 (std.err.=0.06), 41.6 (0.18), and 68.7 (0.35) days more hospital days; 3.1 (0.04), 11.0 (0.13) and 13.2 (0.25) more outpatient specialist physician visits; and five-year public healthcare costs which were 1.2 (<0.01), 6.8 (0.01), and 10.9 (0.02) times higher. Preterm infants also had statistically significant higher levels of GP visits and use of medicines. Higher levels of accessible care is needed for preterm infants across healthcare settings, and over a sustained period of time. As our understanding of the impact of preterm birth on long term clinical outcomes continues to improve, clinicians and policymakers should develop an accurate recognition of these needs for appropriate resource allocation towards research priorities and early intervention strategies.

Budget impact analysis of an early identification and referral model for diagnosing patients with suspected rheumatoid arthritis in Ireland.

ObjectiveTo estimate the budget impact from the perspective of the Irish health-care system attributable to a reconfiguration in the diagnostic care pathway for patients with suspected RA by adopting an early identification and referral model (EIM).MethodsThe budget impact model evaluated the total health-care use and costs attributable to an EIM to diagnose patients with suspected RA relative to the reference scenario of current practice. The modelling also assessed a primary outcome of effect, which examined how many patients can be diagnosed by a rheumatologist within 3 months of symptom onset. The budget impact analysis model was estimated over a 5-year time frame.ResultsThe EIM generated a cost saving for the Irish health-care system of €237 547 over the time frame relative to current practice. The cost savings were realized owing to a reduction in the number of general practitioner (GP) visits of 18 790 and a reduction in diagnostic tests carried out by GPs. The results showed that 1027 (510%) more patients were diagnosed within 3 months of symptom onset in the EIM compared with current practice.ConclusionThis paper has presented an alternative rheumatologist-led service design that can be used in diagnosing patients with suspected RA. The rheumatologist-led service provision detailed in this study has the potential simultaneously to reduce demand for primary care services and to improve the health outcomes of patients. The use of an EIM sees rheumatologist activity incorporate patient demand.

A randomized trial of a multi-level intervention to improve advance care planning and symptom management among low-income and minority employees diagnosed with cancer in outpatient community settings

IntroductionEquitable delivery of advance care planning and symptom management among patients is crucial to improving cancer care. Existing interventions to improve the uptake of these services have predominantly occurred in clinic settings and are limited in their effectiveness, particularly among low-income and minority populations. MethodsThe “Lay health worker Educates Engages and Activates Patients to Share (LEAPS)” intervention was developed to improve advance care planning and symptom management among low-income and minority hourly-wage workers with cancer, in two community settings. The intervention provides a lay health worker to all patients newly diagnosed with cancer and aims to educate and activate patients to engage in advance care planning and symptom management with their oncology providers. In this randomized clinical trial, we will evaluate the effect on quality of life (primary outcome) using the validated Functional Assessment of Cancer Therapy – General Survey, at enrollment, 4- and 12- months post-enrollment. We will examine between-group differences on our secondary outcomes of patient activation, patient satisfaction with healthcare decision-making, and symptom burden (at enrollment, 4- and 12-months post-enrollment), and total healthcare use and healthcare costs (at 12-months post-enrollment). DiscussionMultilevel approaches are urgently needed to improve cancer care delivery among low-income and minority patients diagnosed with cancer in community settings. The current study describes the LEAPS intervention, the study design, and baseline characteristics of the community centers participating in the study.ClinicalTrials.gov Registration #NCT03699748.

Performance of the Functional Comorbidity Index (FCI) in Prognostic Models for Risk Adjustment in Patients With Back Pain.

The Functional Comorbidity Index (FCI) is a comorbidity measure associated with physical function and may contribute to risk adjustment models in rehabilitation settings, but an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) of the FCI has not been tested in outpatient settings. This study examines the ability of an ICD-9-CM- based FCI to predict function, health-related quality of life, and overall health care use. Cohort study. This was a secondary analysis of 5155 adults ≥65 years of age with a new back pain visit from the Back pain Outcomes using Longitudinal Data cohort study. We measured 18 comorbidities with an ICD-9-CM version of the FCI using diagnosis codes 12 months prior to an index visit. Outcomes included the Roland Morris Disability Questionnaire (RMDQ, 0-24), health-related-quality-of-life (EQ5D, 0-1), and total health care use (sum of all relative value units [RVUs]) measured at baseline and 12 months after the index visit. Linear regression and generalized linear models estimated the association between the FCI and each outcome and to examine goodness of fit. We used a 10-fold cross-validation to develop and compare predictive models with and without the FCI. There were 1398 participants (27%) with two or more comorbidities. Adjusted estimates show that for every one unit increase in FCI, RMDQ increased by 1.0 (95% confidence interval [CI] 0.8 to 1.1) and R2 = 0.093; EQ5D decreased by 0.023 (95% CI -0.028 to -0.019) and R2 = 0.076; and mean total RVUs increased by 13% (95% CI 1.09 to 1.17). Cross-validation showed that FCI contributed to small improvements in the performance of predictive models. An ICD-9-CM version of the FCI is associated with long-term function, health-related quality of life, and total health care use among older adults with back pain; however, it explains only a small proportion of the variance.

Comparing the Performance of Comorbidity Indices in Predicting Functional Status, Health-Related Quality of Life, and Total Health Care Use in Older Adults With Back Pain.

To determine how well the functional comorbidity index (FCI) predicts outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. Secondary analysis of a prospective cohort study. We included 5155 adults 65 years of age or older with new primary care visits for back pain. Comorbidity was measured using diagnosis codes 12 months prior to the new visit. Outcomes of functional limitation (Roland-Morris Disability Questionnaire), health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), and total health care use (sum of relative value units) were measured 12 months after the new visit. We compared multivariable models containing preselected prognostic factors. Spearman correlation coefficients among the indices were 0.70 or greater. Multivariable models for the Roland-Morris Disability Questionnaire had similar R2 and root-mean-square error (RMSE) of prediction when using the FCI (R2 = 0.190; RMSE, 6.19), Quan-Charlson comorbidity index (R2 = 0.185; RMSE, 6.20), or Elixhauser comorbidity index (R2 = 0.189; RMSE, 6.19). Multivariable models for the EQ-5D score showed small differences in R2 and RMSE when using the FCI (R2 = 0.157; RMSE, 0.163), Quan-Charlson comorbidity index (R2 = 0.148; RMSE, 0.164), or Elixhauser comorbidity index (R2 = 0.154; RMSE, 0.163). Multivariable models for health care use had similar Akaike information criterion (AIC) values when using the FCI (AIC = 10.04), Quan-Charlson comorbidity index (AIC = 10.04), or Elixhauser comorbidity index (AIC = 10.01). All indices performed similarly in predicting outcomes. There does not seem to be an advantage to using one index over another for older adults with back pain. There is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices. J Orthop Sports Phys Ther 2020;50(3):143-148. Epub 23 Jul 2019. doi:10.2519/jospt.2020.8764.

Comparing Performance of Comorbidity Indices in Predicting Functional Status, Health-Related Quality of Life, and Total Health Care Use in Older Adults With Back Pain.

Secondary analysis of prospective cohort study. Common comorbidity indices were developed to predict mortality and may not be optimal for functional outcomes. Determine how well the Functional Comorbidity Index (FCI) predicts outcomes in older adults with back pain versus the Quan/Charlson and Elixhauser comorbidity indices. We included 5155 adults ≥65 years with new primary care visits for back pain. Comorbidity was measured using diagnosis codes 12 months prior to the new visit. Outcomes of functional limitation (Roland Morris Disability Questionnaire [RMDQ]), health-related quality-of-life (EQ5D), and total health care use (sum of Relative Value Units [RVUs]) were measured 12 months the new visit. We compared multivariable models containing preselected prognostic factors. Spearman's Correlation Coefficients among the indices were ≥0.70. Multivariable models for RMDQ had similar R2 and mean squared error (MSE) of prediction when using the FCI (R2=0.190; MSE= 6.19), Quan/Charlson (R2=0.184; MSE=6.20), or Elixhauser (R2=0.189; MSE=6.19). Multivariable models for EQ5D showed small differences in R2 and MSE when using the FCI (R2=0.157; MSE= 0.163), Quan/Charlson (R2=0.148; MSE=0.164), or Elixhauser (R2=0.154; MSE=0.163). Multivariable models for health care use had similar Akaike's information criterion (AICs) when using the FCI (AIC=10.04), Quan/Charlson (AIC=10.04), or Elixhauser (AIC=10.01). All indices performed similarly in predicting outcomes. There does not seem to be an advantage to using one index over another for older adults with back pain. There is still a need to develop better function-based risk adjustment models that improve prediction of functional outcomes versus standard comorbidity indices. Level 2 Prognostic Evidence. J Orthop Sports Phys Ther, Epub 23 Jul 2019. doi:10.2519/jospt.2019.8764.

Cost-effectiveness of neuromuscular ultrasound in focal neuropathies.

To evaluate the cost-effectiveness of neuromuscular ultrasound (NMUS) for the evaluation of focal neuropathies. A prior prospective, randomized, double-blind controlled trial demonstrated that NMUS, when added to electrodiagnostic testing, resulted in improved clinical outcomes after 6 months of follow-up. From this study, we abstracted quality-adjusted life-years (QALYs) from the 36-item Short Form Health Survey and entered this health-utility estimate into a mixed trial and model-based cost-effectiveness analysis from the societal perspective. Costs of intervention (NMUS) were estimated from Medicare payment rates for Current Procedural Terminology codes. Health care use was otherwise estimated to be equal, but sensitivity analyses further examined this and other key assumptions. Incremental cost-effectiveness ratio (ICER) was used as the primary outcome with a willingness-to-pay threshold of $50,000 per QALY. The predicted mean health outcome associated with use of NMUS was 0.079 QALY, and the mean cost was $37, resulting in an ICER of $463 per QALY. Results and conclusions remained robust across all sensitivity analyses, including variations in time horizon, initial distribution of health states, costs, and effectiveness. From a societal perspective, the addition of NMUS to electrodiagnostic testing when evaluating a focal neuropathy is cost-effective. A study of longer follow-up incorporating total health care use would further quantify the value of NMUS. NCT01394822.

Primary care visit use after positive fecal immunochemical test for colorectal cancer screening.

For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. Among 483,216 individuals aged 50 to 75 years who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, the authors evaluated whether a positive test was associated with a net change in outpatient primary care visit use within the year after screening. Multivariable regression models were used to evaluate the relationship between test result group and net changes in primary care visits after fecal immunochemical testing. In the year after the fecal immunochemical test, use increased by 0.60 clinic visits for patients with true-positive results. The absolute change in visits was largest (3.00) among individuals with positive test results who were diagnosed with colorectal cancer, but significant small increases also were found for patients treated with polypectomy and who had no neoplasia (0.36) and those with a normal examination and no polypectomy performed (0.17). Groups of patients who demonstrated an increase in net visit use compared with the true-negative group included patients with true-positive results (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.54-1.66), and positive groups with a colorectal cancer diagnosis (OR, 7.19; 95% CI, 6.12-8.44), polypectomy/no neoplasia (OR, 1.37; 95% CI, 1.27-1.48), and normal examination/no polypectomy (OR, 1.24; 95% CI, 1.18-1.30). Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have a substantial impact on total health care use. Therefore, these changes should be included in colorectal cancer screening cost models and their causes investigated further. Cancer 2017;123:3744-3753. © 2017 American Cancer Society.

An economic evaluation alongside a randomised controlled trial on psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia

ObjectiveThe rate of caesarean section continues to increase, and there is evidence that childbirth fear is a contributing factor. Insufficient evidence is available on the impact of reducing childbirth fear on health-related quality of life and health service use. We undertook an economic evaluation of a psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia. MethodsPregnant women (n = 339) with high childbirth fear were randomised to a midwife-led psycho-education intervention for childbirth fear or to usual care. This paper presents the economic evaluation of the intervention based on health-related quality of life and health service use from recruitment to six weeks postpartum (n = 184). ResultsThe changes in health-related quality of life after birth (EQ-5D-3L: 0.016 vs. 0.010, p = 0.833, for usual care and intervention) and total health care use cost (AUS$10,110 vs. AUS$9980, p = 0.819) were similar between groups. The intervention did not increase costs; however, in a post hoc analysis, the interventions might be cost-effective for those women with very high childbirth fear. ConclusionThis brief psycho-education intervention by midwives did not improve the health-related quality of life of women, and had no impact on overall cost.

Impact of Early-Onset Acute Otitis Media on Multiple Recurrences and Associated Health Care Use

To quantify the critical age period of first episode of acute otitis media (AOM) and its consequences for AOM recurrences and AOM health care use. Children enrolled in the Wheezing-Illnesses-STudy-LEidsche-Rijn cohort with at least 1 episode of AOM documented in their primary care health record before 2 years of age were followed until 6 years of age. Data on episodes of AOM and associated primary care consultations, antibiotic prescriptions, and specialist referrals were retrieved. Regression models assessed the presence and shape of the associations between age of first AOM and subsequent episodes of AOM and health care use. A total of 796 of 2026 children (39%) experienced a first AOM before 2 years of age. Each month decrease in age at first AOM in the first 2 years of life increased the risk of developing recurrent AOM (≥3 AOM episodes in 6 months or ≥ 4 in 1 year) linearly by 6% (adjusted risk ratio: 1.06; 95% CI: 1.02-1.10). For first AOM occurring before 9 months, the cumulative 6-year primary care consultation rate increased by 8% (adjusted incidence rate ratio: 1.08; 95% CI: 1.03-1.15) and the associated specialist referral increased by 16% (adjusted risk ratio: 1.16; 95% CI: 1.07-1.27) for each month decrease in age. No associations were found between age at first AOM and total AOM episodes or antibiotic prescriptions. The association between earlier age of first AOM and recurrent AOM as well as total health care use during childhood is particularly strong before 9 months of age.

Hospital and Nursing Home Use From 2002 to 2008 Among US Older Adults With Cognitive Impairment, Not Dementia in 2002

Little is known about health care use in the cognitive impairment, not dementia (CIND) subpopulation. Using a cohort of 7130 persons aged 71 years or over from the Health and Retirement Survey, we compared mean and total health care use from 2002 to 2008 for those with no cognitive impairment, CIND, or dementia in 2002. Cognitive status was determined using a validated method based on self or proxy interview measures. Health care use was also based on self or proxy reports. On the basis of the Health and Retirement Survey, the CIND subpopulation in 2002 was 5.3 million or 23% of the total population 71 years of age or over. Mean hospital nights was similar and mean nursing home nights was less in persons with CIND compared with persons with dementia. The CIND subpopulation, however, had more total hospital and nursing home nights--71,000 total hospital nights and 223,000 total nursing home nights versus 32,000 hospital nights and 138,000 nursing home nights in the dementia subpopulation. A relatively large population and high health care use result in a large health care impact of the CIND subpopulation.

Remote Monitoring Reduces Healthcare Use and Improves Quality of Care in Heart Failure Patients With Implantable Defibrillators

Background— Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits. Methods and Results— This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year; P =0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year; P &lt;0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm ( P &lt;0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm ( P =0.026). Conclusions— Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00873899.

Are medically unexplained symptoms and functional disorders predictive for the illness course?: A two-year follow-up on patients' health and health care utilisation

Objective To investigate whether the general practitioners' (GP) diagnosis of medically unexplained symptoms (MUS) and/or the diagnosis functional disorders (FD) can predict the patients' 2-year outcome in relation to physical and mental health and health care utilisation. Furthermore, to identify relevant clinical factors which may help the GP predict the patient's outcome. Method The study included 38 GPs and 1785 consecutive patients who presented a new health problem. The GPs completed a questionnaire on diagnosis for each patient. Patients completed the Common Mental Disorder Questionnaire (CMDQ) and the SF-36 questionnaire at baseline and after 24 months. A stratified sample of 701 patients was diagnosed with a psychiatric research interview. Data on health cost was obtained from national registers. Results A FD diagnosis following the research interview was associated with a decline in physical health (OR 3.27(95%CI 1.84–5.81)), but this was not the case with MUS diagnosed by the GP. MUS was associated with a poor outcome on mental health (OR 2.16 (95%CI 1.07–4.31)). More than 4 symptoms were associated with a poor outcome on physical health (OR 5.35 (95%CI 2.28–12.56)) and on mental health (OR 2.17(95%CI 1.02–4.59)). Neither FD nor MUS were associated with higher total health care use. However, FD (OR 2.31(95%CI 1.24–4.31)) and MUS (OR 1.98(95%CI 1.04–3.75)) was associated with increased cost in primary care. Conclusion Our current diagnoses of MUS show limitations in their prediction of the patients' illness course. Although, the ICD-10 diagnoses of functional disorders was not developed for the primary care setting, our results indicate that some of its elements would be useful to bring in when rethinking the diagnosis for MUS in primary care, elements that are easily obtainable for the GP in a normal consultation. Our results may contribute to the construction of a more useful diagnostic for these patients in primary care.

Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending

Researchers have routinely found that improved medication adherence--getting people to take medicine prescribed for them--is associated with greatly reduced total health care use and costs. But previous studies do not provide strong evidence of a causal link. This article employs a more robust methodology to examine the relationship. Our results indicate that although improved medication adherence by people with four chronic vascular diseases increased pharmacy costs, it also produced substantial medical savings as a result of reductions in hospitalization and emergency department use. Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings.

Medical Comorbidity and its Effect on Workplace Productivity in Specialty Care Patients

Comorbid medical and behavioral conditions are associated with greater functional disability, increased morbidity and suicide-related mortality, and greater total healthcare use and costs.1,2 Mental and substance use disorders are twice as likely to occur among the chronically ill, with depression being the most common comorbid condition among medical patients (approximate prevalence of 25%).3 Although there is evidence of bidirectionality of medical and mental health conditions,4 research on their comorbidity has focused primarily on prevalence rates of

Five‐year followup of a cognitive–behavioral intervention for patients with recently‐diagnosed rheumatoid arthritis: Effects on health care utilization

To investigate whether cognitive-behavioral therapy (CBT) administered early in the course of rheumatoid arthritis (RA) has long-term effects on health care use. We reviewed the files of 47 of the original 53 patients with early RA who volunteered for a randomized controlled trial comparing CBT with no psychological intervention. Occasions of service provision associated with RA were documented and health care use was compared between groups. The CBT group used fewer health care resources than the control group in the 5 years following intervention. Significant differences were observed for the number of inpatient nights, physiotherapy referrals, injections, and for total health care use. There was a trend that closely approached significance toward fewer episodes of surgery and orthopedic referrals in the CBT group. These results suggest that CBT administered early in the course of RA can reduce health care use for the first 5 years after treatment. This is a stringent test of the efficacy of a brief psychological intervention, and supports the fact that brief psychological treatments can have long-term effects.

Racial Differences in Health Care Use among Medicare Only and Dual Eligibles

It has been an important financial issue in the U.S. Medicare expenditures that health care expenses of Medicaid-Medicare dual eligibles (MMDE) are much higher than those of Medicare only beneficiaries (MOB). This paper compares health care use and health status of MMDEs and MOBs who are either Afro-American or white recipients. Using total health care use information from the Medical Expenditure Panel Survey (MEPS) 2000, we find that the proportion of dual eligibles with chronic health conditions is higher by 4% than that of the Medicare only beneficiaries and that dual eligibles make more frequent uses of various health care services. The number of office-based physician visits and outpatient physician visits are higher for Afro-American dual eligibles than white dual eligibles. This finding seems to be contributed to by relatively high medical needs among dual eligibles. Higher utilization of agency-related home health services among Afro-American dual eligibles than among white dual eligibles is considered as a consequence of different ethnicity-specific responses to insurance coverage.

Healthcare use and costs of primary and secondary care patients with prostatitis

Objectives To examine and identify predictors of healthcare use and prostatitis-related and total healthcare costs for primary and secondary care patients with new episodes of care for prostatitis. Methods We compared the use and costs for 270 men with a new episode of care for prostatitis to those of randomly selected male health maintenance organization enrollees matched by age and primary care provider. We examined the episode of care (index visit and next 2 months) and the previous and subsequent years. Patients with prostatitis were interviewed 1 month after the index visit. Results Compared with controls, patients with prostatitis had significantly greater total healthcare use ( P <0.001) and costs ( P <0.05) in each period. The prostatitis costs were only a small proportion of the total costs of the patients with prostatitis and of the difference in costs between patients with prostatitis and controls. The 10% of patients with prostatitis with the greatest total costs accounted for about one half of all costs. White race ( P = 0.04), less education ( P = 0.02), greater disability ( P = 0.003), and greater number of non-pelvic pain sites ( P = 0.004) at baseline predicted greater total healthcare costs after the index visit. Conclusions Health maintenance organization enrollees who seek care for prostatitis have greater total healthcare use and costs than do other enrollees of the same age and primary care provider. Most of the difference in costs reflects care for problems other than prostatitis. A small proportion of patients account for most of the costs.

A depression management programme reduced depression in frequent users of health care but did not reduce healthcare visits

(2000) Arch Fam Med 9, 345. Katzelnick DJ, Simon GE, Pearson SD, et al. . Randomized trial of a depression management program in high utilizers of medical care. . Apr;...