Trends In Health Service Use Research Articles

Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study.

Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association. Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately. The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization. Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.

Trends in Health Service Use for Dry Eye Disease From 2017 to 2021: A Real-World Analysis of 369,755 Outpatient Visits.

We aimed to analyze the trends and patterns in outpatient health service treatment of dry eye disease (DED) using real-world data from Yinzhou District in China. The Yinzhou Health Information System is a comprehensive database including electronic medical records from 277 medical institutions representing over 1.64million residents. We extracted outpatient records from January 1, 2017, to December 31, 2021, that included the first diagnosis of DED according to the International Classification of Diseases, 10th Revision (H04.101, H04.103, H11.104, H16.202, or H18.803). We analyzed the trends and patterns of DED outpatient visits using the Mann-Kendall trend test and Cochran-Armitage trend test. We identified a total of 369,755 outpatient visits from 145,712 patients with DED of all ages (60.37% female; 54.10% 50years or older). Primary medical institutions had the largest number of DED outpatient visits (42%), followed by tertiary medical institutions (35%). Over the 5-year period, the number of DED outpatient visits increased from 59,260 to 90,807 (53.23%). We observed significant consecutive annual proportion increases in females (from 61.09% to 62.01%; P = 0.001), patients 50years or older (from 55.10% to 60.08%; P < 0.001), and outpatient visits in primary medical institutions (from 33.19% to 48.75%; P < 0.001). Our study found an increase in outpatient health service use for DED in Yinzhou from 2017 to 2021, with higher proportions and increases among females, patients 50years or older, and primary medical institutions. The rapid growth in the prevalence of DED indicates high eye healthcare needs in patients.

Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada

BackgroundCannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. MethodsWe conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. ResultsWe did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014–2020). ConclusionOur findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.

Trends in health service use among persons with Parkinson's disease by rurality: A population-based repeated cross-sectional study.

The global burden of Parkinson's disease (PD) has more than doubled over the past three decades, and this trend is expected to continue. Despite generally poorer access to health care services in rural areas, little previous work has examined health system use in persons with PD by rurality. We examined trends in the prevalence of PD and health service use among persons with PD by rurality in Ontario, Canada. We conducted a repeated, cross-sectional analysis of persons with prevalent PD aged 40+ years on April 1st of each year from 2000 to 2018 using health administrative databases and calculated the age-sex standardized prevalence of PD. Prevalence of PD was also stratified by rurality and sex. Negative binomial models were used to calculate rate ratios with 95% confidence intervals comparing rates of health service use in rural compared to urban residents in 2018. The age-sex standardized prevalence of PD in Ontario increased by 0.34% per year (p<0.0001) and was 459 per 100,000 in 2018 (n = 33,479), with a lower prevalence in rural compared to urban residents (401 vs. 467 per 100,000). Rates of hospitalizations and family physician visits declined over time in both men and women with PD in rural and urban areas, while rates of emergency department, neurologist, and other specialist visits increased. Adjusted rates of hospitalizations were similar between rural and urban residents (RR = 1.04, 95% CI [0.96, 1.12]), while rates of emergency department visits were higher among rural residents (RR = 1.35, 95% CI [1.27, 1.42]). Rural residents had lower rates of family physician (adjusted RR = 0.82, (95% CI [0.79, 0.84]) and neurologist visits (RR = 0.74, 95% CI [0.72, 0.77]). Lower rates of outpatient health service use among persons residing in rural regions, contrasting with higher rates of emergency department visits suggest inequities in access. Efforts to improve access to primary and specialist care for persons with PD in rural regions are needed.

Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic

Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services. To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada. COVID-19 pandemic as of March 1, 2020. Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels. Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts. In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.

Timeliness and extent of health service use by Victorian (Australian) children within first year after entry to out-of-home care: Retrospective data linkage cohort study

BackgroundChildren in out-of-home care (OOHC) have high rates of health needs; consequently, many countries (including Australia) have policies and/or statutory requirements for health assessment upon OOHC entry. However, Australia has no data on health service utilisation or timeliness. We aimed to describe timing and extent of health service utilisation by children in the state of Victoria upon entry to OOHC, exploring demographic and specific service exposure variations. MethodsPopulation-based retrospective cohort study. Data from Victoria’s Child Protection dataset (2010–2015) were linked to federal (Medicare Billing Schedule (MBS)) and state (Community Health, Mental Health, Community Dental and outpatient clinic) health datasets. PopulationVictorian first-time entrants to OOHC (April 2010 – December 2015): 6,201 0 – 12 year old children. OutcomeProportion visiting health services within 12 months of entering care; proportion visiting within recommended timeframes. AnalysisDescriptive statistics, multivariable logistic regression, and Kaplan-Meier survival curves. Pre-post health service use following the limited introduction of health assessment clinics was compared with trends elsewhere in Victoria. Principal findings5,676 (92%) children were successfully linked to the MBS dataset. 41 children (<1%) had attended all recommended health services within 12 months of OOHC entry. While most (90%) within the linked cohort visited a General Practitioner, only 37% attended within the recommended 30 days. Around a third visited a paediatrician; fewer than 20% visited a community dentist, optometrist, or audiologist. Children in foster care had higher odds of attending services than those in kinship care. The pre-post trends in health service use in areas where a dedicated assessment clinic commenced were more positive than for areas without the clinic. ConclusionA minority of Victorian children in OOHC accessed health services according to national or state (Victorian) standards, very few in a timely manner. Children in kinship care were less likely to meet guidelines.

The Impact of Driving Time to Family Planning Facilities on Preventive Service Use in Ohio

Publicly funded family planning clinics provide preventive health services to low-income populations in the U.S. In recent years, several states, including Ohio, have restricted public funds for organizations that provide or refer patients to abortion care, often resulting in clinic closures. This research evaluates the effects of such closures on preventive service use and access to care among female adults in Ohio. With data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System, trends in health service use were assessed for female respondents aged 18-45 years with household incomes <$50,000. Clinic locations were combined with restricted-access survey ZIP codes to compute respondents' driving times to the nearest family planning clinic. The association between changes in driving time and the use of routine preventive and unmet care owing to cost were assessed with linear probability models. Analyses took place from March 2019 to February 2020. Each additional 10 minutes of driving time was associated with an 8.9 percentage point increase in the likelihood of avoided care owing to cost (95% CI=1.7, 16.2), a 10.4 percentage point decrease in the likelihood of mammogram receipt during the past 12 months (95% CI= -22.3, 1.5), and a 12.5 percentage point decrease in the likelihood of ever receiving a clinical breast examination (95% CI= -18.7, -6.3). Driving time had insignificant associations with other utilization outcomes. Similar results were obtained when using driving distance. Reduced access to family planning clinics was associated with unmet care due to cost and a reduction in preventive service use among low-income, reproductive-aged females.

Trends in health service use and potentially avoidable hospitalizations before Alzheimer's disease diagnosis: A matched, retrospective study of US Medicare beneficiaries

IntroductionThis study evaluates rates of all-cause emergency department visits, all-cause hospitalizations, potentially avoidable hospitalizations, and falls in 3 years preceding Alzheimer's disease (AD) diagnosis. MethodsPatients with AD and controls with no cognitive impairment were identified from the Medicare claims data. Patients were required to be aged ≥ 65 years and have continuous Medicare enrollment for ≥4 years before the index date (AD cohort: first AD diagnosis in 2012–2014; controls: randomly selected medical claim). Outcomes for each preindex year were compared among propensity score-matched cohorts. ResultsEach year, before index, patients with AD were more likely to have all-cause emergency department visits, all-cause hospitalizations, potentially avoidable hospitalizations, and falls (P < .05 for all comparisons) than matched controls (N = 19,679 pairs). Increasing absolute and relative risks over time were observed for all outcomes. DiscussionThe study findings highlight the growing burden of illness before AD diagnosis and emphasize the need for timely recognition and management of patients with AD.

Equity in health care after 10 years of the New Rural Co-operative Medical Insurance Scheme in China: an analysis of national survey data

BackgroundNew Rural Cooperative Medical Scheme (NCMS) in China rapidly achieved over 90% population coverage since its launch in 2003, and then gradually improved its service coverage and financial protection. Most published studies were conducted in the early years of NCMS or only focused on sub-regions in China. We aimed to provide the first national, comprehensive and up-to-date assessment of the equity of effects of NCMS on service use, medical financial burden, and health from 2003 to 2013. MethodsUsing three waves of the National Health Service Surveys in 2003, 2008, and 2013 (total sample size >600 000 individuals), we classified NCMS enrollees into five income quintiles and analysed national trends in health service use, and catastrophic expenditure over the study period. To further examine the effects of NCMS on trends of catastrophic medical expenditure across income quintiles, three multi-variate logistic regression models were used. FindingsFrom 2003 to 2013, inequity in health service use was greatly reduced with respect to income. In 2013, prevalence of outpatient service use was 14·5% in the lowest income quintile and 13·2% in the highest income quintile; prevalence of inpatient service use was 8·6% in the lowest and 7·8% in the highest income quintile. In 2003, prevalence of outpatient service use was 13·5% in the lowest income quintile and 15·2% in highest income quintile; prevalence of inpatient service use was 1·8% in the lowest and 4·1% in the highest income quintile. Contradicting previous findings of increased financial burden after NCMS implementation, we identified improvements in financial risk protection (odds ratio 0.66, 95% CI 0·57–0·77, for catastrophic medical expenditure in 2013 relative to 2003). The proportion of households with catastrophic medical expenditure only increased in the lowest income quintile (from 16·1% in 2003 to 24·7% in 2013) but decreased in all other income quintiles. InterpretationImprovements in health equity and financial risk protection were seen after 10 years of the NCMS. However, medical financial burdens increased among the poorest people, highlighting the importance of targeting the lowest-income rural residents in future reforms of rural health insurance and medical financial assistance. FundingThis study did not receive funding from any agency.

In This Issue: Trends, Prescribing, Deprescribing

This issue begins by showing trends in health service use and goes on to unpack myriad factors affecting health care delivery, its appropriateness, and the ability of primary care clinicians to serve their role in integrating and personalizing care. An assessment of changes in the ecology of

Validation of Case-Finding Algorithms Derived from Administrative Data for Identifying Adults Living with Human Immunodeficiency Virus Infection

ObjectiveWe sought to validate a case-finding algorithm for human immunodeficiency virus (HIV) infection using administrative health databases in Ontario, Canada.MethodsWe constructed 48 case-finding algorithms using combinations of physician billing claims, hospital and emergency room separations and prescription drug claims. We determined the test characteristics of each algorithm over various time frames for identifying HIV infection, using data abstracted from the charts of 2,040 randomly selected patients receiving care at two medical practices in Toronto, Ontario as the reference standard.ResultsWith the exception of algorithms using only a single physician claim, the specificity of all algorithms exceeded 99%. An algorithm consisting of three physician claims over a three year period had a sensitivity and specificity of 96.2% (95% CI 95.2%–97.9%) and 99.6% (95% CI 99.1%–99.8%), respectively. Application of the algorithm to the province of Ontario identified 12,179 HIV-infected patients in care for the period spanning April 1, 2007 to March 31, 2009.ConclusionsCase-finding algorithms generated from administrative data can accurately identify adults living with HIV. A relatively simple “3 claims in 3 years” definition can be used for assembling a population-based cohort and facilitating future research examining trends in health service use and outcomes among HIV-infected adults in Ontario.

Trends in health service use for women in Australia with diabetes

Objective: To describe the health, health service use and use of recommended guidelines for care for women in Australia with diabetes.Methods: Analysis of survey data 1996–99 from the Australian Longitudinal Study on Women's Health, linked with Medicare data for 1997–2001. Participants were 12,338 mid‐age women aged 45–50 years in 1996 (1.9% with diabetes) and 10,421 older women aged 70–75 years at Survey 1 in 1996 (8.1% with diabetes). The outcome measures were number of general practice and specialist visits and use of glycosylated haemoglobin (HbA1c), lipids and microalbuminuria tests.Results: Women with diabetes at Survey 1, and those diagnosed by Survey 2, were more likely to have hypertension, heart disease and eyesight problems, have high rates of polypharmacy (four or more medications: mid age 32%, older 64%) and more consultations with general practitioners and specialists than women without diabetes. During 1997–2001, there was a trend for a greater percentage of women with diabetes to have an HbA1c test at least annually (mid age 44%–52%, older age 46%–58%). Rates of testing microalbuminuria and lipids also increased but were far from conforming to guidelines. Having more frequent consultations with a general practitioner was significantly associated with having all three recommended tests.Conclusions: There is an increasing use of services by women with diabetes, in part due to an increase in compliance with guidelines for the management of diabetes.Implications: Linked health and administrative data provide a means to monitor health service utilisation, adherence to principles for best practice care and issues of equity in care.