Use Of Health Care Services Research Articles

Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial

BackgroundAtrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with...

Hospital and physician-based mental healthcare during 12 months of opioid agonist treatment for opioid use disorder: Exploring costs and factors associated with acute care.

Individuals with opioid use disorder (OUD) have a high prevalence of co-occurring mental health disorders; however, there exists little information on mental health service use for this population. We aimed to determine the prevalence of non-substance use-related mental health emergency department (ED) visits, hospitalizations, and outpatient physician visits for individuals receiving treatment for OUD over one year. We also explored individual-level characteristics associated with mental health care service use and estimated the costs of this care. We linked observational cohort data collected from 3,430 individuals receiving treatment for OUD in Ontario, Canada, with health administrative records available for all individuals enrolled in Ontario's public health insurance program. Eligible participants were receiving medication treatment for OUD and were recruited between 2011 and 2021 Starting on the day of cohort enrolment, we included health service data for up to 12 months. We identified ED visits and hospitalizations for non-substance use-related mental health disorders using ICD-10-CA diagnostic codes. Outpatient mental health visits to primary care providers and psychiatrists were ascertained by examining the diagnostic codes of physician billing claims. We used logistic regression to explore the association between demographic and clinical factors of interest and mental health-related ED visits or hospitalizations. Mean one-year mental healthcare costs, calculated in 2022 Canadian dollars, were estimated. We fit a two-part zero-inflated negative binomial model to explore the association between factors of interest and healthcare costs. Altogether, 14.9% of individuals had mental health-related acute care ED visits or hospitalizations and 37.3% had outpatient mental health visits during the follow up period. For participants with at least one visit, we determined the mean number of ED visits (1.93, standard deviation [SD] = 2.15), hospitalizations (1.46, SD = 1.05), primary care visits (3.51, SD = 4.31), and psychiatry visits (4.04, SD = 4.73). Lower odds of ED use and hospitalization were associated with older age (46+ compared to less than 25 years: odds ratio [OR] 0.43, 95% confidence interval [CI]: 0.29, 0.63) and being employed (OR 0.48, 95% CI 0.37, 0.61). Higher odds of ED use and hospitalization was associated with positive opioid urine drug screens (50% positive urine drug screens compared to 0%: OR 1.45, 95% CI 1.05, 2.01), having more comorbid conditions (7+ health conditions compared to 0-2 health conditions: OR 3.76, 95% CI 2.60, 5.44), and receipt of outpatient mental healthcare (OR 2.38, 95% CI 1.95, 2.92) were associated with higher odds of ED visits or hospitalizations. Mean one-year mental healthcare costs for individuals receiving ED visits or hospitalizations totaled $9,117.80 (95% CI 7,372.90, 10,862.70) per person. Mean one-year costs for individuals with outpatient mental healthcare alone totaled $382.30 (95% CI 343.20, 421.30) per person. Individuals receiving treatment for OUD receive care in EDs, inpatient units, and outpatient clinics for mental health conditions other than substance use-related diagnoses. Healthcare costs were considerably higher for those receiving acute care treatment for mental health conditions. Studying integrated mental health and substance use disorder treatment in the outpatient setting should be a priority to bolster care for this population.

Attitudes and digital health literacy mediate the relationship of digital information accessibility with intention for digital healthcare service use in patients with multiple myeloma: A cross-sectional study

Attitudes and digital health literacy mediate the relationship of digital information accessibility with intention for digital healthcare service use in patients with multiple myeloma: A cross-sectional study

BARRIERS TO ACCESS HEALTH AND MENTAL HEALTH SERVICES AMONG SOUTH ASIAN OLDER ADULTS

Abstract Research on older immigrants in Canada is in its infancy despite their growing numbers. In 2019, Covenant Health, one of the largest healthcare providers in Canada, in partnership with the Indo-Canadian Women’s Association, a non-government service organization for new immigrants, in Edmonton, conducted a community consultation with South Asian older adults to understand their health and mental care needs and barriers to their access. The consultation was based on anecdotal evidence that South Asian older adults make poor use of health care services in general and mental health care services in particular. Focus groups and individual interviews with older adults were used to gather information, and the data were analyzed using thematic analysis. The results showed that a significant number of South Asian older adults lead marginalized and isolated lives within their community. Lack of language skills, transportation difficulties, poor knowledge of health care services, financial dependence on sponsors, and adherence to traditional beliefs about health and mental health services are some of the barriers to accessing services. Based on these findings, several recommendations are suggested to improve healthcare access for older adults.

Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery

Surgical quality improvement efforts have largely focused on 30-day outcomes, such as readmissions and complications. Surgery may have a sustained impact on the health and quality of life of patients considered frail, yet data are lacking on the long-term health care utilization of patients with frailty following surgery. To examine the independent association of preoperative frailty on long-term health care utilization (up to 24 months) following surgery. This retrospective, observational cohort study included patients undergoing elective general and vascular surgery performed in the Veterans Affairs (VA) Surgical Quality Improvement Program with study entry from October 1, 2013, to September 30, 2018. Patients were followed up for 24 months. Patients with nursing home visits prior to surgery, emergent cases, and in-hospital deaths were excluded. Data analysis was conducted from September 2022 to May 2024. Preoperative frailty as assessed by the Risk Analysis Index (RAI-A) score: robust, less than 20; normal, 20 to 29; frail, 30 to 39; and very frail, 40 or more. The primary outcome was health care utilization through 24 months, defined as inpatient admissions, outpatient visits, emergency department (ED) visits, and nursing home or rehabilitation services collected via Corporate Data Warehouse and Centers for Medicare & Medicaid Services data. χ2 Tests and analysis of variance were used to assess preoperative frailty status, and a Cox proportional hazards model was used to calculate the adjusted association of preoperative frailty on each postdischarge health care utilization outcome. This study identified 183 343 elective general (80.5%) and vascular (19.5%) procedures (mean [SD] age, 62 [12.7] years; 12 915 females [7.0%]; 28 671 Black patients [16.0]; 138 323 White patients [77.3%]; 94 451 Medicare enrollees [51.5%]) with mean (SD) RAI-A score of 22.2 (7.0). After adjustment for baseline characteristics and preoperative use of health care services, frailty was associated with higher inpatient admissions (frail: hazard ratio [HR], 1.75; 95% CI, 1.70-1.79; very frail: HR, 2.33; 95% CI, 2.25-2.42), ED visits (frail: HR, 1.39; 95% CI, 1.36-1.41; very frail: HR, 1.70; 95% CI, 1.65-1.75), and nursing home or rehabilitation encounters (frail: HR, 4.97; 95% CI, 4.36-5.67; very frail: HR, 7.44; 95% CI, 6.34-8.73). For patients considered frail and very frail, health care utilization was higher after surgery and remained significant through 24 months for all outcomes (using piecewise Cox proportional hazards modeling). In this study, frailty was a significant risk factor for high long-term health care utilization after surgery. This may have quality of life implications for patients and policy implications for health care systems and payers.

Estimating Cost Savings of Care Coordination for Older Adults: Evidence from the Iowa Return to Community Program.

In response to rising costs associated with providing health care services to Americans over 65 years old, policymakers have called for the expansion of care coordination programs to reduce total spending while improving patient outcomes and provider efficiency. This study uses a Markov Chain model to estimate financial impacts associated with the implementation of a care coordination program across the state of Iowa. Estimates revealed an association between the implementation of the Iowa Return to Community (IRTC) and a reduction in health care service use, which yielded per capita cost savings of $7,920.24 over a 5-year span. Subgroup analysis showed that inclusion of informal care partners enhances these savings, as they contributed to reduced inpatient hospital use and deferred nursing home admissions. The continued expansion of the IRTC appears as a viable strategy to curtail aggregate health care spending while supporting older adults stay at home.

Staff and patient experiences of crowding, corridor care and boarding: a rapid review.

The increasing use of healthcare services is leading to issues with hospital overcrowding and this is particularly apparent in emergency departments (EDs). Consequently, patients are being cared for in areas that were not designed for that purpose, such as waiting areas and corridors. This negatively affects nurses' and patients' experiences of care. This article provides a rapid review of the evidence on nurses' and patients' experiences of crowding, corridor care and boarding. The findings highlight three main elements experienced by staff and patients when caring or being cared for in such contexts: stress and frustration; dissatisfaction with care; and safety and coping mechanisms. Enhancing nurse autonomy and improving communication with patients could mitigate some of these negative experiences and thereby improve staff retention, reduce staff-patient conflict and reduce the likelihood of patients leaving the ED without being seen.

PP34 Impact Of The COVID-19 Pandemic On Depression Incidence And Healthcare Service Use Among Patients With Depression

IntroductionMost studies on the impact of the COVID-19 pandemic on depression burden focused on the earlier pandemic phase specific to lockdowns, but the longer-term impact of the pandemic is less well studied. In this population-based cohort study with quasi-experimental design, we examined both the short-term and long-term impacts of COVID-19 on depression incidence and healthcare service use among patients with depression.MethodsUsing the territory-wide electronic medical records in Hong Kong, we identified patients with new diagnoses of depression from 2014 to 2022. An interrupted time-series (ITS) analysis examined changes in incidence of depression before and during the pandemic. We then divided patients into nine cohorts based on year of incidence and studied their initial and ongoing service use until December 2022. Generalized linear modeling compared the rates of healthcare service use in the year of diagnosis between patients newly diagnosed before and during the pandemic. A separate ITS analysis explored the pandemic impact on the ongoing service use among preexisting patients.ResultsThere was an immediate increase in depression incidence (RR=1.21; 95% CI: 1.10, 1.33; p<0.001) in the population since the pandemic with a nonsignificant slope change, suggesting a sustained effect until the end of 2022. Subgroup analysis showed that increases in incidence were significant among adults and the older population, but not adolescents. Depression patients newly diagnosed during the pandemic used 11 percent fewer resources than the prepandemic patients in the first diagnosis year. Preexisting depression patients also had an immediate decrease of 16 percent in overall all-cause service use since the pandemic, with a positive slope change indicating a gradual rebound.ConclusionsDuring the COVID-19 pandemic, service provision for depression was suboptimal in the face of greater demand generated by the increasing depression incidence. Our findings indicate the need to improve mental health resource planning preparedness for future public health crises.

Promoting Intensive Transitions for Children and Youth with Medical Complexity from Paediatric to Adult Care: the PITCare study—protocol for a randomised controlled trial

IntroductionChildren with medical complexity (CMC) have chronic, intensive care needs managed by many healthcare practitioners. Medical advances have enabled CMC to survive well into adulthood. However, the availability of supports...

Does syndromic surveillance assist public health practice in early detecting respiratory epidemics? Evidence from a wide Italian retrospective experience.

Large-scale diagnostic testing has been proven ineffective for prompt monitoring of the spread of COVID-19. Electronic resources may facilitate enhanced early detection of epidemics. Here, we aimed to retrospectively explore whether examining trends in the use of emergency and healthcare services and the Google search engine is useful in detecting Severe Acute Respiratory Syndrome Coronavirus outbreaks early compared with the currently used swab-based surveillance system. Healthcare Utilization databases of the Italian region of Lombardy and the Google Trends website were used to measure the weekly utilization of emergency and healthcare services and determining the volume of Google searches from 2020 to 2022. Improved Farrington algorithm (IMPF) and Exponentially Weighted Moving Average (EWMA) control chart were both fitted to detect outliers in weekly searches of nine syndromic tracers. AND/OR Boolean operators were tested aimed for joint using tracers and models. Signals that occurred during periods labelled as free from epidemics were used to measure positive predictive values (PPV) and false negative values (FNV) in anticipating the epidemic wave. Out of the 156 weeks of interest, 70 (45 %) were affected by epidemic waves. Overall, 54 syndromic signals were obtained from any one of the 7 healthcare or Google tracers, generating an outlier from both the EWMA and IMPF models. PPV values of 0.95, 1.00, 0.96 admitting a delay of 0, 1, and 2 weeks, respectively, between signal and epidemic wave. The values of FNP ranged from 0.19 to 0.21. High predictive power for anticipating COVID-19 epidemic waves, even two weeks ahead of the official reports, was obtained from electronic syndromic tracers of healthcare-seeking trends and Google search engine use. Following verification via a prospective approach, public health organizations are encouraged to take advantage of this free forecasting system to anticipate and effectively manage respiratory outbreaks.

Development and Validation of a Frailty Risk Prediction Model for Community-Dwelling Elderly in Shanghai

Background: China is rapidly aging, increasing the burden on families, society, and public health services. The health of elderly individuals tends to deteriorate with age, and chronic conditions like frailty become more prevalent, driving up the use of healthcare services. Early screening and intervention for frailty are crucial in managing this demographic shift. While tools like the Fried Frailty Phenotype and Frailty Index assess frailty in communities, they are resource-intensive and only indicate frailty status without predicting risk or providing management recommendations. This study aims to develop a risk prediction model for frailty using real-world data, which can support the early detection of high-risk individuals in community settings. Objectives: To analyze the prevalence of frailty and its influencing factors in community-dwelling elderly, to construct a frailty risk prediction model and develop a nomogram, and to validate the model and assess its clinical utility. Methods: A cross-sectional survey of 420 elderly individuals in a Shanghai community health center was conducted (August 2022–March 2023). Data from various assessment tools were used to build a frailty prediction model through logistic regression, with validation conducted on 180 additional participants. The model’s predictive performance was evaluated using the ROC, AUC, calibration curves, and decision curve analysis (DCA). Results: The frailty prevalence was 7.4%. Independent risk factors included social support, malnutrition, fatigue, sarcopenia, reduced grip strength, and sleep duration. The prediction model achieved an AUC of 0.968 in the training set and 0.939 in the validation set, indicating high discrimination and calibration. DCA confirmed the model’s clinical utility. Conclusion: This study highlights a frailty prevalence rate of 7.4% among elderly individuals in Shanghai, with key risk factors identified. The validated frailty risk prediction model provides accurate and clinically effective frailty risk assessment, supporting targeted early interventions to prevent frailty in community settings.

Quebec Health-Related Quality-of-Life Population Norms Using the Health Utilities Index Mark 3: Stratification by Sociodemographic Data and Health Problems.

To provide population utility norms from the Health Utilities Index Mark 3 (HUI3) for the province of Quebec, Canada. This study used data from the Care Trajectories Enriched Data (TorSaDE) cohort, which combines data from the Canadian Community Health Survey (CCHS) and the Quebec Provincial Insurance Board [Régie de l'assurance maladie du Quebec (RAMQ)]. The CCHS is a multiround health-related survey conducted by Statistics Canada since 2007. For each round spanning over 2 years, respondents were randomly selected and completed an online questionnaire. Quebec data for the HUI3 were available in the CCHS for rounds 2007, 2009, and 2013. The RAMQ database is an administrative database that contains information on health care services use and medical diagnostics. HUI3 scores were stratified by sociodemographic variables, as well as by self-reported health problems in the CCHS and by medical diagnostics from the RAMQ. Medical diagnostics were retrieved for the CCHS completion year and the year before and identifiable with the ICD-9 code in the RAMQ database. A total of 55,656 individuals were considered in this analysis. The mean (95% CI) and the median interquartile range of HUI3 were respectively 0.919 (0.918-0.919) and 0.973 (0.905-1) for the entire population. Individuals with lower scores were females, those aged 75 and over, divorced or widowed, unemployed during the last 12 months, less educated, or with a lower annual household income. Individuals born abroad and with normal weight of body mass index had higher utility scores. HUI3 score decreased with the number of diagnosed diseases from 0.946 (0.946-0946) for individuals without diagnosed disease to 0.682 (0.678-0.686) for individuals diagnosed with up to 18 diseases. Regardless of the number of diagnosed diseases in the RAMQ database, individuals who self-reported suffering from a single health problem presented a significantly lower HUI3 ranging from 0.944 (0.943-0.944) for Asthma to 0.789 (0.782-0.796) for Alzheimer compared with 0.956 (0.956-0.957) for individuals with no reported health problems. The same pattern was observed when considering individuals regardless of the diagnosed and self-reported diseases. Utility score norms for HUI3 were produced in the general population of Quebec. Significant differences among various health problems were identified and norms can be used to compare populations in studies that do not have a control group.

Does access to and use of primary healthcare services influence health insurance uptake? A mixed-methods study in the Wa Municipality, Ghana

ABSTRACT Purpose This study explored access to quality primary healthcare services under Ghana's National Health Insurance Scheme (NHIS), its impact on NHIS enrolment, and the implications for attaining Universal Health Coverage (UHC). Methods A sequential explanatory mixed-method research design was employed using a multistage sampling technique. We collected data from 413 insured individuals and 47 healthcare facilities for quantitative community-level analysis using questionnaires. Purposive sampling was used to select 17 healthcare providers and 20 insured key informants for qualitative investigation using interview guides. Quantitative data were analyzed using descriptive statistics, independent t-tests, and binary logistic regression. Qualitative data were thematically analyzed to explain the quantitative findings. Results The results indicated a positive association between outpatient and inpatient services, maternal healthcare, and laboratory testing. Maternal healthcare and laboratory diagnostics positively influenced the renewal of NHIS membership. Binary logistic regression revealed that access to, and utilization of PHC services significantly increased the likelihood of NHIS membership renewal, influenced by healthcare system factors such as service availability, acceptability, and affordability. Conclusion Our findings suggest that policymakers must enhance the NHIS with improved service delivery to attain UHC in Ghana.

End-of-Life Health Care Service Use and Cost Among Medicare Decedents With Neurodegenerative Diseases.

Although neurodegenerative diseases are a leading cause of death, little is known about health care utilization and cost during the end-of-life (EoL) period or how it compares with that of other life-limiting conditions. We aimed to describe and compare resource utilization among US Medicare decedents with neurodegenerative diseases with decedents with cancer. We conducted a retrospective study of Medicare Part A and B beneficiaries with Alzheimer disease (AD), Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Decedents diagnosed with malignant brain tumors or pancreatic cancer served as non-neurodegenerative comparators. Descriptive analyses examined demographic and clinical characteristics in the last year of life. The probabilities and associated costs of emergency department (ED), inpatient, skilled nursing facility (SNF), and hospice utilization during the last 12 and 6 months of life were also compared between persons with neurodegenerative diseases and cancer, adjusting for sociodemographic factors and comorbidity burden. A total of 1,126,799 Medicare beneficiaries died in 2018, of which 357,926 had a qualifying diagnosis. Persons with neurodegenerative diseases were older and more frequently received Medicaid assistance than persons with brain or pancreatic cancer. In all groups, health care service utilization increased over the last year of life, and total costs were predominantly attributable to inpatient care. In the last 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Persons with neurodegenerative diseases as compared to persons with malignant brain tumors also had greater odds of ED use (AD: adjusted odds ratio [aOR] 1.17, 95% CI 1.11-1.23; PD: aOR 1.18, 95% CI 1.11-1.25; ALS: aOR 1.11, 95% CI 1.01-1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60-0.68; PD: aOR 0.65, 95% CI 0.61-0.69; ALS: aOR 0.33, 95% CI 0.30-0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31-0.36; PD: aOR 0.33, 95% CI 0.31-0.36; ALS: aOR 0.41, 95% CI 0.36-0.46). The findings were similar in pancreatic cancer. Persons with neurodegenerative diseases in the United States are more likely to visit the ED and less likely to use inpatient and hospice services at EoL than persons with brain or pancreatic cancer. These group differences may stem from prognostic uncertainty and reflect inadequate EoL care practices, requiring further investigation to ensure more timely palliative care and hospice referrals.

Gynecological health care services utilization and violence among female sex workers in Togo in 2021

BackgroundFemale Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo.MethodA cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence.ResultsA total of 447 FSW with a median age of 30 [IQR: (24–38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22–0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19–2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16–2.73); a history of abortion (aOR = 1.53; 95%CI 1.03–2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99–11.94), were more likely to experience violence.ConclusionThere is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

Socioeconomic Inequality in Perceived Need for Mental Healthcare in Patients with Type 2 Diabetes Mellitus in Hamadan, Western Iran

Background and aims: The use of mental healthcare services in type 2 diabetes mellitus (T2DM) patients can depend on socioeconomic status (SES). The current study aimed to evaluate socioeconomic inequality in the perceived need for mental healthcare in patients with T2DM in Hamadan, Western Iran. Methods: This cross-sectional study was conducted between March and July 2023 in Hamadan, Western Iran. The study included T2DM patients who were referred to the Diabetes Center of Hamadan. The variables included in the study were demographics, SES, health insurance status, social support, and self-rated mental health. The outcome of interest was the perceived need for mental healthcare. The socioeconomic inequality was evaluated using concentration index and decomposition analysis. Results: A total of 393 patients (mean age: 56.48±10.65, 62% female and 88% urban inhabitants) were enrolled. The prevalence of perceived need for mental healthcare was 43%, and 50.30% of the patients (85) had delay/avoidance of mental healthcare services. The concentration index (95% confidence interval) of perceived mental healthcare needs was -0.24 (-0.18, -0.30), indicating that perceived needs are more concentrated in the socio-economically disadvantaged patients. Decomposition analysis revealed that low economic status and illiteracy were the main contributors to the inequality (approximately 50%). Cost, minimization, and stigma were the most frequently reported reasons for avoidance/delay of mental healthcare services, respectively. Conclusion: There was a pro-poor socioeconomic inequality in perceived need for mental healthcare among T2DM patients. Healthcare policies and facilities to reduce socioeconomic inequality should mainly focus on disadvantaged T2DM patients.

Elderly Health Care Voucher Scheme in Hong Kong: needs assessment and an evaluation of outcomes

ABSTRACT Elderly Health Care Voucher Scheme represents a form of demand-side subsidy given to the elders to choose a spectrum of medical services in the private medical sector. The current paper aims at (a) conducting a needs assessment of the scheme with an analytical framework of the Four A 's approach (i.e., availability, awareness, accessibility, and acceptance regarding a social program) and (b) evaluating whether the outcome measures of the scheme (i.e., the use of private healthcare services, the use of primary care and the empowerment of the elders in the choice of services) were achieved. The needs assessment concludes that the utilization rate of the elders, awareness and satisfaction rate are high. The positive sides concluded from the needs assessment, however, failed to turn into the fulfillment of outcome measures due to the structural barriers. Recommendations at short-term, medium-term and long-term are made.

Use of primary health care services among children and adolescents with cerebral palsy.

https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.15879

The effect of multidomain lifestyle intervention on health care service use and costs - secondary analyses from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): a randomised controlled trial.

The Finnish multidomain lifestyle intervention study to prevent cognitive impairment and disability (FINGER, N = 1259), a randomised controlled trial had beneficial effects on morbidity in older people, but to what extent such a lifestyle intervention may affect the use of health care services and their costs especially in long term are unknown. This study investigated the effect of a two-year FINGER multidomain intervention on health care service use during the 8-year follow-up. The costs of service use were also evaluated. Health care service use obtained from national health care registers (days of inpatient hospital stay and long-term care, number of visits to emergency services, hospital as outpatient, home care, primary care physician and primary care nurse) was analysed among participants of the FINGER. Trial targeted community-dwelling people aged 60-77years at risk for cognitive impairment, who were randomly allocated to the multidomain intervention or control group. Costs were evaluated as the mean costs of services used. There were no significant differences in total health care costs between the intervention and control groups. The participants in the intervention group, however, had a lower use of the hospital inpatient care (RR 0.73, 95% CI 0.54-1.00) and emergency services (RR 0.83, 95% CI 0.70-0.97) than those in the control group. Hospital inpatient care was lower especially among men. The use of other types of health care services did not differ between the groups. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68-0.99). The FINGER intervention has a potential to reduce the need for the inpatient hospital care and emergency visits and associated costs, especially among men.

Impact des attentats du 13 novembre 2015 sur les enfants des civils exposés et sur les relations parents–enfants

IntroductionSanté publique France carried out a web-based epidemiological survey (ESPA 13 Novembre) between 8 and 12 months after the terrorist attacks of the 13 November 2015. This was done in order to explore the post-traumatic psychological impact of the attacks on the directly exposed civilians and responders as well as their use of healthcare services. The survey took the form of a series of closed-ended questions as well as several open-ended questions. We present here an analysis of the responses of civilians to the following specific question: “If you have children, can you tell us whether you think the experience you went through had an effect on them, or on your relationship with them? Can you explain?”. ObjectiveTo find out about the impact of the attacks on the children of exposed civilians and on parent–child relationships, something that has never been studied in the context of mass attacks. MethodWe carried out a thematic analysis of civilians’ responses to this specific question, building up general themes by data reduction. ResultsThe analyses revealed four main themes which relate to the impact of the exposure to terrorist attacks on parent-child relationships, the changes experienced in their role as parents, their children's reactions and, finally, the ways in which they tried to protect their children. DiscussionThe parents highlighted the psychological changes that operated in them, their unease, their fear of the outside world, and their concern for their children's safety. They discussed the consequences of the attacks on their children in terms of stress, insecurity, psychological disturbances, and even of the emergence of real disorders. The parents have tried to fulfil their protective role in a variety of ways, sometimes with a feeling of powerlessness reinforced for some by the difficulty of finding suitable care spaces. Attachment bonds have, for the most part, tightened in these families demonstrating their reassuring function within the group. It seems essential to care for children, and the family as a whole, alongside their parents, in order to re-establish secure attachment bonds which are a factor in resilience.