Use Of Care Services Research Articles

Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China.

In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures. Using data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders. We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables. This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.

When a home is no longer the best place – older adults’ use of health and care services in the context of a major healthcare reform

Abstract This study investigates the association between insufficient home care and the use of health and social care services among older adults. Data was collected from the Resident Assessment Instrument (RAI) home care register linked to registers for health care and primary health care (N = 33,493). The results show that one in six respondents felt that they would be better off living elsewhere than at home with home care, and these respondents used more hospital, emergency, and home care services than those who preferred living at home. The findings suggest that when older adults perceive their home care to be insufficient, they are more likely to utilize a range of health and social care services. Improved service integration could potentially mitigate the increased use of health and social care services by older adults who perceive their home care as inadequate. Furthermore, the ongoing healthcare reform in Finland aims to promote the integration of health and social services, which could lead to improved care outcomes for older adults. The study's findings can inform policymakers and healthcare providers on the importance of identifying and addressing the needs of older home care clients, particularly in the context of the ongoing healthcare reform in Finland.

Health care use and costs attributable to cardiovascular disease in Ireland: a cross-sectional study

Abstract Cardiovascular disease (CVD) is the leading cause of mortality and disability in Europe but the use of health services and costs associated with CVD are poorly quantified. We examined health service use attributable to CVD and corresponding costs in Ireland. Data on 8113 participants aged 50+ of the first wave of The Irish Longitudinal Study on Ageing was used. CVD was defined as having a self-reported doctor diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Outcomes were the self-reported number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department (A&E) attendances and hospitalisations over the 12 months preceding the interview. Negative binomial regression adjusted for socio-demographic confounders and other chronic conditions was used to study the effects of CVD on the outcomes. Average marginal effects (AME) were estimated to examine the additional use of health services attributable to CVD. We estimated the total additional costs attributable to CVD at the population level using Census 2022 data. Participants with CVD reported higher utilization of all health services. In adjusted models, having CVD was associated with additional 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits over the past year. There were twice as many additional hospitalisations attributable to CVD in males compared to females (AME: 0.20 (95% CI: 0.16, 0.23) in males vs AME: 0.10 (95% CI: 0.07, 0.14) in females), with no difference observed in the additional use of other healthcare services by gender or age groups. The population-level costs of the additional healthcare service use attributable to CVD were an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. There is a substantial additional use of health services due to CVD in Ireland, with hospital admissions being the biggest contributor to costs. Key messages • The vast majority of additional costs attributable to CVD in Ireland are generated through use of secondary care services. • While a shift is being implemented in Ireland to manage uncomplicated CVD cases in primary care, sustained efforts aimed at CVD primary prevention are required to contain health service costs.

10.Q. Workshop: Ukrainian refugees in Europe: tackling challenges in health needs and access to health care

Abstract Because of the Russian invasion, nearly 8 million refugees fleeing Ukraine have been registered across Europe of whom 90% are women and children. Ukrainian refugees’ health and access to health care is a concern of utmost importance in this context; and a critical public health challenge for the European countries. To undertake this task knowledge is needed on how Ukrainian refugees experience problems related to health, wellbeing, and access to health care services in host countries. Yet, knowledge is scarce on general health needs, health reception and access to specific services among Ukrainian refugees in European countries. In this context, our workshop intends to bring together four projects that shed light on health needs and well-being of Ukrainian refugees in different European countries as well as the organization of support and access to healthcare systems. The workshop is structured in a first part with presentations and a second part with an open discussion involving the audience. Each presentation will last a maximum of 8-10 minutes. The first presentation concerns health and wellbeing of Ukrainian refugees in the UK including the role of initial health assessments and local authority involvement. The second presentation addresses Ukrainian refugees’ wellbeing, adaptation and use of health care services in Denmark. The third presentation highlights health and healthcare needs among refugees from Ukraine arriving in Norway during 2022. Finally, the fourth presentation is also from Denmark adressing general practitioners’ assessment of Ukrainian refugees arriving to Denmark. In the last part of the workshop, the chairpersons will open a discussion with all workshop participants in order to exchange experiences. The discussion will focus on how to support research and public health interventions targeted Ukrainian refugees including which areas need urgent focus. By learning from each other, this workshop aim to inform public health researchers and stakeholders on challenges and possible solutions to the important public health problem of Ukrainian refuges health. Key messages • Cross-country sharing of public health knowledge regarding Ukrainian refuges health. • Adressing public health challenges and possible solutions regarding Ukrainian refuges health.

Healthy Finland survey as the latest uptake for 50 years of population health monitoring in Finland

Abstract In Finland, population-based health examination surveys (HESs) have been conducted in regularly since early 1960's to obtain information on population health and health determinants. These surveys have covered adult population living in the mainland Finland. Surveys have always been conducted by specially trained personnel using international standardized protocols such as WHO MONICA protocol or EHES protocol. The latest HES, Healthy Finland, is ongoing and will run until June 2023. The Finnish Institute for Health and Welfare (THL) had the responsibility of the coordination of the preparation phase as well as conducting the survey. Survey planning was started already in early 2021 with a multidisciplinary group including representatives from different stakeholders. Survey sample includes 66.000 randomly selected adults aged 18+ years living in Finland. In the 1st phase, they receive a questionnaire to be filled in. Questionnaire covers topics such as quality of life, health, use of health care services, lifestyles, background information, work ability and functional capacity, wellbeing, accidents, and sexual and reproductive health. In the 2nd phase, 10.000 of those selected to the survey were invited to health examination including for example anthropometric measurements, blood pressure, spirometry test, collection of biological samples and sub-studies. This from these national HESs has been widely used for policy making, planning and evaluation of the prevention programmes, as epidemiological background for clinical treatment guidelines of several diseases, and for research. Information obtained from the Healthy Finland survey will be used for the evaluation of wellbeing service counties which are responsible for the organization of social and health care services in Finland. Survey will generate new information about health inequalities by providing information not only by age and sex but also by education and other socio-economic indicators.

I kua na'u "Let me carry out your last wishes" Clinical trial protocol to promote advance care planning among native Hawaiian populations

Advance Care Planning (ACP) is a communication process about serious illness decision making designed to inform patients of possible medical options. Native Hawaiians consistently have low rates of ACP and low use of palliative and hospice care services. Our multidisciplinary community and research group partnered to create I kua na'u “Let Me Carry Out Your Last Wishes,” an ACP intervention featuring culturally tailored videos and are now testing its efficacy. Focus groups and informant interviews were conducted with Native Hawaiian community members to ensure the curriculum honored the history, opinions, and culture of Native Hawaiians. Native Hawaiian culture has traditionally been an oral culture; the spoken word transmitted the moʻolelo, stories, traditions, histories and genealogies, which merges seamlessly with video media. The I kua na'u intervention included multiple educational sessions enhanced with videos (informational and personal). The specific aims are to compare ACP knowledge (primary outcome) and readiness for ACP engagement, ACP preferences, decisional conflict, and ACP completion rates via electronic medical record review (secondary outcomes) in 220 Native Hawaiians over age 55 in: (a) a randomized controlled trial of 110 people recruited from ambulatory clinics, and (b) a pre-post study design among 110 people living on Hawaiian Homestead communities located on lands set aside for Native Hawaiians or assisted living.Our protocol aims to evaluate the efficacy of our video-based educational intervention for Native Hawaiians to support decision making in this community and decrease disparities in serious illness care.Clinical Trial Registration Number: NCT04771208

Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study

BackgroundPatient-reported outcome (PRO) measures can inform clinical decision making and planning of treatment in the health care system. The aim of this study was to examine whether patient-reported health domains influence the use of health care services in outpatients with epilepsy.MethodsThis was a prognostic cohort study of 2,426 epilepsy outpatients referred to PRO-based follow-up at the Department of Neurology, Aarhus University Hospital, Denmark. Patients filled out a questionnaire covering health literacy areas, self-efficacy, well-being and general health. The main outcome was a record of contact to the epilepsy outpatient clinic, inpatient ward and/or emergency room within 1 year, retrieved from health register data. Associations were analysed by multivariable binomial logistic regression.ResultsA total of 2,017 patients responded to the questionnaire and 1,961 were included in the final analyses. An outpatient contact was more likely among patients with very low health literacy (‘social support’): odds ratio (OR) 1.5 (95% CI: 1.1–2.1), very low and low self-efficacy: OR 1.7 (95% CI: 1.2–2.3) and OR 1.4 (95% CI: 1.0–1.8), low and medium well-being: OR 2.2 (95% CI: 1.6–3.0) and OR 1.4 (95% CI: 1.1–1.9), and patients rating their general health as fair: OR 2.8 (95% CI: 1.7–4.6). Inpatient contact and emergency room contact were associated with the health domains of self-efficacy and general health.ConclusionsPRO questionnaire data indicated that patients with low health literacy (“social support”), well-being, self-efficacy and self-rated general health had an increased use of health care services at 1 year.These results suggest that PRO measures may provide useful information in relation to the possibility of proactive efforts and prevention of disease-related issues and to help identify efficiency options regarding resource utilization.

Decomposition Analysis of Antenatal Care Utilization Inequities in Kembata Tembaro Zone, Southern Ethiopia.

Health equity has emerged as a global issue in the post-2015 Sustainable Development Goals, and Ethiopia is no exception. Despite positive improvements, inequities in maternal health service utilization among demographic groups continue to be one of Ethiopia's significant challenges in decreasing maternal mortality. This study focuses on antenatal care service discrimination among a local poor group known as the "golden hands" community in Ethiopia's Kembata Tembaro zone. The subgroup community consists of outcast artesian groups known as "golden hands," formerly known as "Fuga," who face discrimination in all aspects of life owing to their living conditions and ethnic background. A community-based comparative cross-sectional study was conducted in Ethiopia's Kembata Tembaro, zone in the Southern Nations, Nationalities, and Peoples' Region (SNNPR), from January to February 2022. The study focused on two groups, "golden hands" and "non-golden hands," consisting of women aged 15-49 years. Using stratified and multistage cluster sampling, 1,210 participants were selected, with 440 from golden hand communities and 770 from non-golden hand communities. Data was collected through translated questionnaires, and data quality was rigorously monitored. The concentration curve and index, as well as logistic-based decomposition analysis, were used to examine inequality. The statistical significance threshold was set at p < 0.05 with a 95% confidence interval. This study comprised 1,210 eligible participants, 440 of whom were golden hand community members. Discrimination accounted for 60.23% of the decreased antenatal care (ANC) service use by the golden hand community. Age, urban residence, and wealth index were the most important independent factors with statistically significant contributions to changes owing to differences in effects (discriminated difference). Since ANC service discrimination is prevalent, the government and nongovernmental organizations should take steps to ensure that marginalized groups in society, such as golden hand women, the poor, the uneducated, and rural people, have equal access to service utilization opportunities.

Barriers and facilitators of supportive care access and use among men with cancer: a qualitative study.

Men diagnosed with cancer are underrepresented in existing supportive care programming and related research, with preliminary indications that men face unique challenges in accessing and engaging with such services. This study aims to identify barriers and facilitators related to the supportive care service access and use among men diagnosed with cancer. From March to May 2021, thirty-one Quebec men (Mage = 52.7, range:(26-82 years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing experiences of cancer supportive care services. Content analysis of qualitative data was performed. Barriers and facilitators to men's supportive care access and use were grouped into four categories: (1) alignment between services and men's needs and preferences; (2) delivery of services in an accessible, inclusive, and responsive way; (3) communication and promotion of services in ways that are acceptable, appealing, and attractive to men; and (4) social norms and perceptions of gender and masculinity affecting men's perceptions of and engagement with services. Barriers and facilitators influencing access and use of supportive care services in men are numerous and diverse. These findings may inform the development of new and the adaptation of current supportive care strategies to better address men's needs and preferences after a cancer diagnosis. Increased adequacy of services tailored to men's needs and preferences, with an emphasis on supporting men to take an active role in their recovery, could improve access and adherence to care. Services adopting a more integrated, patient-centered, and holistic approach to service delivery could positively impact the cancer care trajectory and health outcomes of men. Larger systemic changes may be needed to support men in engaging in currently existing activities and services.

Trends in Preventive Care Services Among U.S. Adults With Diagnosed Diabetes, 2008-2020.

Preventive care services are important to prevent or delay complications associated with diabetes. We report trends in receipt of six American Diabetes Association-recommended preventive care services during 2008-2020. We used 2008-2020 data from the cross-sectional Medical Expenditures Panel Survey to calculate the proportion of U.S. adults ≥18 years of age with diagnosed diabetes who reported receiving preventive care services, overall and by subpopulation (n = 25,616). We used joinpoint regression to identify trends during 2008-2019. The six services completed in the past year included at least one dental examination, dilated-eye examination, foot examination, and cholesterol test; at least two A1C tests, and an influenza vaccine. From 2008 to 2020, proportions of U.S. adults with diabetes receiving any individual preventive care service ranged from 32.6% to 89.9%. From 2008 to 2019, overall trends in preventive services among these adults were flat except for an increase in influenza vaccination (average annual percent change: 2.6% [95% CI 1.1%, 4.2%]). Trend analysis of subgroups was heterogeneous: influenza vaccination and A1C testing showed improvements among several subgroups, whereas cholesterol testing (patients aged 45-64 years; less than a high school education; Medicaid insurance) and dental visits (uninsured) declined. In 2020, 8.2% (95% CI 4.5%, 11.9%) of those with diabetes received none of the recommended preventive care services. Other than influenza vaccination, we observed no improvement in preventive care service use among U.S. adults with diabetes. These data highlight services and specific subgroups that could be targeted to improve preventive care among adults with diabetes.

Health care service use by people diagnosed with invasive melanoma in Queensland: a benefit incidence analysis.

To quantify differences, by residential remoteness and socio-economic status, in health care service use by people diagnosed with invasive melanoma in Queensland. Benefit incidence analysis of CancerCostMod data, comprising Queensland Cancer Registry data linked with Queensland Hospital Admitted Patient Data Collection (QHAPDC), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data. Adults (18 years or older) newly diagnosed with invasive melanoma in Queensland during 1 July 2011 - 31 June 2015 and alive three years after diagnosis. Concentration curves and indices quantifying differences by residential postcode-based remoteness (Australian Statistical Geography Standard - Remoteness Area) and socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage) in hospital admissions (overall and by type) and use of MBS (overall and by type) and PBS services during the three years following diagnosis of invasive melanoma. A total of 13 145 adults diagnosed with invasive melanoma during 2011-15 were alive three years after the diagnosis. Public hospital admissions were more frequent for people living in areas of greater socio-economic disadvantage (concentration index, -0.15; 95% confidence interval [CI], -0.19 to -0.12) or outside major cities (concentration index, -0.10; 95% CI, -0.13 to -0.06); private hospital admissions (concentration index, 0.11; 95% CI, 0.07-0.15) and specialist consultations (concentration index, 0.08; 95% CI, 0.07-0.10) were more frequent in areas of lesser disadvantage and in major cities (private hospital admissions: 0.10; 95% CI, 0.06-0.13; specialist services: 0.07; 95% CI, 0.06-0.09). Differences in other melanoma health care service use by residential remoteness and socio-economic disadvantage were not statistically significant. Variation in health care service use by Queenslanders with primary diagnoses of invasive melanoma by residential socio-economic disadvantage and remoteness were generally minor. Our analysis suggests that access to health care for people with melanoma is fairly equitable in Queensland.

Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa: a multilevel robust Poisson regression modelling

BackgroundTimely and appropriate treatment for childhood illness saves the lives of millions of children. In low-middle-income countries such as sub-Saharan Africa (SSA), poor healthcare-seeking behavior for childhood illnesses is identified as a major contributor to the increased risk of child morbidity and mortality. However, studies are limited on Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.ObjectiveTo examine factors associated with a mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.MethodsA secondary data analysis was conducted based on the latest Demographic and Health Survey (DHS) data of 36 sub-Saharan African countries. A total weighted sample of 16,925 mothers who had under-five children with acute respiratory infection symptoms was considered. The Intraclass Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) tests were done to assess the presence of clustering. Model comparison was made based on deviance (-2LLR) value. Variables with a p-value < 0.2 in the bivariable multilevel robust Poisson analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the Adjusted Prevalence Ratio (APR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the association.ResultsThe prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in SSA was 64.9% (95% CI: 64.2%, 65.7%). In the multivariable analysis; mothers who attained primary education (APR = 1.11, 95% CI: 1.08, 1.15), secondary education (APR = 1.13, 95% CI: 1.09, 1.18), and higher education (APR = 1.19, 95% CI: 1.11, 1.27), belonged to the richest household (APR = 1.07: 95% CI: 1.02, 1.12), had media exposure (APR = 1.11, 95% CI: 1.08, 1.15), currently working (APR = 1.08, 95% CI: 1.06, 1.11), had ANC use (APR = 1.25: 95% CI: 1.17, 1.35), health facility delivery (APR = 1.10, 95% CI: 1.07, 1.14), belonged to West Africa (APR = 1.04, 95% CI: 1.01, 1.08) and being in the community with high media exposure (APR = 1.04, 95% CI: 1.02, 1,07) were significantly associated with higher prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. On the other hand, distance to a health facility (APR = 0.87, 95% CI: 0.84, 0.91), and being in central Africa (APR = 0.87, 95% CI: 0.84, 0.91) were significantly associated with a lower prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children.ConclusionMother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. It was influenced by maternal education, maternal working status, media exposure, household wealth status, distance to the health facility, and maternal health care service use. Any interventions aiming at improving maternal education, maternal healthcare services, and media access are critical in improving mothers' healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children, hence lowering the prevalence of ARI-related death and morbidity.

Broken bones and apple brandy: resilience and sensemaking of general practitioners and their at-risk patients during the COVID-19 pandemic in Switzerland

In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick’s (1993) four sources of ­resilience – improvisation, virtual role systems, attitudes of wisdom and respectful interaction – heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as “good soldier” and “at-risk patient” categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems.

Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study.

There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services. This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants' use of health care and social care services over 12 months, and costs were calculated. The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model. People who had been homeless during the previous 12 months were recruited as 'case study participants'; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders. The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services. There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model. Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, 'drop-in' services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (HSDR 13/156/03) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 16. See the NIHR Journals Library website for further project information.

Analisis Faktor-faktor Yang Mempengaruhi Perilaku Ibu Hamil Dalam Pemanfaatan Pelayanan Antenatal Care (K4) Di Wilayah Kerja Puskesmas Pancur Batu Tahun 2023

One of the efforts made to reduce MMR is the Antenatal Care (ANC) examination program which is mandatory for pregnant women. Antenatal care (ANC) is a planned program in the form of observation, education and medical treatment for pregnant women, to achieve a safe and satisfactory pregnancy process and preparation for childbirth. The aim of this research is to determine the factors that influence the behavior of pregnant women in the use of Antenatal Care (K4) services in the Pancur Batu Community Health Center Work Area in 2023. This research uses a descriptive analytical design using quantitative methods with a cross sectional research design approach. The number of samples in this study was 62 respondents. The conclusion of this study is that there is a relationship between maternal knowledge of integrated antenatal care, p = 0.010 (p &lt; a or 0.010 &lt; 0.05). There is a relationship between the Role of the Family in Integrated Antenatal Care, p= 0.001 (p &lt; a or 0.001 &lt; 0.05). It is recommended that pregnant women pay more attention to their pregnancy, namely by making regular integrated antenatal care visits so that the mother's pregnancy can be monitored by health workers.

A secondary analysis of the factors associated with women´s adequate utilization of antenatal care services during their last pregnancy in Uganda

BackgroundAdequate antenatal care services (ANC) use is critical to identifying and reducing pregnancy risks. Despite the importance placed on adequate antenatal care service utilization, women in Uganda continue to underutilize antenatal care services. The primary goal of this study is to identify the factors associated with women’s adequate utilization of antenatal care services in Uganda.MethodsSecondary data from the 2016 Uganda Demographic and Health Survey were used in this study. The study sample consists of 9,416 women aged 15 to 49 who reported giving birth in the five years preceding the survey. The adequate use of antenatal care services is the dependent variable. A woman who used antenatal care services at least four times is considered to have adequately used antenatal care services. We used univariate, bivariate, and multilevel logistic regression modelling to identify the factors associated with adequate utilization of antenatal care services. STATA version 14.2 was used to analyze the data.ResultsThe prevalence of adequate utilization of antenatal care services in Uganda was found to be 61.4%. Women with secondary or higher education were 32.0% (AOR = 1.32, 95% CI;1.07–1.63), employed women were 26.0% (AOR = 1.26, 95% CI;1.10–1.44), women who received high-quality antenatal care content were 78.0% (AOR = 1.78, 95% CI;1.58–2.02), and women who belong to the rich category of the wealth index bracket were 27.0% (AOR = 1.27, 95% CI;1.09–1.49), more likely to use antenatal care services adequately. Finally, the study discovered that women from less diverse ethnic communities were 15.0% (AOR, 0.85, 95%CI; 0.73–0.99) less likely to use antenatal care services adequately.ConclusionWomen’s adequate utilization of antenatal care was influenced by both community and individual-level characteristics. Policymakers must use a multi-sectoral approach to develop policies that address both individual and community-level characteristics.

Effect of the COVID-19 pandemic on the pediatric infectious disease landscape.

This narrative review aims to present an overview of the COVID-19 pandemic's effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children ("long COVID"), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription. Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of "long COVID" in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage. What is Known: •COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible. •The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse. What is New: •Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols. •The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).

Factors associated with unmet pediatric health care needs during the coronavirus pandemic

PurposeTo examine risk factors for unmet pediatric health care needs during the coronavirus pandemic in a national sample of US children under 17 years of age. Design and methodsIn this cross-sectional study, we used data from the 2021 National Survey of Children's Health (n = 50,892). Unmet pediatric health care needs were assessed as follows: “during the past 12 months, was there any time when this child needed health care but it was not received?”. Logistic regression with multiple imputations was used to evaluate bivariate and multivariable associations between predisposing, enabling, and need factors of health care services use and unmet pediatric health care needs. ResultsApproximately 3.6% of children had unmet health care needs, with significant differences by sample characteristics. Unmet health care needs were notably prevalent among select groups, including children with difficulty covering basic needs (10.6%) and those with ≥2 health conditions (8.9%). In multivariable analyses, factors associated with unmet pediatric health care needs included predisposing factors such as older age, ≥2 children with special health care needs in the household, primary language other than English or Spanish, and poor caregiver health; enabling factors such as difficulty covering basic needs, no insurance, and no personal doctor or nurse; and need factors such as poor perceived or evaluated child health. Reasons for unmet needs included financial, nonfinancial, and accessibility barriers. ConclusionsSeveral factors were associated with unmet health care needs. Practice implicationsWe identified children who would benefit from targeted interventions aimed at promoting health care services use.

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

Objective This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. Design and setting A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. Subjects PHC patients aged 60 years or more with a T2D were included. Main outcome measures Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). Results In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39–1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39–1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74–1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86–0.96]). Conclusions In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities. Key Points In older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality. The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services. The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.

Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement.

Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.