Use Of Health Care Services Research Articles

Disability and Health Services: The Case of Women in Spain

Background: For as long as data have been collected, women with disabilities have had worse health conditions than other women. Moreover, women with disabilities make more use of healthcare services than women without disabilities. Objective: The main aim of this study is to analyze the impact of various factors on the use of healthcare services by this group of women at risk of exclusion. Methods: Binary logistic regression models are used to examine seven indicators of the use of healthcare services and evaluate the influence of factors, such as age and emotional and personal support. To that end, the analysis uses data from the most recent Spanish National Health Survey (SNHS, 2017) published by the Spanish Statistical Office (INE). Results: Studies on the use of healthcare services have focused on the influence of social status on economic factors and do not include explanatory variables relating to the social and family environment of women with disabilities. Therefore, this study includes variables representing home care services and emotional and personal support to capture the impact of human relationships and the home care environment on health in such a way that its importance and its effect on the use of health services can be determined, distinguishing between the general population and the female population with disabilities. Conclusion: The data in this study revealed important differences in the use of healthcare services by women with disabilities compared to other women and the population in general, as mentioned in the table and the results indicated above. It is essential that healthcare workers and policymakers identify and account for the different requirements of women with disabilities.

Care pathways of sepsis survivors: sequelae, mortality and use of healthcare services in France, 2015–2018

BackgroundIndividuals who survive sepsis are at high risk of chronic sequelae, resulting in significant health-economic costs. Several studies have focused on aspects of healthcare pathways of sepsis survivors but comprehensive, longitudinal overview of their pathways of care are scarce. The aim of this retrospective, longitudinal cohort study is to identify sepsis survivor profiles based on their healthcare pathways and describe their healthcare consumption and costs over the 3 years following their index hospitalization.MethodsThe data were extracted from the French National Hospital Discharge Database. The study population included all patients above 15 years old, with bacterial sepsis, who survived an incident hospitalization in an acute care facility in 2015. To identify survivor profiles, state sequence and clustering analyses were conducted over the year following the index hospitalization. For each profile, patient characteristics and their index hospital stay and sequelae were described, as well as use of care and its associated monetary costs, both pre- and post-sepsis.ResultsNew medical (79.2%), psychological (26.9%) and cognitive (18.5%) impairments were identified post-sepsis, and 65.3% of survivors were rehospitalized in acute care. Cumulative mortality reached 36.6% by 3 years post-sepsis. The total medical cost increased by 856 million € in the year post-sepsis. Five patient clusters were identified: home (65.6% of patients), early death (12.9%), late death (6.8%), short-term rehabilitation (11.3%) and long-term rehabilitation (3.3%). Survivors with early and late death clusters had high rates of cancer and primary bacteremia and experienced more hospital-at-home care post-sepsis. Survivors in short- or long-term rehabilitation clusters were older, with higher percentage of septic shock than those coming back home, and had high rates of multiple site infections and higher rates of new psychological and cognitive impairment.ConclusionsOver three years post-sepsis, different profiles of sepsis survivors were identified with different mortality rates, sequels and healthcare services usage and cost. This study confirmed the importance of sepsis burden and suggests that strategies of post-discharge care, in accordance with patient profile, should be further tested in order to reduce sepsis burden.

Practice guidelines for cardiovascular disease: how is depression addressed?

Abstract Introduction Multimorbidity is associated with increased mortality, decreased quality of life, and increased use of healthcare services and complicates medical decision-making. Depression is more prevalent among patients with CVD than in the general population, with a direct impact on cardiovascular outcomes and management. Clinical practice guidelines (CPGs) aim to provide the best available advice for improving patient care and outcomes. Question: Do CPGs on CVD provide any practical guidance on depression screening and management? Methods National and international CPGs on CVD prevention and management published between 2012 and 2023. English language only. Databases: MEDLINE n=2432. EMBASE n=327; G.I.N. n=57; Guideline Central: n=97; Uptodate n=26; Society homepages (e.g. NICE, SIGN) n=7. Selection criteria: general management guidelines for adult patients diagnosed with a CVD, as well as disease-specific CPGs (e.g. heart failure (HF), coronary artery disease, peripheral arterial disease (PAD), ischaemic disease, stroke or hypertension (HT)) providing patient-management guidance. Eligible guidelines: evaluated for any mention of depression, with a focus on: 1) recommendations regarding depression screening and treatment; 2) drug-drug or drug-disease interactions associated with depression. Results 43 CVD CPGs provide comprehensive management advice: 7 from CVD in general and 36 from specific disease in CVD (11 from HT, 7 from ischemic heart disease, 7 from HF, 5 from dyslipidemia, 3 from stroke, and 3 from PAD). 26 CVD CPGs mention depression as a CV comorbidity at least once: 22 in specific disease CPG and 4 in general CVD CPGs. 15 CVD CPGs advise to screen for depression: 4 from CVD in general and 11 from specific disease in CVD (4 from ischemic heart disease, 3 from HF, 2 from HT, 1 from PAD, and 1 from stroke). 8 CVD clinical practice guidelines provide advice on management of depression: 3 from CVD in general and 5 from specific disease (2 from HT, 2 from ischemic heart disease and 1 from HF). 4 CVD clinical practice guidelines advise on drug-drug or drug-disease interactions. When provided, the level and quality of guidance for treating physicians on how to screen and manage depression remains very low. Conclusion Management of CVD in the specific clinical setting of depression remains poorly addressed, despite it being documented that factors associated with poor adherence to CVD treatment include depression. Future directions: The psychosocial needs of patients with CVD should be systematically assessed and addressed in an evidence-based manner. There is a need for clear practical guidance on the frequency at which a patient’s mental health should be reassessed. Patient panels can help provide practical information toward addressing depression in the development of guidelines.The AIDS CPG address depression in detail and could serve as a model for future CVD CPGs.

The Taiwanese Map of Axial Spondyloarthritis: Living with the Condition.

Background and Objective: The International Map of Axial Spondyloarthritis (IMAS) explores the physical, psychological, and social experiences of patients with axial spondyloarthritis (axSpA). This initiative is now being expanded to Taiwan as the Taiwanese Map of Axial Spondyloarthritis (TMAS). We aim to provide rheumatologists with insights into the perspectives of Taiwanese patients, enabling physicians to better understand the unmet needs of these patients and optimize their management. Materials and Methods: The TMAS is a cross-sectional study gathering data through an online survey of axSpA patients, promoted by the Ankylosing Spondylitis Caring Society of R.O.C. (ASCARES), conducted from July 2017 to March 2018 by Ipsos, and analyzed by the Health & Territory Research (HTR) group of the University of Seville. The questionnaire includes 99 questions that cover domains such as patient profile, diagnosis, habits/lifestyle, employment status, physical/psychological health status, social support, use of healthcare services, and treatments. Results: A total of 112 axSpA patients were included in this survey. The mean age was 38.6 years and 75.0% were male. The average diagnostic delay was 3 years, and 19.6% reported extra-articular manifestations. Out of the 49 respondents who reported HLA-B27 information, 35 were HLA-B27-positive. The disease burden was high, with a mean BASDAI score of 4.9 and 75.9% having a mild to moderate degree of spinal stiffness. Furthermore, they were socially and psychologically burdened, with 88.4% experiencing work-related issues and 25.9% suffering from anxiety. Conclusions: The TMAS sheds light on the overall perspective of axSpA patients in Taiwan. The TMAS shows shorter diagnostic delay compared to patients from the EMAS. However, high disease activity and significant psychological distress still trouble the patients, causing functional impairments and even leading to career failures. Understanding the perspective of axSpA patients can help rheumatologists adjust treatment strategies to their unmet needs and improve their disease outcomes.

Healthcare service use in paediatric inflammatory bowel disease: a questionnaire on patient and parent care experiences in Germany

BackgroundPaediatric inflammatory bowel disease (PIBD) patients require chronic care over the lifespan. Care for these patients is complex, as it is adapted for childrens’ life stages and changing disease activity. Guideline based care for this patient group recommends a multidisciplinary approach, which includes in addition to paediatric gastroenterologists, nutritional and psychological care services. For PIBD patients, a discrepancy between available guideline-based multidisciplinary care and actual care has been found from the provider side, but to what extent patients experience this is unclear.ObjectivesTo identify which healthcare services were used and whether socio-demographic, geographic or disease related factors have an influence on health service utilisation.MethodsA standardised questionnaire (CEDNA) was distributed amongst parents of children aged 0–17 diagnosed with PIBD and adolescents (aged 12–17) with a PIBD. Items related to health service use were analysed, these included specialist care, additional care services, reachability of services and satisfaction with care. Logistic regression models on additional service use were calculated. Service availability and reachability maps were made.ResultsData was analysed for 583 parent and 359 adolescent questionnaires. Over half of the respondents had Crohn’s Disease (CD, patients n = 186 parents n = 297). Most patients and parents reported their paediatric gastroenterologist as their main care contact (patients 90.5%; parents 93%). Frequently reported additional services were nutritional counselling (patients 48.6%; parents 42.2%) and psychological support (patients 28.1%; parents 25.1%). Nutritional counselling was more frequently reported by CD patients in both the patient (OR 2.86; 95%CI 1.73–4.70) and parent (OR 3.1; 95%CI 1.42–6.71) sample. Of the patients, 32% reported not using any additional services, which was more likely for patients with an illness duration of less than one year (OR 3.42; 95%CI 1.26–9.24). This was also observed for the parent population (OR 2.23; 95%CI 1.13–4.4). The population-based density of specialised paediatric gastroenterologists was not proportionate to the spatial distribution of patients in Germany, which may have an influence on access.ConclusionsParents and children reported highly specialised medical care. Multidisciplinary care offers do not reach the entire patient population. Access to multidisciplinary services needs to be ensured for all affected children.

49 Health Literacy and Well-Being in Older Adults

Objective:Although health problems are often a natural consequence of aging, many older adults struggle to manage their health care problems. Health literacy refers to the ability to access, process, and use health information to make appropriate decisions to promote good overall health. Low levels of health literacy are associated with a host of negative outcomes such as less efficient use of healthcare services, higher healthcare costs, increased mortality, and poorer self-rated health. In those with medical conditions (e.g., diabetes), lower health literacy is linked with higher levels of depression. It is important to investigate whether mental health is linked to health literacy as understanding these links has the potential to identify those at risk for negative outcomes and thus implement protective strategies. Therefore, the current study sought to determine the extent to which various mental health constructs such as happiness, well-being, anxiety and depression are related to health literacy in a community-based sample of cognitively healthy individuals. We hypothesized that higher levels of health literacy would be associated with higher self-reported well-being, happiness, and lower anxiety and depression.Participants and Methods:Design - Cross-sectional, prospective study. Setting - Community-based. 93 individuals were included with mean age=59.02 years (SD=15.12) and mean education=15.70 (SD=2.39). 60% were women, the majority were White (55%) while 38% were Black and 7% belonged to other races; 90% were non-Hispanic.Measures:Health Literacy - Health literacy was measured by an 8-item instrument in the Rush Memory and Aging Project that examined the participant’s understanding of health care, treatment, and related behaviors. Happiness - Happiness was measured by 5 items from the Satisfaction with Life Scale using a 7-point scale (1 = strongly agree; 7 = strongly disagree). Higher scores indicated lower levels of happiness. Well-being - Well-being was measured with an 18-item instrument from the Rush Memory and Aging project, with higher scores indicating better well-being. Statistics: Bivariate correlations between age, education, and mental health measures and health literacy were examined.Results:Higher level of health literacy was significantly associated with age (r = .282 p = .009) and education (r = .228 p = .039). Contrary to our hypothesis, health literacy was not significantly associated with happiness (r = .002 p = .987), well-being (r = .037 p = .742), depression (r = .005 p = .962) or anxiety (r = -.064 p = .568). Even after controlling for age and education, these associations remained significant.Conclusions:Higher level of healthy literacy was associated with older age and higher level of education. However, no significant association was found between health literacy and mental health measures of happiness, well-being, depression, and anxiety in cognitively healthy individuals, even after controlling for demographics. The lack of such associations in this study was unexpected and suggests that other factors such as the presence of health conditions (e.g., diabetes, cancer) might critically contribute to such associations. Future studies should examine these associations in a larger context to better understand how to promote healthy self-care behaviors.

Identifying user profiles of healthcare, social and employment services in a working-age population: A cluster analysis with linked individual-level register data from Finland.

A thorough understanding of the use of services in the population is important in order to comprehend the varying service needs of different groups. This explorative study aimed to find distinct user profiles in a working-age population based on individuals' annual use of healthcare, social and employment services and to explore socio-demographic and morbidity-related predictors of the user groups. Administrative register data on the use of various services and individual-level covariates from year 2018 were linked for all residents aged 18-64 of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their frequency of using 22 distinct healthcare, social and employment services during 2018. Multinomial logistic regression models were utilized to assess the associations of cluster assignment with socio-demographic and health-related covariates (sex, age, marital status, education, occupational class, income, days in employment, chronic disease and receipt of different social benefits). Five distinct clusters were identified in terms of service use, labelled low to moderate users of healthcare (82.0%), regular employment services users with moderate use of healthcare (9.6%), supported employment services users with moderate use of healthcare with an emphasis on preventive care (2.9%), frequent users of healthcare, social and employment services (2.9%), and rehabilitation, disability services and specialized healthcare users (2.6%). Each cluster not only showed different patterns of service use but were also differently associated with demographic, socio-economic and morbidity-related covariates, creating distinct service user types. Knowledge on the different user profiles and their determinants may help predict future need and use of services in a population, plan timely, coordinated and integrated services, and design early interventions and prevention measures. This is important in order to save costs and improve the effectiveness of services for groups with different care needs.

Adolescents’ experience of mistreatment and abuse during childbirth: a cross-sectional community survey in a low-income informal settlement in Nairobi, Kenya

BackgroundAdolescent girls in Africa have poorer maternal health outcomes than older women partly because they are less likely to access antenatal and facility-based delivery care. Mistreatment and abuse of adolescents...

Use of healthcare services before diagnosis of attention-deficit/hyperactivity disorder: a population-based matched case-control study

ObjectiveTo compare use of healthcare services and reasons for attendance by children and young people (CYP) with attention-deficit/hyperactivity disorder (ADHD) versus non-ADHD controls.DesignPopulation-based matched case-control study.SettingEnglish primary care electronic health...

Use of outpatient healthcare services before and after the onset of unemployment

Abstract Background The onset of unemployment may entail adverse health effects and, thus, increase the need for healthcare services. On the other hand, the onset of unemployment may weaken access to the healthcare services, which may as such decrease the overall use of healthcare services. The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services. Methods Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for propensity score matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls. Results The use of healthcare services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational healthcare services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of healthcare services. Conclusions When access to occupational healthcare services ceases, other healthcare services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status. Key messages • The overall use of outpatient healthcare services decreases significantly after job loss in Finland because of a decrease in the use of occupational healthcare services. • Adequate and easily accessible healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status or other socio-demographic factors.

Bigdata is breaking new grounds

Abstract Health services research (HSR) must now integrate the technological and methodological developments of ‘Big Data’ that are transforming health research as a whole. E-health devices, social networks, and electronic medical records (EHR) are all sources that can enrich HSR. For example, social networks have become tools for hospital evaluation (ranking) and patient experience, as well as strategies for the dissemination of prevention messages by health authorities. Electronic medical records make it possible to carry out ‘real-life’ longitudinal studies on the entire population of a territory, offering a vision of the health care pathways in health care services. This cross-sectional view of the use of healthcare services renders possible the description and analysis of the evolution of healthcare networks in space and time. These sources also make offer a better understanding of the disparities in access to and use of healthcare services on various geographical scales. Finally, E-health devices can be used to help organize and optimize care. However, we must remain cautious in the face of this acceleration of information flows and the mass of data that are only of interest if they bring value to our research and do not endanger the users of healthcare services: respect for ethical rules, respect for the rights of individuals, or rights, duties and responsibilities in the use of artificial intelligence tools that can be used in big data.

Clustering users of healthcare, social and employment services: a register study from Finland

Abstract Background Understanding the population's overall use of healthcare, social and employment services is important for comprehending service needs and improving the coordination of services. The aim of this exploratory study was to find separate groups in a working-age population based on individuals’ use of various healthcare, social and employment services during one year and to investigate sociodemographic and health-related predictors of user groups. Methods Administrative register data on the use of 22 distinct healthcare, social and employment services and on socio-demographic and health-related covariates from year 2018 were linked for all working-age residents of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their yearly frequency of using each service. Multinomial logistic regression was used to assess the associations of sociodemographic and health-related covariates with cluster assignment. Results Five distinct clusters were identified, labelled ‘low to moderate users of healthcare’ (82%), ‘regular employment services users with moderate use of healthcare’ (10%), ‘supported employment services users’ (3%), ‘frequent users of healthcare, social and employment services’ (3%) and ‘disability and specialized services users’ (3%). Each cluster showed different patterns of service use and was also uniquely associated with sociodemographic and health-related covariates, reflecting distinct service user types. Conclusions The study identified five distinct groups of healthcare, social and employment services users in a working-age population. Knowledge of different user profiles and their determinants can help predict future need and use of services, coordinate and integrate services, and plan early interventions and prevention measures. This is important in order to save costs and improve the overall quality and effectiveness of services for groups with different care needs. Key messages • In terms of their use of healthcare, social and employment services, the working-age population can be classified into distinct groups, uniquely associated with various determinants. • Understanding the population’s use of different services can help predict future needs and improve coordination, integration and effectiveness of services in groups with different needs.

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.

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.

1.M. Workshop: Health Services Research in Europe: time to dust off the field

Abstract Since the 90s, and in spite of major transformations in health systems and the new challenges they face (e.g. rising social inequities, labour shortages), the health Services Research (HSR) field has seen little evolution in the definition of the ground it covers. In 2021, researchers from the EHESP School of Public Health (France) launched a CNRS- and INSERM-funded research team devoted to Health Services and Management Research. To mark the event, a seminar was held to reflect on what HSR stands for today and the specific contributions of our team to the field. In this workshop, Eric Breton will first briefly present the summary of the conclusions of the seminar and the topic areas our research team addresses. He will point to the specificities of HSR in the context of strong European welfare regimen and the importance of recognising the impact upstream social determinants of health have on health systems. We will then move on to our panellists who will, through their own research, question the current perspectives on HSR and highlight new advances in methodological approaches and tools at hand. Here is the list of topic we will cover. For our first panellist, Nicolas Sirven, the HSR scene is witnessing the coming of age of public policy evaluations in Europe, which is reflected in enhanced capacities to inform health system governance. He will argue that European health systems are increasingly collecting and giving access to large datasets. These datasets stand out as they cover whole populations or at least large shares of them. They will stress the importance of making the best of new evaluation approaches and methods that not only inform on impacts and outcomes but also on contextual conditions for policies to deliver. Drawing lessons from his work on access to kidney transplantation waiting list, Latame Komla Adoli will raise the issue of gender discrimination in health services. After presenting the evidence of this gender gap, he will demonstrate the capacity of HSR to provide valuable insights on how to close the gender gap and the importance of combining bio-statistical analyses with qualitative investigations. Nolwenn Le Meur-Rouillard will share insights on how big data and new data collection tools are opening up a new landscape for HSR. E-health devices, social networks, and electronic medical records (EHR) are all sources that can feed HSR making possible ‘real-life’ longitudinal studies on the entire population of a territory. This is offering a renewed vision of the disparities in access to and use of healthcare services. Carla Perrota, from the University College Dublin will conclude the workshop by offering some general remarks on the French HSR agenda and provide an account of her vision on the future of HSR. This interactive workshop will be facilitated by a web-based survey tool to further engage members of the audience. Highlights of the workshops will be published in a short paper. Key messages • Most definitions of health services research limit investigation to health care services; a situation that does not reflect the scope of actions of the strong welfare systems of Europe. • From a social determinant of health perspective, health services research needs to address programmes and policies governments deliver beyond health care to promote population health and equity.

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.

Health Literacy in a migrant portuguese speaking community in Portugal and healthcare use

Abstract Background Health Literacy is strongly related with barriers to accessing healthcare services. Migrants may represent a vulnerable population in this matter, usually correlated with the language barrier. We aim to answer the question “Which are the perceptions, behaviors and skills of a migrant Portuguese speaking community using and getting access to health care in Portugal?” Methods Descriptive, cross-sectional and exploratory study. The Health Literacy Questionnaire (Osborne et al.,2013) was applied with a sociodemographic and health characterization. Data were collected and processed from a sample of 101 participants from a group of 570 people from a migrant community, all native Portuguese speakers mostly born in African Countries with Portuguese as an Official Language. Results The sample represented 17,7% of the total population. Thus, a confidence level of 95% and a margin of error of 9% were assumed. In the Health Literacy Questionnaire, the Cronbach's Alpha internal consistency coefficient was calculated as between 0.714 and 0.928. The analysis dimensions were mostly positioned below the average of the scale and were influenced by education, migratory status and age. “Feeling understood and supported by health professionals” had the worst score. There were better results in those who sought primary health care services and who had chronic illnesses. Self-rated health worsened with increasing length of stay in the country. Approximately 31% never attended healthcare in Portugal because they did not feel the need or were unable to access it. Conclusions This study demonstrated the association between health literacy with migrants and healthcare use excluding the language factor. This community presented low healthcare services use and low health literacy levels despite the use of the same language. Interaction with primary healthcare services improved migrants health literacy. This study supported a community intervention with public and private stakeholders. Key messages • Migrants places potential constraints on healthcare utilisation in destination countries that are not necessarily related to language barrier. • Health Literacy is crucial to migrants health, health care access and Public Health improvement.

Income and health insurance effects on modern health-seeking behaviours in rural Ghana: nature and extent of bias involved

PurposeThis study examined the influence of income and health insurance on the health-seeking behaviour of rural residents, addressing the concerns of endogeneity and heterogeneity bias.Design/methodology/approachA two-stage residual inclusion was utilised to correct self-selection-based endogeneity problems arising from health insurance membership.FindingsThis study provides support for Andersen's behavioural model (ABM). Income and health insurance positively stimulate rural residents' use of modern healthcare services, but the effect of insurance risks a downward bias if treated as exogenous. Further, the effect of health insurance differs between males and females and between adults and the elderly.Originality/valueThis study advances the literature, arguing that, within the ABM framework, enabling (i.e. income and insurance) and predisposing factors (i.e. age and gender) complement each other in explaining rural residents' use of modern health services.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2023-0223

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.