Utilization Of Outpatient Medical Care Research Articles

Utilization of outpatient medical services and satisfaction with care in children and adolescents with a migration background-results of the KiGGS study

Reasons for lower use of medical services by children and adolescents with migration background have not yet been investigated. The aim is therefore to identify factors that are related to the utilization of outpatient medical care and subjective patient satisfaction as well as explain differences according to migration background. On the basis of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS, baseline study: 2003-2006), in which 17,640 children and adolescents participated, prevalences with 95% confidence intervals as well as multivariate binary logistic regression analyzes on the relationship between migration background, country of origin, the use of outpatient medical care services in the last 12months, and satisfaction with the last medical treatment were calculated. Children up to age 13 with two-sided migration background had lower utilization of specialist doctors compared to those without migration background (OR = 0.64 [0.56-0.74]). However, among the 14- to 17-year-olds, the utilization did not differ significantly (OR = 0.79 [0.60-1.03]). The lower use of outpatient medical care is associated with ashorter length of stay and limited German language skills. In addition, parents from Poland and the former Soviet Union are less likely to be very satisfied with the last outpatient treatment of their 0‑ to 13-year-old child, even after adjustments for German language skills and length of stay. To make it easier for children with migration background to access specialist services, it is important to reduce language barriers in outpatient medical care and to promote processes of intercultural opening.

Guided Digital Cognitive Behavioral Program for Anxiety in Primary Care: Propensity-Matched Controlled Trial.

BackgroundCognitive behavioral therapy (CBT) is the gold standard treatment for adult anxiety disorders but is often not readily available in a scalable manner in many clinical settings.ObjectiveThis study examines the feasibility, acceptability, and effectiveness of a coach-facilitated digital cognitive behavioral program for anxious adults in primary care.MethodsIn an open trial, patients who screened positive for anxiety (General Anxiety Disorder-7 [GAD7] score ≥5) were offered the digital cognitive behavioral program (active group, n=593). Primary outcomes included anxiety, quality of life (QoL), and ambulatory medical use over 6 months. Intent-to-treat (ITT) and modified intent-to-treat (mITT) analyses were completed. Subsequently, we compared the outcomes of participants with those of a matched control group receiving primary care as usual (CAU; n=316).ResultsMore than half of the patients downloaded the cognitive behavioral mobile app program and about 60% of these were considered engaged, which was defined as completion of ≥3 techniques. The active group demonstrated medium size effects on reducing anxiety symptoms (effect size d=0.44; P<.001) and improving mental health QoL (d=0.49; P<.001) and showed significantly improved physical health QoL (d=0.39; P=.002) and a decreased likelihood of high utilization of outpatient medical care (odds ratio=0.49; P<.001). The active group did not significantly outperform the CAU group in anxiety reduction or QoL improvement (d=0.20; P=.07). However, intent-to-treat analysis showed that the active group had a significantly lower likelihood of high utilization of outpatient medical care than the enhanced CAU group (P<.0001; odds ratio=0.09).ConclusionsA coach-facilitated digital cognitive behavioral program prescribed in primary care is feasible and acceptable. Primary care patients prescribed a digital cognitive behavioral program for anxiety experienced significant improvements in anxiety symptoms, QoL, and reduced medical utilization. This effect was observed even among patients with chronic medical conditions and behavioral health comorbidities. Although the primary outcomes in the active group did not improve significantly more than the CAU group, health care utilization declined, and some secondary outcomes improved in participants who engaged in the program compared to the CAU group.Trial RegistrationClinicalTrials.gov NCT03186872; https://clinicaltrials.gov/ct2/show/NCT03186872

Utilization of outpatient medical care and substance use among rural stimulant users: Do the number of visits matter?

Rural substance users are less likely than their urban peers to use formal substance use treatment. It is therefore important to understand how the utilization of potentially more appealing care options, such as outpatient medical care (OMC), may affect substance use over time. This study sought to examine whether the number of OMC visits, after controlling for important covariates, was associated with days of alcohol, crack and powder cocaine, and methamphetamine use among a sample of rural stimulant users over a three year period. Data were collected from a natural history study of 710 stimulant users living in rural communities in Arkansas, Kentucky, and Ohio. Participants were adults, not in drug treatment, and reporting stimulant use in the last 30days. In terms of alcohol use, for participants with higher employment-related problems, having 3 or more OMC visits (relative to none) was associated with fewer days of alcohol use. The results for days of cocaine and methamphetamine use were mixed. However, we did find that for participants reporting at least one substance use treatment or mutual help care visit in the past 6-months, having 1–2 OMC visits (compared to none) was associated with fewer days of crack cocaine use. Regarding methamphetamine use, results showed that for participants without medical insurance, having 3 or more OMC visits (compared to none) was associated with significantly fewer days of methamphetamine use if they also reported greater than or equal to a high school education. The findings from this study may help us begin to understand some of the characteristics of rural drug users, who utilize OMCs, associated with reductions in substance use. These findings may help health care administrators better plan, coordinate, and allocate resources to rural OMCs to more effectively address substance use in this population.

Utilization of outpatient medical care in Germany.

Outpatient care in Germany is mainly provided in physicians' private practices. Data from health surveys enable to analyse the utilization of outpatient services from the patient's perspective, and to identify associations with social determinants and other influencing factors. As part of the GEDA 2014/2015-EHIS study, data was collected for the indicator 'utilization of outpatient medical care in the last 12 months'. The analysis found that 90.9% of women aged 18 years and over and 84.1% of men had used outpatient medical services within the last 12 months. The utilization of outpatient medical care increases with age: about 94% of people aged 65 or over were provided with outpatient medical treatment in the last 12 months. There were significant differences in utilization between younger men and women, which balance out with age. No differences were identified in relation to educational level or federal state.

Tobacco Use and Utilization of Medical Services in Adolescence: An Analysis of the KiGGS Data

In Germany, there is a lack of information on the correlation between tobacco use by adolescents and their utilization of medical care. The aim of this article is to identify possible early consequences of adolescent smoking. We conducted a re-analysis of cross-sectional data of the baseline wave (2003-2006) of the German Health Survey for Children and Adolescents (KiGGS). To examine the association between current smoking status and utilization of medical care during the 12 months before the interview, prevalence of selected diseases was calculated, and stratified by smoking status. Besides, the proportion of adolescents who consulted a physician at least once and the total number of medical consultations were estimated. For the inpatient setting, information about the number of nights spent in a hospital was analyzed. In a multiple logistic regression, the association of smoking behavior with utilization of outpatient medical care was assessed, further adjusting for sociodemographic variables and comorbidities. The study population included 3 679 adolescents aged between 14 and 17 years. 49.1% were female and 31.7% were current smokers. Among smokers, there was an increased prevalence of cystitis (+87.0%) and bronchitis (+50.0%). Tobacco users consulted a general practitioner more frequently than non-smokers (+30.8%). As far as medical specialists are concerned, there were more consultations with psychiatrists (+171.4%) and psychologists (+94.4%), but there was no increase in the total number of visits. Additionally, smoking adolescents were more frequently hospitalized (+26.5%) and the stays were of longer duration (+19.7%). There was a statistically significant association between current tobacco use and a greater utilization of medical care (OR=1.20; 95%-CI: 1.02-1.40). Tobacco use among adolescents was associated with increased prevalence of certain diseases and a greater utilization of medical care. Nevertheless, whether there is a causal connection is still debatable. The KiGGS cohort study will provide opportunities to further clarify the observed association.

Effects of a doctors' strike on primary care utilization in Varkaus, Finland.

Changes in out-patient medical care utilization at the health centre of Varkaus were studied during the Finnish doctors' strike in spring, 1984. In this urban and semi-urban area, about 80% of the out-patient medical services to the population are provided by the municipal health centre. Visits to the physicians decreased by 70% during the strike, and for urgent visits the decrease was 55%. The private sector compensated only a very small share of this "deficit". Of the common urgent illnesses the relative decrease was greatest for "cold" and ill-defined "abdominal pains". Open wounds were treated normally although there was some indication that the wounds treated were more serious than normally. The post-strike increase in visits suggests an increase in unmet needs. For all face-to-face encounters the increase was eight per cent, but for low back pain, urinary infection and hypertension the observed post-strike rates were more than 40% higher than expected by pre-strike rates. A marked reduction in various other activities of the health centre, such as telephone calls and home visits, was observed. The present study gave no evidence of harmful effects of the strike. This was the impression of the health care personnel, too. There were no public claims of reduced access to care or its delay. The distress among patients or other experiences of the population were, however, not measured. The strike was fairly short and any conclusions concerning the effects of a more prolonged or extensive strike on health care are unwarranted.

Sex Differences in Medical Care Utilization: An Empirical Investigation

This study examines factors related to sex differences in outpatient medical care utilization in a representative sample from a defined geographical area. Medical care use was measured using records from virtually all providers in the area. The multivariate model developed explained more than 80% of the sex difference in outpatient utilization in the year preceding the interview, but only about one-third of the difference in the year after the interview. The most important predictors of sex differences were reported number of chronic health conditions and whether or not a woman gave birth during the study period. The analyses of these data and data from other studies indicate that part of the sex differences in utilization can be attributed to real differences in health. Adjusting utilization rates for reported tendency to use physician services and belief in preventive medicine also helped explain the sex difference, but only for prior use.