Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

BackgroundEvidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (<55 and ≥55 years), DMD exposure and health service use in the MS population.MethodsWe conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations.ResultsWe included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged <55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the <55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (<55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs.ConclusionOur study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged <55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.

Out-Patient Attitude towards Hospitals during COVID-19 in India

COVID-19, one of the worst pandemics in recent years, have changed the face of our world. Every sector has been experiencing a tug in unexpected directions than anticipated. Often it is said that the healthcare sector is facing a boom in this COVID-19 episode, nevertheless there has been a decline of out-patient segment in hospitals. An out-patient is one who visits a hospital for treatment without staying overnight. Through this time of uncertainty where a new normal is being burgeoned, the people’s attitude towards healthcare has shifted a great deal. Predominantly out-patients are hesitant to continue with their regular physician visits by delaying or avoiding unneeded visits. People with underlying diseases, both which are at low risk or at high risk, find themselves at higher caution due to the COVID-19. This study focuses to understand the attitude of out-patients and of out-patient’s with risk during this COVID-19 pandemic towards hospitals in India. Online or Tele medical consultation has picked up momentum among out-patients during the COVID-19 Unlock phase which shines a possibility as a new normal in the healthcare industry.

Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults

Objectives This study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults. Methods Nine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services. Results African American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits. Discussion Compared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.

Use of and Satisfaction with Telemedicine Services during the Pandemic. Findings from the COVID-19 Snapshot Monitoring in Germany (COSMO)

Our aim was to investigate to what extent physician visits were replaced by telemedicine services because of the COVID-19 pandemic and the satisfaction with such telemedicine services. Cross-sectional data from the “COVID-19 Snapshot Monitoring in Germany” (COSMO, wave 49 from 11 to 12 August 2021 with n = 967). The average age was 44.9 years (SD: 15.6 years, ranging from 18 to 74 years) and 50.8% were female. Indiviuals were asked whether any physician visit was replaced by a telemedicine service (e.g., video consultation) since March 2020 because of the pandemic (yes, once; yes, several times; yes, always; no, not replaced; no, there was no need to see a doctor). Additionally, individuals who gave positive responses (i.e., yes, once; yes, several times; yes, always) were asked how satisfied they were with the corresponding telemedicine services (from 1 = very dissatisfied to 7 = very satisfied). While 55.4% of the respondents reported no need to see a doctor and 31.3% of the respondents did not replace physician visits by telemedicine services, about 13.3% of the respondents did replace physician visits by telemedicine services (4.8%: yes, once; 6.4%: yes, several times; 2.1%: yes, always). Among the individuals who used such services, the average satisfaction was moderately high (4.7, SD: 2.0). Additionally, several correlates of the replacing telemedicine service use were identified (e.g., perceived severity of a COVID-19 infection). In conclusion, about one out of seven individuals replaced physician visits by telemedicine services during the pandemic. For example, knowledge about the correlates of satisfaction with such services might be of importance to increase the quality of such services.

Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease

Background and objectivesPatients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of adults with CKD and eGFR of 15–59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.ResultsIn total, 1003 adults were included in the study. Within the eGFR of 15–29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30–59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.ConclusionsIn patients with CKD and eGFR of 15–59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15–29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

Early Dental Caries and Their Associated International Classifications of Disease Morbidity: A 16-Year Population Study

Objective: The study objective was to examine the relationship between dental caries diagnosed before the age of four and ICD diseases over a 16-year period. Methods: The sample of approximately 33,531 (48% female) individuals having a total of 2,864,790 physician diagnoses over 16 years comprised a the cohort two groups, one with (2.7% of the sample) and one without dental caries (dependent variable) that were under the age of four years in the first two years of the sample data. Categories of dental caries and associated gingivitis and periodontal disease were based on the International Classification of Disease (ICD Version 9) diagnostic codes 521-523. The sample was described. Odds ratios comparing those with and without dental caries and the main ICD classes were calculated. Additionally, the ratio of each ICD diagnosis frequency comparing the cohort groups were calculated and represented the diagnoses assigned over the first 15 physician visits. Results: Males had proportionally more dental caries diagnosed. Diagnoses were made predominantly by general practitioners. Within the dental caries cohort group, associated ICD diagnoses were over-represented in both odds ratios and within individual ICD diagnoses on the first diagnosis and over the first 15 diagnoses in time. Conclusion: Dental caries diagnosed in very young children before the age of four are associated with multi-morbidity over subsequent years. Sex differences and patterns of associated morbidity may contribute to a better understanding of early life vulnerability to dental caries and their sequelae.

Trends in Family Physician Usage among Canadians from 2001 to 2016: An Age-Period-Cohort Analysis

As primary health care providers, family physicians play a critical role in Canada’s health care system by providing first-level contact for patients and acting as advocates for preventative medicine. Due to their essential role in population health, public health practitioners are concerned about temporal trends surrounding family physician visits. This study uses eight cycles of the Canadian Community Health Survey, a nationally representative survey, to conducing an age-period-cohort analysis with the bounding method, while controlling for sex and race. Most notably, we discover a declining cohort trend indicating that later cohorts are less likely to visit a family doctor over a 12-month period. These results suggest that health promotion policies surrounding family physician use should not only be targeted towards middle and older-aged adults who experience declining health, as the cohort effect implies that a portion of health care avoidance behaviour is molded in youth and young adulthood.

Disease-modifying drugs for multiple sclerosis and subsequent health service use

Objective: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. Methods: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. Results: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. Conclusion: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.

Competition and physician-induced demand in a healthcare market with regulated price: evidence from Ghana

Using panel data of administrative claims spanning 36 months (2017–2019) and an instrumental variable method, this study examines whether physician-induced demand for hypertension disease care exists in Ghana’s healthcare system where price is regulated, and there is no co-payment. We find that an increase in competition—measured as a high doctor-to-population ratio at the district level—leads to an increase in the number of physician visits, suggesting physician-induced demand exists, and that effects are greater for large hospitals and public health providers. This result is further supported by alternative measures and specifications showing that physicians’ revenue from medication and gross revenue increase as the physician density increases. These pattern suggest that physicians in high density areas, faced with a decrease in number of patients per physician, make up for the decline in income by inducing more patient visits.

Healthcare utilization among persons living with HIV in Manitoba, Canada, prior to HIV diagnosis: A case-control analysis

Background Understanding care patterns of persons living with HIV prior to diagnosis can inform prevention opportunities, earlier diagnosis, and engagement strategies. We examined healthcare utilization among HIV-positive individuals and compared them to HIV-negative controls. Methods Data were from a retrospective cohort from Manitoba, Canada. Participants included individuals living with HIV presenting to care between 2007 and 2011, and HIV-negative controls, matched (1:5) by age, sex, and region. Data from population-based administrative databases included physician visits, hospitalizations, drug dispensation, and chlamydia and gonorrhea testing. Diagnoses associated with physician visits were classified according to International Classification of Diseases chapters. Conditional logistic regression models were used to compare cases/controls, with adjusted odds ratios (AORs) and their 95% confidence intervals (95% CI) reported. Results A total of 193 cases and 965 controls were included. Physician visits and hospitalizations were higher for cases, compared to controls. In the 2 years prior to case date, cases were more likely to be diagnosed with “blood disorders” (AOR: 4.2, 95% CI: 2.0–9.0), be treated for mood disorders (AOR: 2.4, 95% CI: 1.6–3.4), and to have 1+ visits to a hospital (AOR: 2.2, 95% CI: 1.4–3.6). Conclusion Opportunities exist for prevention, screening, and earlier diagnosis. There is a need for better integration of healthcare services with public health.