scholarly journals Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5705
Author(s):  
Yu-Han Chen ◽  
Yi-Chen Lai ◽  
Yu-Cih Wu ◽  
Jun Sasaki ◽  
Kang-Ting Tsai ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Healthcare Services ◽  
Population Based ◽  
Emergency Department Visits ◽  
Population Database ◽  
Annual Percent Change ◽  
Full Spectrum ◽  
Population Based Study ◽  
Care Plans ◽  
Medical Resource Utilization

To evaluate the trend of healthcare utilization among patients with dementia (PwD) in different post-diagnosis periods, Taiwan’s nationwide population database was used in this study. PwD were identified on the basis of dementia diagnoses during 2002–2011. We further subdivided the cases into 10 groups from the index year to the 10th year after diagnosis. The frequency of emergency department visits and hospitalizations, the length of stay, outpatient and department visits, and the number of medications used were retrieved. The Joinpoint regression approach was used to estimate the annual percent change (APC) of healthcare utilization. The overall trend of healthcare utilization increased with the progression of dementia, with a significant APC during the first to second year after diagnosis (p < 0.01), except that the frequency of outpatient visits showed a decreasing trend with a significant APC from the first to fifth year. All sex- and age-stratified analyses revealed that male gender and old age contributed to greater use of healthcare services but did not change the overall trend. This study provides a better understanding of medical resource utilization across the full spectrum of dementia, which can allow policymakers, physicians, and caregivers to devise better care plans for PwD.

Huntington’s Disease in Israel: A Population-based Study Using 20 Years of Routinely-Collected Healthcare Data

2021 ◽  
pp. 1-9
Author(s):  
Natalie Gavrielov-Yusim ◽  
Yael Barer ◽  
Michael Martinec ◽  
Athanasios Siadimas ◽  
Spyros Roumpanis ◽  
...  
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Healthcare Utilization ◽  
Behavioral Problems ◽  
Clinical Manifestations ◽  
Population Based ◽  
Emergency Department Visits ◽  
Study Cohort ◽  
Population Based Study ◽  
Healthcare Data

Background: Huntington’s disease (HD) is a rare, genetic, neurodegenerative disease. Obtaining population-level data on epidemiology and disease management is challenging. Objective: To investigate the epidemiology, clinical manifestations, treatment, and healthcare utilization of patients with HD in Israel. Methods: Retrospective population-based cohort study, including 20 years of routinely collected data from Maccabi Healthcare Services, an insurer and healthcare provider for one-quarter of the Israeli population. Results: The study cohort included 109 adult patients (aged ≥18 years) diagnosed with HD, with mean age of 49.9 years and 56%females. The most common HD-related conditions were anxiety (40%), behavioral problems (34%), sleep disorders (21%), and falls (13%). Annual incidence rates for HD ranged from 0.17 to 1.34 per 100,000 from 2000 to 2018; the 2018 crude prevalence in adults was 4.36 per 100,000. Median survival from diagnosis was approximately 12 years (95%CI: 10.4–15.3). The most frequent symptomatic treatments were antidepressants (69%), antipsychotics (63%), and tetrabenazine (63%), the only drug approved for the treatment of HD chorea in Israel during the examined period. Patterns of healthcare utilization changed as disease duration increased, reflected by increased frequency of emergency department visits and home visits. Conclusion: This retrospective population-based study provides insights into the prevalence, incidence, clinical profile, survival, and resource utilization of patients with HD in ethnically diverse Israel. The findings in this study are generally consistent with the international literature and demonstrate the value of routinely collected healthcare data as a complementary resource in HD research.

scholarly journals Driving Factors for the Utilisation of Healthcare Services by People with Osteoarthritis: Results from A Nationwide Population-Based study

2021 ◽  
Author(s):  
Daniela Costa ◽  
Ana M Rodrigues ◽  
Eduardo B Cruz ◽  
Helena Canhão ◽  
Jaime da Cunha Branco ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Multinomial Logistic Regression ◽  
Healthcare Utilisation ◽  
Healthcare Services ◽  
Structured Interview ◽  
Population Based ◽  
Enabling Factors ◽  
Population Based Study ◽  
The Impact

Abstract Background: Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen’s behavioural model. Methods: We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt . Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables.Results: In our sample, a high proportion of participants are overweight or obese (82,6%, n=748) and physically inactive (20,6%, n=201) and a small proportion had physiotherapy management (14,4%, n=141). We identified three profiles of healthcare utilisation: “HighUsers”; “GPUsers”; “LowUsers”. “HighUsers” represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. "GPUsers" represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location – indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations ( p <0,05) with the higher utilisation of healthcare services profiles. Conclusions: Healthcare utilisation by people with knee osteoarthritis is not driven only by clinical needs. The predisposing characteristics and enabling factors associated with healthcare utilisation reveal inequities in the access to healthcare and variability in the management of people with knee osteoarthritis. Research and implementation of whole-system strategies to improve equity in the access and quality of care are paramount in order to diminish the impact of osteoarthritis at individual-, societal- and economic-level.

scholarly journals Healthcare utilization after stroke in Canada- a population based study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Adebimpe O. Obembe ◽  
Lisa A. Simpson ◽  
Brodie M. Sakakibara ◽  
Janice J. Eng
Keyword(s):  
Healthcare Utilization ◽  
Population Based ◽  
Population Based Study

scholarly journals The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252441
Author(s):  
Elissa Rennert-May ◽  
Jenine Leal ◽  
Nguyen Xuan Thanh ◽  
Eddy Lang ◽  
Shawn Dowling ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Population Based ◽  
Emergency Department Visits ◽  
System Capacity ◽  
Population Based Study ◽  
Health Measures ◽  
Ed Visits ◽  
The Impact

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

scholarly journals Driving factors for the utilisation of healthcare services by people with osteoarthritis in Portugal: results from a nationwide population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniela Costa ◽  
Ana M. Rodrigues ◽  
Eduardo B. Cruz ◽  
Helena Canhão ◽  
Jaime Branco ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Multinomial Logistic Regression ◽  
Healthcare Utilisation ◽  
Healthcare Services ◽  
Structured Interview ◽  
Population Based ◽  
Enabling Factors ◽  
Population Based Study ◽  
The Impact

Abstract Background Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen’s behavioural model. Methods We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt, in Portugal. Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables. Results In our sample, a high proportion of participants are overweight or obese (82,6%, n = 748) and physically inactive (20,6%, n = 201) and a small proportion had physiotherapy management (14,4%, n = 141). We identified three profiles of healthcare utilisation: “HighUsers”; “GPUsers”; “LowUsers”. “HighUsers” represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. “GPUsers” represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location – indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations (p < 0,05) with the higher utilisation of healthcare services profiles. Conclusions Healthcare utilisation by people with knee osteoarthritis is not driven only by clinical needs. The predisposing characteristics and enabling factors associated with healthcare utilisation reveal inequities in the access to healthcare and variability in the management of people with knee osteoarthritis. Research and implementation of whole-system strategies to improve equity in the access and quality of care are paramount in order to diminish the impact of osteoarthritis at individual-, societal- and economic-level.

scholarly journals Hypoglycemic and Hyperglycemic Crises Among U.S. Adults With Diabetes and End-stage Kidney Disease: Population-Based Study, 2013–2017

2021 ◽  
Author(s):  
Rodolfo J. Galindo ◽  
Mohammed K. Ali ◽  
Shealeigh A. Funni ◽  
Andrew B. Dodge ◽  
Shaheen S. Kurani ◽  
...  
Keyword(s):  
Kidney Disease ◽  
The United States ◽  
Population Based ◽  
Emergency Department Visits ◽  
End Stage Kidney Disease ◽  
Population Based Study ◽  
Hyperglycemic Hyperosmolar State ◽  
Patients With Diabetes ◽  
End Stage ◽  
Event Rates

<b>Objective</b>: We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabetes and end-stage kidney disease (DM/ESKD). <p> </p> <p><b>Design</b>: Nationwide, retrospective study of adults (≥18 years) with DM/ESKD, from the United States Renal Data System registry, 2013 to 2017. Primary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1000 person-years. Adjusted event rates and risk factors were adjusted for patient age, sex, race/ethnicity, dialysis modality, comorbidities, treatment regimen and U.S. region.</p> <p> </p> <p><b>Results</b>: Among 521,789 adults with DM/ESKD (median age 65 years [IQR 57-73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, the risks decreased with age and were lowest in older patients (≥75 vs 18-44 years: IRR 0.35 [95% CI 0.33-0.37] and 0.03 [0.02-0.03], women (IRR 1.09 [1.06-1.12] and 1.44 [1.35-1.54]), and with smoking (IRR 1.36 [1.28-1.43] and 1.71 [1.53-1.91]), substance abuse (IRR 1.27 [1.15-1.42] and 1.53 [1.23-1.9]), retinopathy (IRR 1.10 [1.06-1.15] and 1.36 [1.26-1.47]), and insulin therapy (vs. no therapy; IRR 0.60 [0.59-0.63] and 0.44 [0.39-0.48]), respectively. For hypoglycemia, specifically, additional risk was conferred by Black race (IRR 1.11 [1.08-1.15]) and amputation history (IRR 1.20 [1.13-1.27]).</p> <p> </p> <p><b>Conclusions</b>: In this nationwide study of patients with DM/ESKD, hypoglycemic crises were three-fold more common than hyperglycemic crises, greatly exceeding national reports in non-dialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected. </p>

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