Problems faced by patients and health service utilization experiences of gastrointestinal patients during lockdown due to COVID-19 pandemic

Objectives: The COVID-19 pandemic undermined the health service delivery and utilization of essential health care services globally. The current study therefore aimed to explore the health-seeking behaviors and challenges faced by patients for the management of gastrointestinal diseases. Methods: A cross-sectional study was conducted at the outpatient department of Gastroenterology, Liaquat National Hospital, Karachi from March 2020 to July 2020 during the COVID-19 lockdown phase to explore patient experiences. Data was collected using a survey questionnaire. All patients of either gender were included after informed consent. Statistical analysis of the data was conducted using SPSS 21.0. Results: A total of 184 patients were included who visited the hospital to seek medical services during the COVID-19 lockdown phase. The mean age of the population was 42.7 years (±16.13). Of these, n=94 (51.1%) were males All patients had gastrointestinal issues with different comorbid conditions. One forty-seven n=147 (79.9%) presented with active complaints whereas, n=37 (20.1%) patients visited the hospital for their follow-up checkup. Out of 184 patients, n=33 (17.9%) patients reported of having fear of visiting hospital due to COVID-19 outbreak. A statistically significant difference p<0.001 was noted between the history of comorbidities and patient delaying a visit to the healthcare due to the fear of COVID-19. Additionally, 61 (73.5%) patients with co-morbidity faced difficulty in finding public transport (p=0.01). Nevertheless, n=171 (93.0%) patients expressed satisfaction with the services provided by the hospital during the lockdown phase. Conclusion: Patients with gastrointestinal conditions were largely affected by lockdown largely due to fear of contacting COVID-19 disease and inaccessibility to the public transportation. Widely available telemedicine service might overcome these shortcomings and ensure continuity of quality care. doi: https://doi.org/10.12669/pjms.38.3.4799 How to cite this:Kalwar HA, Kamani L. Problems faced by patients and health service utilization experiences of gastrointestinal patients during lockdown due to COVID-19 pandemic. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4799 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Determinants of Health Service Utilization Among Adults at High Risk of Developing Type 2 Diabetes in Kerala, India

The purpose of this study was to examine the determinants of health service utilization in a population at high risk of developing type 2 diabetes mellitus in India. Using Andersen’s behavioral model of healthcare utilization, multivariate logistic regression analysis was performed on baseline data of the Kerala Diabetes Prevention Program. We examined the association between predisposing, enabling, and need factors with outpatient health service use in the past four weeks and inpatient health service use in the past 12 months. More than a quarter (27.9%) and 12.9% of 1007 participants used outpatient services and inpatient services, respectively. Men were less likely to use outpatient services (odds ratio [OR] = 0.56; 95% confidence interval [CI] [0.39, 0.82]). Outpatient service utilization was positively associated with low social support (OR = 1.69; 95% CI [1.09, 2.62]), low general health status (OR = 5.71; 95% CI [2.42, 13.47]), and time off from work due to illness (OR = 8.01; 95% CI [5.32, 12.07]). Higher educational status (OR = 0.63; 95% CI [0.41, 0.95]), low general health status (OR = 3.59; 95% CI [1.54, 8.34]), and time off from work due to illness (OR = 1.21; 95% CI [0.76,1.93]) were associated with increased utilization of inpatient services. Although gender, educational status, and social support had important roles, health service utilization in this study population was largely dependent on general health status and presence of illness.

A Comparative Study of Predictors of Health Service Utilization among Rural and Urban Areas in Ilorin East Local Government Area of Kwara State

Objective: Health facilities utilization among Nigerians is affected by access to hospitals and, availability of personnel. This study compared the predictors of health service utilization in rural and urban areas of Ilorin East Local Government Area of Kwara State. Method: A cross-sectional study, involving 250 rural and 250 urban respondents selected through multi-stage sampling techniques. Quantitative data were collected using an interviewer-administered questionnaire. Qualitative data collection was done with an FGD guide. Data were analyzed using SPSS version 16. Chi-square, t-test, and z-test were used to test for significance. The level of significance was set at p < 0.05. Results: The mean age of urban respondents was 37.1±7.9 years and 42.6 ±13.7 years for rural. Utilization among the urban respondents were 71.2%, and 89.2% among rural (z-score = 27.93; p-value = 0.01). Health services factors such as waiting time (Adjusted OR=1.012; p-value=0.989) were found to be a strong predictor of utilization among urban respondents compared with the availability of drugs (Adjusted OR= 1.696; p-value=0.407) and availability of drugs (Adjusted OR= 1.696; p-value=0.407) which were the strongest predictor among rural respondents, though they were all not statistically significant. Other factors identified were lack of staff 46.5% among rural and lack of drug 26.1% among urban communities respectively. Conclusion: The study demonstrated higher utilization among the rural community. Knowledge of available health services was important for utilization; waiting time, and availability of drugs were major predictors of health service utilization among urban and rural communities respectively.

Does the Socioeconomic Status Predict Health Service Utilization in Persons with Enhanced Health Care Needs? Results from A Population-Based Survey in Persons with Spinal Cord Lesions from Switzerland

Background: Evidence suggests that the socioeconomic status (SES) affects individuals' health service utilization. Spinal cord injury is a condition that often leads to physical impairments and enhanced health care needs. It therefore presents an informative and yet under-researched case in point to investigate social inequalities in health service utilization. This study aims to describe associations between SES and health service utilization in adults with spinal cord injury from Switzerland.Methods: We use cross-sectional data from 1,294 participants of the Swiss Spinal Cord Injury Cohort Study community survey 2017. SES was operationalized with education, household income, perceived financial hardship, subjective status, and granting of supplementary financial benefits. Health service utilization was assessed with information on visits to 13 different health care providers and four health care institutions (inpatient stays, outpatient clinics, emergency departments, specialized spinal cord centers) during the past 12 months. The dichotomized outcomes on service utilization (visited vs. not visited) were regressed on SES indicators, including adjustments for sociodemographics, lesion characteristics, and health status. Results: Persons with higher SES reported higher likelihood for specialist, dentist, and dental hygienist visits and reported utilizing a larger number of different care providers. Further, specific SES indicators were associated with certain care provider visits (i.e., higher education and subjective status: higher odds for pharmacist visits; higher income: higher odds for natural healer visits; higher subjective status: higher odds for chiropractor visits; supplementary benefit granting: higher odds for general practitioner and home care service visits). We found statistically non-significant trends towards lower likelihood for inpatient stays, outpatient clinic and emergency department visits and enhanced likelihood for specialized spinal cord-center visits in higher SES groups. Conclusions: This study generally supports the claim that basic health care provision is guaranteed for all patients with spinal cord injury in Switzerland, independently of their SES. However, social inequalities were still observed for the utilization of specific providers, such as oral health care providers. Given that oral health is key for health maintenance in persons with spinal cord injury, specific interventions to enhance regular dental check-ups in lower SES groups are highly recommended.

The Myth of Care Coordination: Whether Professional Care Coordination Improved Older Adults’ Health Outcomes?

Background Current evidence on the effects of Care Coordination (CC) on older adults’ well-being and health service utilization is inconsistent. Previous studies are mostly limited to regional data and focus mostly on nurse-led CC instead of layperson Care Coordinators like family caregivers. This study explores the effects of having CC in a national sample of U.S. older adults and whether the coordinators’ professionalism impacts the effect of having CC on multidimensional health outcomes (Health outcomes were conceptualized as physical health, healthcare utilization, and care encounters). Methods Data were from the 2016 and 2018 waves of the Health and Retirement Study (HRS) (n=1,372). Multivariate regression models were used to examine the effects of CC on multidimensional health outcomes in 2016 and the longitudinal effects of having CC. We also tested the effect of Care Coordinators’ professionalism on the multidimensional health outcomes. All models controlled for sociodemographic characteristics and health status. Results Findings suggest that having CC doesn’t have a positive effect on older adults’ health outcomes. Having CC was associated with an increased number of acute diseases (β = 0.16, p &lt; .001) and nonacute diseases (β = 0.21, p &lt; .01) in longterm. The results regarding cross-sectional effects show that receiving care from a Coordinator was related to increased health service utilization. Participants with professional Care Coordinators were more likely to report receiving person-centered care (OR=1.60, p&lt;.05). Conclusion This study demonstrates the limited effects of CCs on older adults’ physical health outcomes, and emphasized the importance of care coordinators’ qualifications.

Examining the Gender Disparities in Health Service Utilization Among Older Adults Managing Cognitive Impairments

Comorbid conditions can complicate healthcare access, yet little is known about the impact of cognition on accessing those services. This study aims to examine the effect of gender on health service utilization among the aging population. Data from the National Health Interview (2019) Survey (n=3,058) were utilized to assess the impact of gender on the use of physician and dental services among older adults managing cognitive impairments. We estimated logistic regression models controlling for demographic, health/physical functioning, and psychological predictors. Findings indicated older male respondents managing cognitive impairments were less inclined to utilize both physician (p&lt;.05) and dental (p&lt;.01) health services on a yearly basis as compared to their female counterparts. Household income (aOR = 0.62 [-0.91, -0.06]; aOR = 0.34 [-1.25, -0.90]) and health insurance coverage (aOR = 0.18 [-2.31, -1.13]; aOR = 0.32 [-1.68, -0.62]) respectively were the strongest structural factors limiting access to both physician and dental services, with lower levels of educational attainment (aOR = 0.46 [-1.00, -0.55]) being an additional barrier for dental service utilization. Respondents with low self-rated health were inclined to utilize physician more than dental services (aOR = 2.31 [0.38, 1.29]; aOR = 0.73 [-0.50, -0.14]). It is imperative geriatric practitioners adopt a more integrative approach to health, especially among the aging population managing chronic disabilities, where additional community supports are warranted to promote and maintain physical and oral health.

Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care

The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.