Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

AbstractObjectiveTo examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta.MethodsA retrospective, population-based cohort (2002–2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs).ResultsDuring the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000;p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit.ConclusionsSociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

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Does the frequency of routine follow-up after curative treatment for head-and-neck cancer affect survival?

Current Oncology ◽

10.3747/co.26.4949 ◽

2019 ◽

Vol 26 (5) ◽

Author(s):

S. F. Hall ◽

T. Owen ◽

R. J. Griffiths ◽

K. Brennan

Keyword(s):

Health Care ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Population Based ◽

Kaplan Meier ◽

Multiple Variable ◽

Multiple Variable Regression ◽

Oncology Practice

Background: Routine follow-up is a cornerstone of oncology practice but evidence is lacking to support most aspects. Our Objective was to investigate the relationship between frequency of routine follow-up and survival.Methods: A population-based study using electronic health-care data based on 5310 patients from Ontario diagnosed with squamous cell head and neck cancer between 2007 and 2012. Treatments included surgery (24.6%), radiotherapy +/- chemotherapy (52.4%) and combined surgery and radiotherapy (23%). We determined the follow-up oncologist for each patient, calculated the average follow-up visits over 2.5 years for all the patients of each oncologist and compared by treatment the overall survival of the patients for the high, medium and low follow-up oncologist groups using Kaplan Meier and multiple variable regression analysis. Results: Many oncologists saw patients 40 to 80% more often than others. There was no relationship between appointment frequency and survival for patients for any treatment group.Conclusion: The practice of routine follow-up varies and is costly to both a health care system and to patients. Without evidence on the effectiveness of our current policies further research is required to investigate new or optimal practices.

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Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

Canadian Medical Association Journal ◽

10.1503/cmaj.111697 ◽

2012 ◽

Vol 184 (12) ◽

pp. E665-E674 ◽

Cited By ~ 25

Author(s):

A. S. Newton ◽

R. J. Rosychuk ◽

K. Dong ◽

J. Curran ◽

M. Slomp ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Emergency Departments ◽

Health Care Use ◽

Emergency Health Care

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A population-based study of emergency department presentations for asthma in regions of Alberta

CJEM ◽

10.1017/s1481803500012434 ◽

2010 ◽

Vol 12 (04) ◽

pp. 339-346 ◽

Cited By ~ 5

Author(s):

Rhonda J. Rosychuk ◽

Donald C. Voaklander ◽

Terry P. Klassen ◽

Ambikaipakan Senthilselvan ◽

Thomas J. Marrie ◽

...

Keyword(s):

Emergency Department ◽

Data Analysis ◽

Emergency Departments ◽

Population Based ◽

Administrative Databases ◽

Population Based Study ◽

Ed Visits ◽

Age And Sex

ABSTRACTObjective:We describe the epidemiology of asthma presentations to emergency departments (EDs) for 3 main regions in the province of Alberta.Methods:We used a comprehensive ED database to identify ED visits in Alberta from April 1999 to March 2005. We linked the visits to other provincial administrative databases to obtain all data on follow-up encounters for asthma during that period. Information extracted included demographics, regions of residence (Edmonton, Calgary or non–major urban [NMU]), timing of ED visits, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates.Results:During the 6-year study period, 93 146 patients made 199 991 ED visits for asthma. Crude rates in 2004/05 were 7.9/1000, 6.5/1000 and 15.4/1000 in the Edmonton, Calgary and NMU regions, respectively. The Edmonton and Calgary regions had consistently lower visit rates than the NMU regions. The ED visits were followed by low rates of follow-up visits in a variety of non-ED settings, at different intervals.Conclusion:Asthma is a relatively common presenting problem in Alberta EDs. This study identified relatively stable rates of presentation during the study period, and variation among regions in terms of age and sex. This study provides further understanding of the variation associated with ED presentation and indicates possible targets for specific interventions to reduce asthma-related ED visits.

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Self-reported musculoskeletal pain predicts long-term increase in general health care use: A population-based cohort study with 20-year follow-up

Scandinavian Journal of Public Health ◽

10.1177/1403494814542263 ◽

2014 ◽

Vol 42 (7) ◽

pp. 698-704 ◽

Cited By ~ 22

Author(s):

Jan Hartvigsen ◽

Michael Davidsen ◽

Karen Søgaard ◽

Ewa M Roos ◽

Lise Hestbaek

Keyword(s):

Health Care ◽

Cohort Study ◽

Musculoskeletal Pain ◽

General Health ◽

Population Based ◽

Health Care Use

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Cervical cancer survivors and health care use: A Danish population-based register study

Gynecologic Oncology ◽

10.1016/j.ygyno.2021.02.003 ◽

2021 ◽

Vol 161 (2) ◽

pp. 565-572

Author(s):

Malene Skorstengaard ◽

Maria Eiholm Frederiksen ◽

Miguel Vázquez-Prada Baillet ◽

Anna-Belle Beau ◽

Pernille Tine Jensen ◽

...

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Cancer Survivors ◽

Population Based ◽

Health Care Use ◽

Danish Population

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Mycosis fungoides and Sézary syndrome: a population-wide study on prevalence and health care use in Finland in 1998–2016

BMC Health Services Research ◽

10.1186/s12913-021-06109-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jaana Keto ◽

Sonja Hahtola ◽

Miika Linna ◽

Liisa Väkevä

Keyword(s):

Health Care ◽

Mycosis Fungoides ◽

Hospital Costs ◽

Fold Increase ◽

Medical Specialty ◽

Health Care Use ◽

Sézary Syndrome ◽

Sezary Syndrome ◽

Outpatient Visits

Abstract Background Information about health care use and costs of cutaneous T-cell lymphoma (CTCL) patients is limited, particularly in a European setting. Methods In this population-wide study we set out to investigate prevalence, and trends in health care use in two CTCL subtypes, mycosis fungoides (MF) and Sézary syndrome (SS) over a time period of 19 years in 1998–2016 by using a nation-wide patient register containing data on all diagnosed MF and SS cases in Finland. Results The prevalence of diagnosed MF and SS rose from 2.04 to 5.38/100000, and from 0.16 to 0.36/100000 for MF and SS respectively during 1998–2016. We found a substantial decrease in inpatient treatment of MF/SS in the past two decades with a mean of 2 inpatient days/patient/year due to MF/SS in 2016, while the mean numbers of MF/SS related outpatient visits remained stable at 8 visits/year/patient. Most MF/SS-related outpatient visits occurred in the medical specialty of dermatology. In a ten-year follow-up after MF/SS diagnosis, the main causes for outpatient visits and inpatient stays were MF/SS itself, other cancers, and other skin conditions. Also cardiovascular disease and infections contributed to the number of inpatient days. Mean total hospital costs decreased from 11,600 eur/patient/year to 3600 eur/patient/year by year 4 of the follow-up, and remained at that level for the remainder of the 10-year follow-up. MF/SS accounted for approximately half of the hospital costs of these patients throughout the follow-up. Conclusions The nearly 3-fold increase in prevalence of diagnosed MF/SS during 1998–2016 puts pressure on the health care system, as this is a high-cost patient group with a heavy burden of comorbidities. The challenge can be in part answered by shifting the treatment of MF/SS to a more outpatient-based practice, and by adapting new pharmacotherapy, as has been done in Finland.

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Community mental health care after self-harm: A retrospective cohort study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416676366 ◽

2016 ◽

Vol 51 (7) ◽

pp. 727-735 ◽

Cited By ~ 7

Author(s):

Matthew J Spittal ◽

Fiona Shand ◽

Helen Christensen ◽

Lisa Brophy ◽

Jane Pirkis

Keyword(s):

Mental Health ◽

Health Care ◽

Community Mental Health ◽

Health Services ◽

Mental Health Care ◽

Psychiatric Inpatient ◽

Community Mental Health Services ◽

Community Mental Health Care ◽

Self Harm

Objective: Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). Methods: We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. Results: A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. Conclusion: Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community.

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