scholarly journals Sex Differences in the Medical Utilization for Ischemic Heart Disease Among Newly Diagnosed Hypertensive Korean Patients (P04-170-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Jiae Shin ◽  
Dongwoo Ham ◽  
Seoeun Ahn ◽  
Hee-Young Paik ◽  
Hyojee Joung
Keyword(s):  
Medical Care ◽  
Medical Cost ◽  
Medical Utilization ◽  
Care Utilization ◽  
Newly Diagnosed ◽  
Care Providers ◽  
Men And Women ◽  
Hypertensive Patients ◽  
Medical Care Utilization ◽  
The Mean

Abstract Objectives This study aimed to investigate sex differences in the medical utilization for ischemic heart disease (IHD) among newly diagnosed hypertensive patients using a cohort data of South Korea. Methods We analyzed the National Sample Cohort version 2.0 of the National Health Insurance Service. Newly diagnosed hypertensive patients aged 40–84 were extracted from the baseline population, who received health examinations during 2003–2006 without pre-existing type 2 diabetes or circulatory diseases. Propensity score was applied to match men to women with the same ratio of body mass index (BMI) and fasting blood glucose (FBG) among the patients. Men and women (each 10, 110) were selected for analyses and followed until the end of 2015. Person-year was defined as the period from the diagnosis of hypertension to the incidence of IHD. Associations between IHD and the medical care utilization such as the mean of medical care visit, the mean medical cost, and the type and the location of medical care providers were investigated using Cox proportional hazard model. Hazard ratios (HR) of IHD according to medical care utilization were adjusted for age, income, BMI, FBG, smoking, and alcohol consumption. Results Incidence rates (per 1000 person-years) of IHD were 43.1 in men and 43.0 in women. The mean follow-up period was 5.2 person-years. The HRs of IHD were significantly higher in the subjects with a high mean medical cost (T3) (men, HR = 1.39, 95% CI 1.25–1.54; women, HR = 1.33, 95% CI 1.20–1.48) than in those with a low mean medical cost (T1). However, the subjects visiting medical care providers more (T3) had lower HRs than those visiting less (T1) (men, HR = 0.80, 95% CI 0.72–0.89; women, HR = 0.79, 95% CI 0.71–0.88). Conclusions Hypertensive patients in Korea showed an increased risk of IHD when they paid medical cost more and visited medical care less per person-year in both men and women. Funding Sources This research was supported by Support Program for Women in Science, Engineering and Technology through the National Research Foundation of Korea funded by the Korea government (MSIT). (No.2016H1C3A1903202). Supporting Tables, Images and/or Graphs

scholarly journals Impact of Crizanlizumab on Acute Medical Care Utilization in the Height of the COVID-19 Pandemic

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4178-4178
Author(s):  
Shivani Rao ◽  
Nicole K. Yun ◽  
James L. Coggan ◽  
Peter Wu ◽  
Teresa O'Brien ◽  
...  
Keyword(s):  
Medical Care ◽  
Regression Models ◽  
Statistical Significance ◽  
Final Analysis ◽  
Advisory Board ◽  
Urgent Care ◽  
Care Utilization ◽  
Medical Care Utilization ◽  
The Mean ◽  
Acute Medical Care

Abstract Background Sickle cell disease (SCD) is a hemoglobinopathy which manifests clinically as hemolytic anemia and recurrent episodes of pain caused by vaso-occlusion, among other symptoms. Vaso-occlusive crises (VOCs) account for an overwhelming majority of visits to the emergency room (ER) and hospitalizations for patients with SCD (Shah et al. PLoS One 2019). Upregulation of P-selectin, a cellular adhesion protein expressed on activated platelets and endothelial cells, contributes to the pathophysiology of VOCs. Crizanlizumab is a monoclonal antibody administered intravenously that inhibits the interaction of P-selectin with its ligand; it was approved by the Food and Drug Administration (FDA) as a treatment for SCD patients in 2019. In the Phase II SUSTAIN trial, crizanlizumab therapy resulted in a significantly lower rate of sickle cell-related pain crises than placebo (Ataga et al. N Engl J Med 2017). Due to their high-risk status for COVID-19, the pandemic has posed significant challenges for SCD patients to readily access healthcare, including novel therapies such as crizanlizumab. This study aimed to investigate the utility of telemedicine in facilitating access to crizanlizumab as well as compare acute medical care utilization for patients on crizanlizumab six months before initiating therapy and up to six months after their final dose in 2020. Methods All patients (≥18 years of age as of January 1, 2020) with SCD who received crizanlizumab between January 1, 2020 and December 31, 2020 at Rush University Medical Center (RUMC) were included in the final analysis. Demographic features as well as the type of visit when the patient and healthcare provider discussed crizanlizumab treatment was documented. Paired t-tests and Wilcoxon matched-pairs signed rank tests were utilized to compare acute medical care utilization - defined by the number of ER visits, urgent care visits, and hospitalizations - six months prior to initiating therapy and six months after completing the specified therapy regimen for 2020. Simple linear regression models and multiple regression models were conducted to control for sex, BMI, age, insurance, duration of treatment, and type of visit. Results A total of ten patients were included in the final analysis. Five (50%) patients first agreed to proceed with crizanlizumab therapy during a telehealth video visit with their provider, one (10%) made the decision during a telehealth phone visit, and the other four (40%) did so during a traditional office visit. 9 (90%) patients were still on crizanlizumab after June 1, 2020, the date that RUMC urgent care started seeing patients with SCD. The mean number of visits to the ER in the period before initiating therapy was 2.8 (SD=4.26) compared to 2.5 (SD=2.76) after last dose in 2020, however this finding did not achieve statistical significance (p>0.9999). Visits to the urgent care clinic, on average, increased significantly from 1.7 (SD=2.87) in the six months before initiating therapy to 8.2 (SD=11.02) in the six months after ending therapy for 2020 (p=0.0234). The mean number of hospitalizations in the period before initiating therapy was 6.6 (SD=5.19) compared to 4.6 (SD=3.44) in the period after last dose in 2020, however this was also not statistically significant (p=0.2309). None of the covariates had a significant effect on differences in acute care utilization in the period before and after therapy in 2020. Conclusion This study suggests that administration of crizanlizumab therapy did reduce hospitalization and ED visits, but the results could not achieve statistical significance due to our small sample size and short study duration. The number of urgent care visits for these patients, however, did differ significantly from the period before initiating therapy to the six months after the last dose in 2020. This finding can be attributed to the fact that due to the COVID-19 pandemic, urgent care services were made increasingly available to SCD patients beginning on June 1, 2020 to avoid admissions to the ER and hospital. Additionally, our study suggests that during the COVID-19 pandemic, telemedicine played an important role in providing health services to patients with SCD, and it could continue to improve care accessibility for SCD patients after the pandemic. Continued collection and analysis of real-world data is needed to further understand the effect of crizanlizumab therapy on utilization of acute medical care. Figure 1 Figure 1. Disclosures Jain: DOVA: Other: advisory board; Sanofi: Other: advisory board; Argenx: Other: advisory board; Novartis: Speakers Bureau; GBT: Speakers Bureau.

scholarly journals Determinants of medical care utilization: physicians' use of laboratory services.

1972 ◽  
Vol 62 (6) ◽  
pp. 846-853 ◽  
Author(s):  
D K Freeborn ◽  
D Baer ◽  
M R Greenlick ◽  
J W Bailey
Keyword(s):  
Medical Care ◽  
Care Utilization ◽  
Medical Care Utilization ◽  
Laboratory Services

scholarly journals Use of Folk Therapy in Taiwan: A Nationwide Cross-Sectional Survey of Prevalence and Associated Factors

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Chun-Chuan Shih ◽  
Lu-Hsiang Huang ◽  
Hsin-Long Lane ◽  
Chin-Chuan Tsai ◽  
Jaung-Geng Lin ◽  
...  
Keyword(s):  
Health Behaviors ◽  
Medical Care ◽  
National Health ◽  
Associated Factors ◽  
Medical Utilization ◽  
Care Utilization ◽  
Research Database ◽  
Unhealthy Lifestyle ◽  
Cross Sectional Survey ◽  
Factors Associated

Background. This study investigates the prevalence of and factors associated with users of folk therapy in Taiwan.Methods. Using data from the 2005 National Health Interview Survey and the National Health Insurance Research Database, we identified 16,750 adults aged 20 years and older. Sociodemographic factors, lifestyle, medical utilization, and health behaviors were compared between people using and not using folk therapy. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of factors associated with folk therapy were analyzed.Results. The one-month prevalence of folk therapy use was 6.8%, which was significantly associated with ages of 30–59 years (OR = 1.98, 95% CI = 1.49–2.63), women (OR = 1.63, 95% CI = 1.40–1.90), nonindigenous population (OR = 1.90, 95% CI = 1.14–3.17), having two or more unhealthy lifestyle habits (OR = 1.51, 95% CI = 1.26–1.81), high density of traditional Chinese medicine (TCM) physicians (OR = 1.40, 95% CI = 1.20–1.62), and being ill without receiving medical care in past six months (OR = 2.11, 95% CI = 1.76–2.53). Medical care utilization of TCM and Western medicine were also associated factors for folk therapy.Conclusions. The use of folk therapy is correlated with sociodemographics, lifestyle and health behaviors.

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