scholarly journals COVID-19 and Its Impact on Older Adults’ Routine and Urgent Health Care Visits

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 723-723
Author(s):  
Lindsay Wilkinson ◽  
Julie Masters ◽  
Julie Blaskewicz Boron
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Services ◽  
Financial Strain ◽  
Care Utilization ◽  
Health Crisis ◽  
Logistic Regression Models ◽  
Care Visit ◽  
Health Care Visit ◽  
The Impact

Abstract Older adults have not only been disproportionately affected by the COVID-19 pandemic, but relatedly, are also more vulnerable to other health problems. Moreover, previous research on epidemics shows that health care services are often disrupted during health crises—leading to less access to and lower utilization of health services unrelated to the health crisis. The primary aim of this research is to examine the impact of the COVID-19 pandemic on both routine and urgent health care visits. Using data collected in December 2020 on adults ages 54 to 100 living in one of nine senior living communities (SLCs) in the state of Nebraska (n = 723), logistic regression models were used to investigate correlates of missed health care visits, adjusting for sociodemographic and health characteristics. The results show that 58% of older adults in SLCs skipped or postponed a routine health care visit due to the pandemic, whereas 8% of older adults missed an urgent health care visit. The results further reveal that older adults with better perceived health (p < 0.05), higher life satisfaction (p < 0.01), and higher resilience (p < 0.05) all had lower odds of missing a routine health care visit due to the pandemic. In contrast, those who missed an urgent health care visit were more likely to have higher perceived financial strain (p < 0.05). The findings from this study demonstrate the consequences of the COVID-19 pandemic on older adults’ health care utilization, which may have serious implications for their long-term health.

scholarly journals P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
B.H. Rowe ◽  
A.S. Newton
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Grey Literature ◽  
Study Data ◽  
Care Utilization ◽  
Alternative Source ◽  
Increased Risk ◽  
The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

scholarly journals Implementing Behavioral Health Social Workers' Increased Mental Health Care Among Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 542-543
Author(s):  
Elizabeth Pfoh ◽  
Jessica Hohman ◽  
Kathleen Alcorn ◽  
Nirav Vakharia ◽  
Michael Rothberg
Keyword(s):  
Older Adults ◽  
Behavioral Health ◽  
Social Workers ◽  
Demographic Variables ◽  
Primary Care Visit ◽  
Stepped Wedge ◽  
Logistic Regression Models ◽  
Care Visit ◽  
Implementation Period ◽  
The Impact

Abstract Depression is underdiagnosed and undertreated among older adults. Health systems can screen patients to identify depression, but systemic linkages to treatment are required to ensure care. We used a retrospective stepped-wedge study to identify the impact of implementing behavioral health social workers (BHSWs) on receipt of treatment after a new depression diagnosis. We included adults over 65 years of age with a primary care visit between 2016 and 2019 at a large integrated health system. We excluded patients who were diagnosed with or treated for depression in 2015. Patients were categorized into control (diagnosed before implementation) and intervention (diagnosed after implementation) groups. From our electronic health record, we collected prescriptions for pharmacotherapy and behavioral health visits. Patients were considered treated if they received pharmacotherapy or had a behavioral health visit within 30 days of diagnosis. We used multilevel logistic regression models to identify the association between implementation period (pre versus post) and treatment, adjusted for demographic variables and clustering within site. Our population included 4,475 people. The percent of patients that received treatment increased from 47% to 54% after implementation and the percent of patients with ≥1 behavioral health visit within 30 days increased from 3% to 8% (p<0.01, respectively). The adjusted odds ratio of receiving treatment (AOR: 4.13, 95%CI: 2.84-6.01) and having a behavioral health visit (AOR: 3.12, 95%CI: 2.31-4.24) was significantly higher in the post-implementation period. In conclusion, implementation of BHSWs was associated with increased treatment for older patients with depression.

Food Insecurity and Health Care Utilization Among Older Adults

2016 ◽  
Vol 36 (12) ◽  
pp. 1415-1432 ◽  
Author(s):  
Vibha Bhargava ◽  
Jung Sun Lee
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Food Insecurity ◽  
Health Care Services ◽  
Performance Outcomes ◽  
Home Health ◽  
Care Utilization ◽  
Assistance Programs ◽  
Care Services

This study examined the relationship between food insecurity and health care utilization (physician, inpatient, emergency room, and home health visits) among older adults. Survey data collected from Georgia Advanced Performance Outcomes Measures Project 6 linked to the Centers for Medicare and Medicaid Services (GA Advanced POMP6-CMS) data 2008 ( N = 957) were analyzed. Nearly one half of the sample (48.3%) was food insecure. Food insecure individuals were significantly less likely than food secure individuals to have any physician (69.7% vs. 80.2%) and home health visits (24.9% vs. 32.3%) during 2008. However, there were no significant differences in levels of health care utilization by food secure and food insecure older adults. Food secure and food insecure older adults utilized comparable levels of health care services. Public assistance programs such as Medicare and meal services targeted toward older adults may enable economically constrained, food insecure older adults to access needed health care services.

scholarly journals Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services

2018 ◽  
Vol 3 (1) ◽  
pp. 238146831876029 ◽  
Author(s):  
Kyle T. Smith ◽  
Denise Monti ◽  
Nageen Mir ◽  
Ellen Peters ◽  
Renuka Tipirneni ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Preventive Care ◽  
Health Care Services ◽  
Care Utilization ◽  
Financial Toxicity ◽  
Logistic Regression Models ◽  
Care Services ◽  
Avoidance Behaviors ◽  
Multivariable Analyses

Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization.

scholarly journals Access to Five Nonprimary Health Care Services by Homebound Older Adults: An Integrative Review

2018 ◽  
Vol 31 (1) ◽  
pp. 55-69
Author(s):  
Cynthia Sterling-Fox
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Services ◽  
Integrative Review ◽  
Future Research ◽  
Care Providers ◽  
Care Services ◽  
Homebound Older Adults ◽  
The Impact

Globally, the number of homebound older adults is rising exponentially as the aging population increases. Homebound older adults have complex medical and psychological issues for which many receive home-based primary care services. The purpose of this integrative review was to identify, analyze, and synthesize the existing literature regarding homebound older adults’ need for, use of, and access to five nonprimary health care services. They are dental, nutritional, optical, pharmacy, and psychological services. The integrative review was conducted using a database search of CINAHL, Health Source: Nursing Education, PubMed, Medline, PsycINFO, and Cochrane, that was supplemented by a hand search. Little research was found addressing the five nonprimary health care services. Five themes emerged from the 10 studies. They were (1) complex and interrelated health problems require more health care services; (2) perceived unimportance of nonprimary health care services; (3) barriers to use of and access to nonprimary health care services; (4) the impact of socioeconomic and demographical factors on access to services; and (5) the impact of psychological factors (depression and social isolation) on the use and access to health care services. These findings suggest further inequity and barriers to health care services by homebound older adults. Future research is needed with nonprimary health care providers to examine the clinical outcomes and costs of providing the services to homebound older adults.

Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 19-19
Author(s):  
Dylan M. Zylla ◽  
Grace Gilmore ◽  
Justin Eklund ◽  
Sara Richter ◽  
Anders Carlson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Urgent Care ◽  
Care Utilization ◽  
Intravenous Chemotherapy ◽  
Logistic Regression Models ◽  
Patients With Cancer ◽  
One Year ◽  
The Impact

19 Background: Glucocorticoid (GC) use is commonly used in chemotherapy regimens and may lead to hyperglycemia and increased infection rates. We assessed the impact of diabetes (DM) and hyperglycemia on rates of health-care utilization, infections and survival among patients with cancer receiving chemotherapy. Methods: We performed a retrospective analysis on 1,781 patients who received intravenous chemotherapy with GC between 2010 and 2015. Demographic, clinical, and health-care utilization (HCU) data was obtained using electronic medical record, billing modules, and the tumor registry; HCU included tallies of emergency room, urgent care, and inpatient visits. Logistic regression models were used to compare survival and new infections between patients with and without DM, after adjusting for demographic and cancer-related variables. Results: In the first 12 months following chemotherapy, patients with DM (n = 330) had higher rates of hospital admissions (70.9% vs 57.4%, p< 0.001), more infection-related admissions (37.0% vs 29.2%, p = 0.007), and increased rates of new infections (61.2% vs 49.2%, p < 0.001) when compared to patients without DM (n = 1,451). One-year survival rate was worse among patients with DM (67.3% vs 78.3%, p < 0.001), as well as patients with at least one glucose reading above 300 mg/dL following chemotherapy (60.8% vs 78.5, p < 0.001). After adjusting for cancer stage, age, and gender, we found DM history increased the odds of dying within one year after diagnosis by 86% (OR 1.86, 95% CI (1.37 – 2.52), p < 0.001) and of new infections by 68% (OR 1.68, 95% CI (1.26 – 2.24), p < 0.001). Conclusions: Among patients with cancer receiving intravenous chemotherapy with GC we demonstrate patients with DM have more hospital admissions, increased rates of infections, and worse survival. Prospective studies are urgently needed to elucidate what level of glycemic control is needed to potentially improve outcomes for patients with DM receiving chemotherapy with GC.

scholarly journals Depressive symptoms, chronic medical illness, and health care utilization: findings from the Korean Longitudinal Study of Ageing (KLoSA)

2011 ◽  
Vol 23 (8) ◽  
pp. 1285-1293 ◽  
Author(s):  
Hongsoo Kim ◽  
Sang-Min Park ◽  
Soong-Nang Jang ◽  
Soonman Kwon
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Depressive Symptoms ◽  
South Korea ◽  
Health Care Utilization ◽  
Health Care Services ◽  
Care Utilization ◽  
Medical Illness ◽  
Care Services ◽  
Chronic Medical Illness

ABSTRACTBackground: This population-based study examined the relative and combined relationships of chronic medical illness (CMI) and depressive symptoms with health care utilization among older adults in South Korea.Methods: A nationally representative sample of 3224 older adults participating in the Korean Longitudinal Study of Ageing (KLoSA) were categorized into four groups based on clinical characteristics: CMI only; depressive symptoms only; CMI and depressive symptoms; and neither CMI nor depressive symptoms. We estimated the use of various health care services by the groups while adjusting for clinical and sociodemographic characteristics.Results: Depressive symptoms, as measured by the short-form Center for Epidemiological Studies-Depression scale (CES-D10), were prevalent, often occurring together with CMI in community-dwelling older adults in South Korea. Having depressive symptoms was positively associated with the use of inpatient services, outpatient physician services, and public health centers. The odds of using health care services were larger among older people with both depressive symptoms and CMI than depressive symptoms only.Conclusions: Self-reported depressive symptoms and self-reported CMI are prevalent among older adults in South Korea, often occurring together and possibly increasing health care utilization. These findings imply a need for chronic disease management targeting older people with complex mental and medical conditions and evaluation of its effects on health outcomes and service use.

Sign in / Sign up

Export Citation Format

Share Document