scholarly journals Health care utilisation preceding relapse or second malignant neoplasm after childhood acute lymphoblastic leukaemia: a population-based matched cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e050285
Author(s):  
Karen Schow Jensen ◽  
Birgitte Klug Albertsen ◽  
Henrik Schrøder ◽  
Alina Zalounina Falborg ◽  
Kjeld Schmiegelow ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Malignant Neoplasm ◽  
Population Based ◽  
Health Care Utilisation ◽  
Second Malignant Neoplasm ◽  
Childhood All ◽  
Bimodal Structure ◽  
Childhood Acute Lymphoblastic Leukaemia ◽  
Care Utilisation

ObjectivesTo investigate health care utilisation including both primary and secondary health care 6 months before the diagnosis of a relapse or a second malignant neoplasm (SMN) in survivors of childhood acute lymphoblastic leukaemia (ALL).Design and settingA Danish population-based matched cohort study linking multiple nationwide registries.ParticipantsParticipants were recruited from a total of 622 childhood ALL 2.5-year event-free survivors diagnosed between 1994 and 2015. Cases were survivors developing a relapse or an SMN and references were survivors still in first remission. Each case was matched with five references on age, sex, treatment protocol and risk group.Primary outcome measuresConsultations in general practice and hospital the last 6 months before relapse or SMN. Cases and references were compared with monthly incidence rate ratios (IRRs) from negative binomial regression models.ResultsOf the 622 childhood ALL survivors, 60 (9.6%) developed a relapse (49) or an SMN (11) and 295 matched references were identified. Health care utilisation in general practice increased among cases the last month before the event compared with references with an IRR of 2.71 (95% CI 1.71 to 4.28). Data showed a bimodal structure with a significantly increased number of visits 4, 5 and 6 months before the event. Hospital health care utilisation increased 2 months before the event in cases with an IRR of 5.01 (3.78 to 6.63) the last month before the event and an IRR of 1.94 (1.32 to 2.85) the second-last month comparing cases and references.ConclusionsSurvivors of childhood ALL developing a relapse or an SMN have a short period of increased health care utilisation before diagnosis. At hospital, this might be explained by pre-diagnostic examinations. In general practice, data suggest a bimodal structure with children later developing a relapse having more contacts also half a year before the relapse, suggesting that there could be early warnings.

scholarly journals Health care utilisation following childhood acute lymphoblastic leukaemia: a population-based matched cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049847
Author(s):  
Karen Schow Jensen ◽  
Birgitte Klug Albertsen ◽  
Henrik Schrøder ◽  
Alina Zalounina Falborg ◽  
Kjeld Schmiegelow ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Cohort Study ◽  
Population Based ◽  
Health Care Utilisation ◽  
First Year ◽  
Matched Cohort ◽  
Childhood All ◽  
Care Utilisation ◽  
Secondary Health Care

ObjectivesSurvival among children diagnosed with acute lymphoblastic leukaemia (ALL) has increased considerably. However, morbidity in survivors constitutes a potential increasing burden not limited to secondary health care. Our objectives were to compare health care utilisation, including both primary and secondary health care, between childhood ALL survivors and matched references up to 15 years after curative treatment. Moreover, to increase knowledge on survivors’ health service seeking behaviour as time from treatment elapsed.Design and settingA Danish population-based matched cohort study linking multiple nationwide registries.Participants675 cases, diagnosed with childhood (1.0–17.9 years) ALL between 1994 and 2015, and 6750 matched references sampled randomly from the source population (matched on age, gender and geographical region).Primary outcome measuresRepeated consultations in general practice and hospital (outpatient and inpatient) estimated as yearly rates from 2.5 years after diagnosis and onwards. We compared cases and references with yearly incidence rate ratios (IRRs) from negative binomial regression models.ResultsSurvivors of childhood ALL had a mean number of yearly daytime contacts in general practice of 4.75 (95% CI 4.41 to 5.11) the first year, corresponding to an IRR of 1.85 (95% CI 1.71 to 2.00); decreasing to 1.16 (1.01 to 1.34) after 15 years, and without significant impact of gender (p=0.894) or age (p=0.399). For hospital contacts, ALL survivors had a mean number of yearly contacts of 14.21 (13.38–15.08) the first year, corresponding to an IRR of 31.50 (28.29–35.07); decreasing to 2.42 (1.59–3.68) after 15 years. No differences were found across calendar time.ConclusionsALL survivors used significantly more health care services across sectors than the reference population. Decreasing use over 15 years illustrated the dynamics of health care needs; this knowledge may inform the future organisation of integrated follow-up programmes.Trial registration numberNCT03985826.

scholarly journals The Impact of Population-Based Disease Management Services on Health Care Utilisation and Costs: Results of the CAPICHe Trial

2018 ◽  
Vol 34 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Paul A. Scuffham ◽  
Joshua M. Byrnes ◽  
Christine Pollicino ◽  
David Cross ◽  
Stan Goldstein ◽  
...  
Keyword(s):  
Health Care ◽  
Disease Management ◽  
Population Based ◽  
Health Care Utilisation ◽  
Care Utilisation ◽  
The Impact ◽  
Management Services

scholarly journals Characterizing mental health/addictions and assault visits in the year prior to death: a population-based linked cohort study of homicide victims

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Meghan O'Neill ◽  
Emmalin Buajitti ◽  
Peter D Donnelly ◽  
Kathy Kornas ◽  
Laura Rosella
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Population Based ◽  
Health Care Utilisation ◽  
Health Care Use ◽  
Care Utilisation ◽  
Older Youth ◽  
Ed Visits ◽  
One Year ◽  
Utilisation Data

IntroductionHomicide is an important cause of death for older youth and adult Canadians; however, little is known about health care use prior to death among this population. ObjectivesTo characterise health care use for mental health and addictions (MHA) and serious assault (herein referred to assault) one year prior to death among individuals who died by homicide in Ontario, Canada using linked mortality and health care utilisation data. MethodsWe report rates of health care use for MHA and assault in the year prior to death among all individuals 16 years and older in Ontario, Canada, who died by homicide from April 2003 to December 2012 (N=1,541). Health care use for MHA included inpatient stays, emergency department (ED) visits and outpatient visits, whereas health care use for assault included only hospital-based care (ED visits and inpatient stays). Sociodemographic characteristics and health care utilisation were examined across homicide deaths, stratified by sex. ResultsOverall, 28.5% and 5.9% of homicide victims sought MHA and assault care in the year prior to death, respectively. A greater proportion of females accessed care for MHA, whereas a greater proportion of males accessed assault-related health care. Males were more likely to be hospitalised following an ED visit for a MHA or assault related reason, in comparison to females. The most common reason for a MHA hospital visit was for substance-related disorders. We found an increase over time for hospital-based visits for assault prior to death, a trend that was not observed for MHA-related visits. ConclusionsA large proportion of homicide victims interacted with the health care system for MHA or assault in the year prior to death. An increase in hospital-based visits for assault-related reasons prior to death was observed. These trends may offer insight into avenues for support and prevention for victims of homicide.

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