scholarly journals Health care utilization following “digi-physical” assessment compared to physical assessment for infectious symptoms in primary care

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Artin Entezarjou ◽  
Maria Sjöbeck ◽  
Patrik Midlöv ◽  
Veronica Milos Nymberg ◽  
Lina Vigren ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Physical Examination ◽  
Office Visit ◽  
Urinary Symptoms ◽  
Care Utilization ◽  
Office Visits ◽  
Physical Concept ◽  
Physical Assessment

Abstract Background The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits. Methods This pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD). Results No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician. Conclusions Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept. Trial registration Clinicaltrials.gov identifier: NCT03474887.

PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

2008 ◽  
Vol 21 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Melissa A. Polusny ◽  
Barry J. Ries ◽  
Jessica R. Schultz ◽  
Patrick Calhoun ◽  
Lisa Clemensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Physical Health ◽  
Natural Disaster ◽  
Ptsd Symptom ◽  
Symptom Clusters ◽  
Care Utilization ◽  
Rural Primary Care ◽  
Primary Care Patients

scholarly journals Health status and health care utilization after discharge from geriatric in-hospital stay – description of a register-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
E. Rydwik ◽  
R. Lindqvist ◽  
C. Willers ◽  
L. Carlsson ◽  
G. H. Nilsson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Future Studies ◽  
Healthcare Data ◽  
Utilization Data ◽  
Hospital Stays ◽  
Socioeconomic Data

Abstract Background This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge. Methods The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8). Results Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care. Conclusion The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.

scholarly journals Approaches to Evaluations of Virtual Care in Primary Care

2022 ◽  
Vol 2 (1) ◽  
pp. es0358
Author(s):  
Daphne Hui ◽  
Bert Dolcine ◽  
Hannah Loshak
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Cost Analyses ◽  
Virtual Care ◽  
Primary Care Health ◽  
Guidance Documents ◽  
Care Health

A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

scholarly journals Intersectional equity in health care: assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Fortune N. Nyamande ◽  
Paola A. Mosquera ◽  
Miguel San Sebastián ◽  
Per E. Gustafsson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Horizontal Equity ◽  
Care Utilization ◽  
Northern Sweden ◽  
Equity In Health ◽  
Percentage Points ◽  
Low Educated ◽  
Equity In Health Care

Abstract Background Knowledge remains scarce about inequities in health care utilization between groups defined, not only by single, but by multiple and intersecting social categories. This study aims to estimate intersectional horizontal inequities in health care utilization by gender and educational level in Northern Sweden, applying a novel methodological approach. Methods Data on participants (N = 22,997) aged 16–84 years from Northern Sweden came from the 2014 Health on Equal Terms cross sectional survey. Primary (general practitioner) and secondary (specialist doctor) health care utilization and health care needs indicators were self-reported, and sociodemographic information came from registers. Four intersectional categories representing high and low educated men, and high and low educated women, were created, to estimate intersectional (joint, referent, and excess) inequalities, and needs-adjusted horizontal inequities in utilization. Results Joint inequalities in primary care were large; 8.20 percentage points difference (95%CI: 6.40–9.99) higher utilization among low-educated women than high-educated men. Only the gender referent inequity remained after needs adjustment, with high- (but not low-) educated women utilizing care more frequently than high-educated men (3.66 percentage points difference (95%CI: 2.67–5.25)). In contrast, inequalities in specialist visits were dominated by referent educational inequalities, (5.69 percentage points difference (95%CI: 2.56–6.19), but with no significant horizontal inequity – by gender, education, or their combination – remaining after needs adjustment. Conclusion This study suggests a complex interaction of gender and educational inequities in access to care in Northern Sweden, with horizontal equity observable for secondary but not primary care. The study thereby illustrates the unique knowledge gained from an intersectional perspective to equity in health care.

scholarly journals Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys

2020 ◽  
Vol 26 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Catherine L Saunders ◽  
Adam Steventon ◽  
Barbara Janta ◽  
Mai Stafford ◽  
Carol Sinnott ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Dental Care ◽  
Odds Ratio ◽  
Service Planning ◽  
Care Utilization ◽  
Cross Sectional ◽  
Objective Evidence ◽  
The Uk

Objective To contribute objective evidence on health care utilization among migrants to the UK to inform policy and service planning. Methods We analysed data from Understanding Society, a household survey with fieldwork from 2015 to 2017, and the European Health Interview Survey with data collected between 2013 and 2014. We explored health service utilization among migrants to the UK across primary care, inpatient admissions and maternity care, outpatient care, mental health, dental care and physiotherapy. We adjusted for age, sex, long-term health conditions and time since moving to the UK. Results Health care utilization among migrants to the UK was lower than utilization among the UK-born population for all health care dimensions except inpatient admissions for childbirth; odds ratio (95%CI) range 0.58 (0.50–0.68) for dental care to 0.88 (0.78–0.98) for primary care). After adjusting for differences in age and self-reported health, these differences were no longer observed, except for dental care (odds ratio 0.57, 95%CI 0.49–0.66, P < 0.001). Across primary care, outpatient and inpatient care, utilization was lower among those who had recently migrated, increasing to the levels of the nonmigrant population after 10 years or more since migrating to the UK. Conclusions This study finds that newly arrived migrants tend to utilize less health care than the UK population and that this pattern was at least partly explained by better health, and younger age. Our findings contribute nationally representative evidence to inform public debate and decision-making on migration and health.

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