scholarly journals Health services use by children identified as heterozygous hemoglobinopathy mutation carriers via newborn screening

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara D. Khangura ◽  
Beth K. Potter ◽  
Christine Davies ◽  
Robin Ducharme ◽  
A. Brianne Bota ◽  
...  
Keyword(s):  
Health Services ◽  
Newborn Screening ◽  
Service Use ◽  
Carrier Status ◽  
Health Services Use ◽  
Inpatient Hospitalization ◽  
Potential Health ◽  
Ed Visits ◽  
Rate Ratios ◽  
Services Use

Abstract Background Newborn screening (NBS) for sickle cell disease incidentally identifies heterozygous carriers of hemoglobinopathy mutations. In Ontario, Canada, these carrier results are not routinely disclosed, presenting an opportunity to investigate the potential health implications of carrier status. We aimed to compare rates of health services use among children identified as carriers of hemoglobinopathy mutations and those who received negative NBS results. Methods Eligible children underwent NBS in Ontario from October 2006 to March 2010 and were identified as carriers or as screen-negative controls, matched to carriers 5:1 based on neighbourhood and timing of birth. We used health care administrative data to determine frequencies of inpatient hospitalizations, emergency department (ED) visits, and physician encounters through March 2012, using multivariable negative binomial regression to compare rates of service use in the two cohorts. We analyzed data from 4987 carriers and 24,935 controls. Results Adjusted incidence rate ratios (95% CI) for service use in carriers versus controls among children < 1 year of age were: 1.11 (1.06–1.17) for ED visits; 0.97 (0.89–1.06) for inpatient hospitalization; and 1.02 (1.00–1.04) for physician encounters. Among children ≥1 year of age, adjusted rate ratios were: 1.03 (0.98–1.07) for ED visits; 1.14 (1.03–1.25) for inpatient hospitalization and 0.92 (0.90–0.94) for physician encounters. Conclusions While we identified statistically significant differences in health services use among carriers of hemoglobinopathy mutations relative to controls, effect sizes were small and directions of association inconsistent across age groups and health service types. Our findings are consistent with the assumption that carrier status is likely benign in early childhood.

scholarly journals Health services use in eating disorders

2007 ◽  
Vol 38 (10) ◽  
pp. 1465-1474 ◽  
Author(s):  
R. H. Striegel-Moore ◽  
L. DeBar ◽  
G. T. Wilson ◽  
J. Dickerson ◽  
F. Rosselli ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Health Services ◽  
Health Plan ◽  
Service Use ◽  
Healthcare Services ◽  
Primary Care Visit ◽  
Health Services Use ◽  
Health Maintenance ◽  
Co Morbidity ◽  
Services Use

BackgroundThis study examined healthcare services used by adults diagnosed with an eating disorder (ED) in a large health maintenance organization in the Pacific Northwest.MethodElectronic medical records were used to collect information on all out-patient and in-patient visits and medication dispenses, from 2002 to 2004, for adults aged 18–55 years who received an ED diagnosis during 2003. Healthcare services received the year prior to, and following, the receipt of an ED diagnosis were examined. Cases were matched to five comparison health plan members who had a health plan visit close to the date of the matched case's ED diagnosis.ResultsIncidence of EDs (0.32% of the 104 130 females, and 0.02% of the 93 628 males) was consistent with prior research employing treatment-based databases, though less than community-based samples. Most cases (50%) were first identified during a primary-care visit and psychiatric co-morbidity was high. Health services use was significantly elevated in all service sectors among those with an ED when compared with matched controls both in the year preceding and that following the receipt of the incident ED diagnosis. Contrary to expectations, healthcare utilization was found to be similarly high across the spectrum of EDs (anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified).ConclusionsThe elevation in health service use among women both before and after diagnosis suggests that EDs merit identification and treatment efforts commensurate with other mental health disorders (e.g. depression) which have similar healthcare impact.

scholarly journals Does an mHealth system reduce health service use for asthma?

2020 ◽  
Vol 6 (3) ◽  
pp. 00340-2019
Author(s):  
Teresa To ◽  
M. Diane Lougheed ◽  
Rachel McGihon ◽  
Jingqin Zhu ◽  
Samir Gupta ◽  
...  
Keyword(s):  
Health Services ◽  
Intervention Group ◽  
External Control ◽  
Control Group ◽  
Health Services Use ◽  
Physician Visits ◽  
Asthma Patients ◽  
Ed Visits ◽  
The Impact ◽  
Services Use

BackgroundBreathe is a mobile health (mHealth) application developed for the self-management of asthma in adults. There is evidence to suggest that mHealth interventions can be used for asthma control; however, their effects on the use of health services remain poorly understood. We sought to determine whether Breathe reduces health services use amongst asthma patients who used the app compared to controls who did not.MethodsThe impact of Breathe on health services use was estimated using a quasi-experimental approach. Two groups of subjects who had participated in a previous randomised clinical trial were included: an intervention group of asthma patients who used the app for 12 months, and a group of controls who did not use the app but received equivalent quality asthma care. A third, external control group of asthma patients were matched to the intervention participants. Generalised linear mixed models were used to determine relative changes in rates of asthma hospitalisations, emergency department (ED) visits, outpatient physician visits and completion of pulmonary function tests (PFTs) over time.ResultsA total of 677 individuals with asthma were included in the study: 132 in the intervention group, and 149 and 396 in the internal and external control groups, respectively. There were no statistically significant differences in the change of asthma hospitalisations, ED visits, physician office visits or completion of PFTs between the intervention group and either control group.ConclusionsUse of the Breathe app is not associated with changes in health services use in adults with asthma.

scholarly journals 0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A321-A321
Author(s):  
M Tzuang ◽  
J T Owusu ◽  
J Huang ◽  
O C Sheehan ◽  
G W Rebok ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Services ◽  
Home Health Care ◽  
Home Health ◽  
Community Dwelling ◽  
Health Services Use ◽  
Ed Visits ◽  
Insomnia Symptoms ◽  
Services Use

Abstract Introduction Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults. Methods Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency &gt;30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits. Results Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p&lt;0.001), all-cause hospitalizations (OR=1.30, p&lt;0.01), preventable hospitalizations (OR=1.83, p&lt;0.05), 30-day readmissions (OR=1.73, p&lt;0.05), and home health care use (OR=1.27, p&lt;0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p&lt;0.05). Conclusion Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use. Support National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”

scholarly journals Influence of established and subjectively perceived as well as evaluated individual characteristics on the utilization of mental health services among individuals with depressive disorders: protocol of a longitudinal study examining how to supplement the “behavioral model of health services use” and on need-congruent use of mental health services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Katharina Reinhold ◽  
Julia Louise Magaard ◽  
Anna Levke Brütt
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Health Services Use ◽  
Services Use

Abstract Background Approximately one out of every three people in Germany who meets the diagnostic criteria for major depression has contact with mental health services. Therefore, according to treatment guidelines, two thirds of all individuals with depression are insufficiently treated. In the past, the subjective perspective of people who (do not) make use of mental health services has been neglected. Factors related to the use of health services are described in Andersen’s Behavioral Model of Health Services Use (ABM). The aim of this study is to supplement operationalizations of subjectively perceived and evaluated individual characteristics in the ABM and to evaluate whether the supplemented model can better explain mental health services use in individuals with depression than established operationalizations. Methods A representative telephone study with two measurement points will be conducted. In an explanatory mixed-methods design, qualitative interviews will be added to further interpret the quantitative data. A nationwide sample scoring 5 or more on the Patient Health Questionnaire (PHQ-9) will be recruited and interviewed via telephone at T0 and 12 months later (T1). Data on established and subjective characteristics as well as mental health service use will be collected. At T1, conducting a diagnostic interview (Composite International Diagnostic Interview, DIA-X-12/M-CIDI) enables the recording of 12-month diagnoses according to DSM-IV-TR criteria. Ideally, n = 768 datasets will be available and analyzed descriptively by means of regression analysis. Up to n = 32 persons who use or do not use depression-specific health services incongruent with their objective or subjective needs will be interviewed (face-to-face) to better explain their behavior. In addition, theories of non-need-based mental health service use are developed within the framework of the grounded theory-based analysis of the qualitative interviews. Discussion The study intends to contribute to the theoretical foundation of health services research and to specify the characteristics described in the ABM. Thus, after completion of the study, a further sophisticated and empirically tested model will be available to explain mental health services. The identified modifiable influencing factors are relevant for the development of strategies to increase mental health service use in line with the objective and subjective needs of individuals with depression.

scholarly journals Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults

SLEEP ◽  
2020 ◽  
Author(s):  
Marian Tzuang ◽  
Jocelynn T Owusu ◽  
Jin Huang ◽  
Orla C Sheehan ◽  
George W Rebok ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Health Services ◽  
Home Health Care ◽  
Home Health ◽  
Community Dwelling ◽  
Health Services Use ◽  
Ed Visits ◽  
Insomnia Symptoms ◽  
Services Use

Abstract Study Objectives Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults. Methods Participants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency &gt;30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits. Results Overall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24–2.07, p &lt; 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01–1.65, p &lt; 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88–3.29, p &lt; 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23–1.87, p &lt; 0.001; IRR = 1.21, 95% CI = 1.02–1.44, p &lt; 0.05, respectively) after adjusting for demographic and health characteristics. Conclusions Among older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.

scholarly journals INEQUALITY IN COMMUNITY HEALTH SERVICES USE IN ISRAEL: A COMPARISON BETWEEN ELDER JEWS AND ARABS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S863-S863
Author(s):  
Ariela Lowenstein ◽  
Sigal Pearl Naim
Keyword(s):  
Quality Of Life ◽  
Health Services ◽  
Service Use ◽  
Population Aging ◽  
Economic Status ◽  
Public Health Issue ◽  
Health Services Use ◽  
Socio Economic Status ◽  
Services Use

Abstract Population aging is an important social and public health issue globally. However, increase in longevity causes physical frailty and disability for many elders, which might lead to independence loss and impact quality of life. This increases health services usage and leads to higher costs of medical treatments. Data show that higher socio-economic status and accessibility to health services might reduce inequality in service use and impact mortality rates and quality of life. Also, that improved socio-economic status and population accessibility to Health services may stem from inner health system factors, as well as those related to the patients. Among minorities lower usage of formal professional services, including health services, are often related to cultural differences and many times to lower technological level, which are not considered by service providing organizations. Thus, lack of attention to service using minorities’ needs may cause a gap between potential consumers to services use. Israel is a multi-cultural society with mixed population of Jews and Arabs. Currently, Arabs comprise 20.9% and Jews 74.3%. However, the rate of disabled Jews is 16% compared to 31% among older Arabs.

scholarly journals Effect of smoke-free legislation on respiratory health services use in children with asthma: a population-based open cohort study in Ontario, Canada

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048137
Author(s):  
Teresa To ◽  
Ivy Fong ◽  
Jingqin Zhu ◽  
Rachel McGihon ◽  
Kimball Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Services ◽  
Population Based ◽  
Respiratory Morbidity ◽  
Health Services Use ◽  
Children With Asthma ◽  
Ed Visits ◽  
The Impact ◽  
Sports Fields ◽  
Services Use

ObjectiveThis study will add to existing literature by examining the impact of smoke-free legislation in outdoor areas among children with asthma. We aimed to examine the effect of the 2015 Smoke-Free Ontario Act (SFOA) amendment, which prohibited smoking on patios, playgrounds and sports fields, on health services use (HSU) rates in children with asthma.MethodsWe conducted a population-based open cohort study using health administrative data from the province of Ontario, Canada. Each year, all Ontario residents aged 0–18 years with physician diagnosed asthma were included in the study. Annual rates of HSU (emergency department (ED) visits, hospitalisations and physician office visits) for asthma and asthma-related conditions (eg, bronchitis, allergic rhinitis, influenza and pneumonia) were calculated. Interrupted time-series analysis, accounting for seasonality, was used to estimate changes in HSU following the 2015 SFOA.ResultsThe study population ranged from 618 957 individuals in 2010 to 498 812 in 2018. An estimated average increase in ED visits for asthma in infants aged 0–1 years of 0.42 per 100 individuals (95% CI: 0.09 to 0.75) and a 57% relative increase corresponding to the 2015 SFOA was observed. A significant decrease in ED visits for asthma-related conditions of 0.19 per 100 individuals (95% CI: −0.37 to –0.01) and a 22% relative decrease corresponding to the 2015 SFOA was observed.ConclusionBased on the observed positive effect of restricting smoking on patios, playgrounds and sports fields on respiratory morbidity in children with asthma, other jurisdictions globally should consider implementing similar smoke-free policies.

scholarly journals 0844 Links of Napping With Subsequent All-Cause Hospitalizations and Emergency Department Visits in Older Adults

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A321-A322
Author(s):  
M Tzuang ◽  
J T Owusu ◽  
J Huang ◽  
O C Sheehan ◽  
G W Rebok ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Health Services ◽  
National Health ◽  
Community Dwelling ◽  
Objective Measures ◽  
Health Services Use ◽  
Medicare Claims ◽  
Ed Visits ◽  
Services Use

Abstract Introduction Few studies have examined whether napping is associated with objective measures of health services use. We investigated links of napping characteristics with all-cause hospitalizations and emergency department (ED) visits in Medicare claims from a nationally representative sample of older adults. Methods Participants were 869 community-dwelling Medicare beneficiaries aged ≥65 years from Round 3 (2013) and Round 4 (2014) of the National Health and Aging Trends Study (NHATS) who had continuous fee-for-service coverage 1 year before and after the NHATS interview. Participants reported past-month napping frequency (re-categorized as non-nappers, infrequent nappers, frequent nappers), napping type (intentional, unintentional), and nap duration. Outcomes were from linked Medicare claims measured after napping assessment: all-cause ED visits and hospitalizations (yes vs. no), and number of hospitalizations and ED visits. Results Overall, 45.4% of participants were nappers, and 55.2% of the nappers reported taking unintentional naps. After adjustment for demographics, depressive/anxiety symptoms, medical comorbidities and BMI, compared with non-nappers, infrequent and frequent nappers had a higher odds of hospitalization (odds ratio (OR)=1.65 and 1.73, respectively, both p&lt;0.05), as did unintentional nappers (OR=1.85, p&lt;0.05). We found no significant adjusted associations of napping frequency with ED visits. However, compared with non-nappers, unintentional nappers had a higher odds of visiting the ED (OR=1.94, p&lt;0.01). Additionally, compared to nappers taking short naps (≤30 minutes), those with naps &gt;60 minutes had a greater number of ED visits (Incidence Rate Ratio=1.99, p&lt;0.05). Conclusion Among older adults, napping—and particularly unintentional napping—may be a modifiable risk factor for health services use. More studies that consider multiple napping characteristics (e.g., duration, frequency), and using objective measures (e.g., actigraphy), are needed to advance understanding of how napping might influence health services use. Support National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”

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