scholarly journals Specialist psychiatric health care utilization among older people with intellectual disability – predictors and comparisons with the general population: a national register study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
G. Ahlström ◽  
A. Axmon ◽  
M. Sandberg ◽  
J. Hultqvist
Keyword(s):  
Health Care ◽  
Intellectual Disability ◽  
General Population ◽  
Health Care Utilization ◽  
Older People ◽  
Age Groups ◽  
Care Utilization ◽  
Increased Risk ◽  
National Cohort ◽  
Specialist Health Care

Abstract Background People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. Material and methods We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002–2012. Results After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. Conclusions Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers’ plans of resources to meet the needs of these people.

Health and Health-Care Utilization of the Older Population of Ireland: Comparing the Intellectual Disability Population and the General Population

2017 ◽  
Vol 39 (6) ◽  
pp. 693-718 ◽  
Author(s):  
Mary McCarron ◽  
Eimear Cleary ◽  
Philip McCallion
Keyword(s):  
Health Care ◽  
Intellectual Disability ◽  
General Population ◽  
Health Care Utilization ◽  
Behavioral Health ◽  
Health Planning ◽  
Community Dwelling ◽  
Care Utilization ◽  
Physical And Mental Health ◽  
Age Related

Background/Objectives: Largely unresearched are the similarities and differences compared to the general population in the aging of people with an intellectual disability (ID). Data reported here compare the health and health-care utilization of the general aging population in Ireland with those who are aging with ID. Design: Data for comparisons were drawn from the 2010 The Irish Longitudinal Study on Ageing (TILDA) and the Intellectual Disability Supplement (IDS)-TILDA Wave 1 data sets. Setting: TILDA participants were community dwelling only while IDS-TILDA participants were drawn from community and institutional settings. Participants: TILDA consists of a sample of 8,178 individuals aged 50 years and older who were representative of the Irish population. The IDS-TILDA consists of a random sample of 753 persons aged 40 and older. Using age 50 as the initial criterion, 478 persons with ID were matched with TILDA participants on age, sex, and geographic location to create the sample for this comparison. Measurements: Both studies gathered self-reported data on physical and mental health, behavioral health, functional limitations, and health-care utilization. Results: Rates of chronic disease appeared higher overall for people with ID as compared to the general population. There were also age-related differences in the prevalence of diabetes and cancer and different rates of engagement between the two groups in relevant behavioral health activities such as smoking. There were higher utilization levels among IDS-TILDA participants for allied health and general practitioner visits. Conclusion: Different disease trajectories found among IDS-TILDA participants raise concerns. The longitudinal comparison of data for people with ID and for the general population offered a better opportunity for the unique experiences of people with ID to be included in data that inform health planning.

scholarly journals Health Status and Health Care Utilization of Multiple Sclerosis in Canada

2007 ◽  
Vol 34 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Sheri L. Pohar ◽  
C. Allyson Jones ◽  
Sharon Warren ◽  
Karen V.L. Turpin ◽  
Kenneth Warren
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Status ◽  
General Population ◽  
Health Care Utilization ◽  
Resource Utilization ◽  
Health Behaviours ◽  
Health Care Resource ◽  
Care Utilization ◽  
Health Care Resource Utilization

Background:Persons with multiple sclerosis (MS) represent a small segment of the population, but given the progression of the disease, they experience substantial physical, psychosocial and economic burdens.Objective:The primary aim was to compare demographic characteristics, health status, health behaviours, health care resource utilization and access to health care of the community dwelling populations with and without MS.Methods:Cross-sectional survey using data from the Canadian Community Health Survey (CCHS 1.1). Adjusted analyses were performed to assess differences between persons with MS and the general population, after controlling for age and sex. Normalized sampling weights and bootstrap variance estimates were used.Results:Respondents with MS were 7.6 times (95% CI: 5.4, 10.7) more likely to have health-related quality of life scores that reflected severe impairment than respondents without MS. Respondents with MS were 12.2 times (95% CI: 8.6, 17.2) to rate their health as ‘poor’ or ‘fair’ than the general population. Urinary incontinence and chronic fatigue syndrome were 18.7 times (95% CI: 12.5, 28.2) and 21.9 times (95% CI: 11.9, 40.3), more likely to be reported by respondents with MS than those without. Differences between the two populations also existed in terms of health care resource utilization and access and health behaviours.Conclusion:Large discrepancies in health status and health care utilization existed between persons with MS who reside in the community and the general population according to all indicators used. Health care needs of persons with MS were also not met.

General Health, Health Care Utilization, and Medical Comorbidity in Dysthymia

1993 ◽  
Vol 23 (3) ◽  
pp. 211-238 ◽  
Author(s):  
Robert H. Howland
Keyword(s):  
Health Care ◽  
Major Depression ◽  
Health Care Utilization ◽  
General Health ◽  
Public Health Problem ◽  
Care Utilization ◽  
Medical Comorbidity ◽  
Medical Settings ◽  
Poor General Health ◽  
Increased Risk

Objective: This article reviews the literature on the general health, health care utilization, prevalence, medical comorbidity, and treatment of dysthymia in medical settings. Method: The literature was searched by using MEDLINE and by reviewing the bibliographies of recent publications. Studies were selected that included health data on patients with dysthymia or chronic depression according to DSM-III, DSM-III-R, ICD-9, or RDC criteria, or patients who were described as having persistent depressive symptoms. Results: This review shows that dysthymic patients are at increased risk for poor general health and frequently use medical services. Compared to the general population, dysthymia is more prevalent in primary care and among patients with various medical and neurological conditions, sleep disorders, chronic fatigue, hypothyroidism, and somatoform disorders. Pharmacotherapy is effective, but has not been well studied. Non-tricyclic antidepressants might be especially useful. Psychotherapy studies are virtually nonexistent. Conclusions: Although dysthymia is considered a minor depressive condition, these findings show that it is a significant public health problem, comparable to major depression. Recent efforts to improve the recognition and treatment of major depression in medical settings, therefore, should be extended to include the entire spectrum of depressive disorders. Future studies should investigate the type and pattern of medical comorbidity and health care utilization, different antidepressant and psychosocial therapies, and the clinical and biological correlates of treatment response in different chronic depressive subtypes in medical settings and compare them to major depressive and subsyndromal depressive conditions.

Health Care Utilization for Rome IV Irritable Bowel Syndrome; A Three-Country Survey in the General Population

2017 ◽  
Vol 152 (5) ◽  
pp. S68 ◽  
Author(s):  
Navkiran Jossan ◽  
Magnus Simren ◽  
Ami D. Sperber ◽  
Imran Aziz ◽  
William E. Whitehead ◽  
...  
Keyword(s):  
Health Care ◽  
Irritable Bowel Syndrome ◽  
General Population ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Irritable Bowel ◽  
Rome Iv

scholarly journals Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

2020 ◽  
Vol 29 (4) ◽  
pp. 311-317
Author(s):  
Patricia S. Andrews ◽  
Sophia Wang ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Sikandar Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Health Care Utilization ◽  
Mortality Risk ◽  
Hazard Ratio ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees

2016 ◽  
Vol 45 (2) ◽  
pp. 311-316 ◽  
Author(s):  
Margot R. Krauss ◽  
Nadia U. Garvin ◽  
Michael R. Boivin ◽  
David N. Cowan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Stress Fracture ◽  
Body Fat ◽  
Stress Fractures ◽  
Musculoskeletal Injuries ◽  
Care Utilization ◽  
Injury Incidence ◽  
Increased Risk ◽  
Rate Ratios

Background: Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures. Hypothesis: The incidence of, and excess health care utilization for, stress fracture and non–stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits. Study Design: Cohort study; Level of evidence, 3. Methods: All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005–September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service. Results: Among the weight-qualified women, unfit participants had a higher non–stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non–stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1.19-2.21) and 1.22 (95% CI, 1.10-1.36), respectively. Among fit women exceeding body fat limits, the stress fracture incidence and related excess health care utilization rate ratios were 0.79 (95% CI, 0.49-1.28) and 1.44 (95% CI, 1.20-1.72), respectively, compared with those who were weight qualified. Conclusion: The results indicate a significantly increased risk of musculoskeletal injuries, including stress fractures, among unfit recruits and an increased risk of non–stress fracture musculoskeletal injuries among recruits who exceeded body fat limits. Once injured, female recruits who were weight qualified but unfit and those who were fit but exceeded body fat limits had increased health care utilization. These findings may have implications for military accession and training policies as downsizing of military services will make it more important than ever to optimize the health and performance of individual service members.

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