A modeling study exploring the impact of homelessness on rostered primary care utilization in Calgary, Canada

Purpose To our knowledge to date, the effect of primary care utilization on health outcomes in cancer patients has not been described. The objective of this study was to investigate the impact of primary care utilization within 6 months of cancer diagnosis on survival in patients with lung cancer. Patients and Methods We used electronic medical record data (1997 to 2005) to identify male veterans with incident lung cancers (N = 323). Primary care utilization was assessed in the 6 months after cancer diagnosis. Patients were observed from cancer diagnosis to death or to last date of health care utilization (ie, censoring date). Univariate and multivariate Cox proportional hazards models tested whether primary care utilization was associated with improved survival. Multivariate analyses adjusted for demographic and clinical characteristics. Results During an average follow-up of 16.6 months, 259 patients died. In multivariate analysis, the risk of death was 36% (hazard ratio [HR], 0.64; 95% CI, 0.45 to 0.90), 56% (HR, 0.44; 95% CI, 0.29 to 0.65), and 57% (HR, 0.43; 05% CI, 0.29 to 0.64) lower for patients who had one, two, or at least three primary care visits, respectively, in the first 6 months after cancer diagnosis as compared with those without primary care utilization. The median survival duration (P < .0001, log-rank test) was 3.68, 7.52, 13.88, and 13.75 months for patients with no, one, two, or at least three primary care visits, respectively. Conclusion Primary care utilization in the early phase of cancer treatment has a marked effect that results in a reduced mortality risk in patients with incident lung cancer. Additional research is required to determine how and why primary care utilization is an important prognostic indicator of prolonged survival in patients with lung cancer.

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The impact of improved access to after-hours primary care on emergency department and primary care utilization: A systematic review

Health Policy ◽

10.1016/j.healthpol.2020.05.015 ◽

2020 ◽

Vol 124 (8) ◽

pp. 812-818

Author(s):

Michael Hong ◽

Amardeep Thind ◽

Gregory S. Zaric ◽

Sisira Sarma

Keyword(s):

Systematic Review ◽

Primary Care ◽

Emergency Department ◽

Care Utilization ◽

After Hours ◽

Primary Care Utilization ◽

The Impact

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Predictors of post-release primary care utilization among HIV-positive prison inmates: A pilot study

AIDS Care ◽

10.1080/09540120500161892 ◽

2006 ◽

Vol 18 (4) ◽

pp. 290-301 ◽

Cited By ~ 30

Author(s):

A. J. Harzke ◽

M. W. Ross ◽

D. P. Scott

Keyword(s):

Primary Care ◽

Pilot Study ◽

Care Utilization ◽

Hiv Positive ◽

Prison Inmates ◽

Primary Care Utilization

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Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽

10.1542/peds.106.s3.937 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 937-941

Author(s):

Kenneth D. Mandl ◽

Charles J. Homer ◽

Oren Harary ◽

Jonathan A. Finkelstein

Keyword(s):

Primary Care ◽

Length Of Stay ◽

Early Discharge ◽

Urgent Care ◽

Care Utilization ◽

Care Services ◽

Primary Care Services ◽

Ambulatory Services ◽

The Impact ◽

Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

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Evaluating Child Health Plus in Upstate New York: How Much Does Providing Health Insurance to Uninsured Children Increase Health Care Costs?

PEDIATRICS ◽

10.1542/peds.105.se1.728 ◽

2000 ◽

Vol 105 (Supplement_E1) ◽

pp. 728-732 ◽

Cited By ~ 2

Author(s):

Jack Zwanziger ◽

Dana B. Mukamel ◽

Peter G. Szilagyi ◽

Sarah Trafton ◽

Andrew W. Dick ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

New York ◽

Health Insurance ◽

Care Utilization ◽

Average Change ◽

Uninsured Children ◽

Primary Care Utilization ◽

Care Costs ◽

Child Health Plus

Background. In response to the increase in the number of American children without health insurance, new federal and state programs have been established to expand health insurance coverage for children. However, the presence of insurance reduces the price of care for families participating in these programs and stimulates the use of medical services, which leads to an increase in health care costs. In this article, we identified the additional expenditures associated with the provision of health insurance to previously uninsured children. Methods. We estimated the expenditures on additional services using data from a study of children living in the Rochester, New York, area who were enrolled in the New York State Child Health Plus (CHPlus) program. CHPlus was designed specifically for low-income children without health insurance who were not eligible for Medicaid. The study sample consisted of 1910 children under the age of 6 who were initially enrolled in CHPlus between November 1, 1991 and August 1, 1993 and who had been enrolled for at least 9 continuous months. We used medical chart reviews to determine the level of primary care utilization, parent interviews for demographic information, as well as specialty care utilization, and we used claims data submitted to CHPlus for the year after enrollment to calculate health care expenditures. Using this information, we estimated a multivariate regression model to compute the average change in expenditures associated with a unit of utilization for a cross-section of service types while controlling for other factors that independently influenced total outpatient expenditures. Results. Expenditures for outpatient services were closely related to primary care utilization—more utilization tended to increase expenditures. Age and the presence of a chronic condition both affected expenditures. Children with chronic conditions and infants tended to have more visits, but these visits were, on average, less expensive. Applying the average change in expenditures to the change in utilization that resulted from the presence of insurance, we estimated that the total increase in expenditures associated with CHPlus was $71.85 per child in the year after enrollment, or a 23% increase in expenditures. The cost increase was almost entirely associated with the provision of primary care. Almost three-quarters of the increase in outpatient expenditures was associated with increased acute and well-child care visits. Conclusions. CHPlus was associated with a modest increase in expenditures, mostly from additional outpatient utilization. Because the additional primary care provided to young children often has substantial long-term benefits, the relatively modest expenditure increases associated with the provision of insurance may be viewed as an investment in the future.

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