Treatment Chronicle: a Tool for Assessing Health Service Utilization among Insured Individuals

Background: Assessment of the health services utilization among the insured individuals is difficult for insurance companies because they have no integrated information. So, the aim of this study was to introduce a tool to facilitate this issue named "Treatment Chronicle". Method: This descriptive and applied study was conducted in 2017. To investigate the health services utilization among the insured people and considering the information fragmentation in medical document system of Iran Health Insurance organization (IHIO), Treatment Chronicle was designed. Then, information was collected from medical document system of IHIO about patients' reference to physicians and paraclinics in various specialized levels in an 8-month period from the beginning of 2017. In this regard, 175 insured patients who used the health services very frequently were randomly selected and the Treatment Chronicle was drawn for them. Finally, some criteria were suggested for identifying the causes of over utilizing health services and a specific kind of service. Results: Data in the IHIO were categorized according to patients' referral to physician, drug store, laboratory, and imaging center and were accessible in the form of tables and charts by entering the individual's national code number in the medical document system of IHIO. However, some problems existed for reviewing the health care utilization due to information fragmentation and lack of up-to-date information. Treatment Chronicle tool showed the referring information of each insured individual in a certain time period. It also represented the sequence, diversity, and combination of individuals' reference to physicians and utilization of paraclinical services. Conclusion: Treatment Chronicle is a useful tool for insurance organizations to monitor individuals' health services seeking behavior. It can facilitate the interpretation and analysis of the healthcare use by illustrating the sequence and combination service utilization.

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Depressive symptoms and health service utilization among Chinese middle aged and older adults: A national population-based longitudinal survey

10.21203/rs.3.rs-27279/v1 ◽

2020 ◽

Author(s):

Jing Guo ◽

Dexia Kong ◽

Anao Zhang ◽

Liming Fang ◽

Yingxue Zhu

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Health Service ◽

Health Services ◽

Service Utilization ◽

Health Service Utilization ◽

Health Services Utilization ◽

Middle Aged ◽

Cross Sectional ◽

Services Utilization

Abstract Background: The prevalence of depressive symptoms has been steadily increasing in recent years, however middle aged and older adults was less likely to use mental health services. The aims of this study were to 1) examine the cross-sectional and longitudinal relationships between depressive symptoms and health services utilization among Chinese middle-aged and older adults; and 2) evaluate whether there exists a rural-urban difference in such relationships. Methods: Data was obtained from China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015, a nationally representative survey of 13,551 adults aged 45 years and above in China. Multivariate logistic regression analyses were conducted to assess the cross-sectional and longitudinal relationship between depressive symptoms and health services utilization in the whole sample, and urban and rural subsamples respectively. Results: Depressive symptoms were positively associated with a greater likelihood of outpatient and inpatient health services utilization. In addition, the relationships between depressive symptoms and health service use were consistent across rural and urban settings, indicating the robustness of such findings across geographic areas. Conclusions: Findings indicate that depressive symptoms are significantly associated with both in-patient and out-patient health service utilization among Chinese adults. Screening for depressive symptoms needs to be incorporated in these care settings in China.

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Integrating Interprofessional Trainees into a Complex Care Program for Veterans Experiencing Homelessness: Effects on Health Services Utilization

Journal of General Internal Medicine ◽

10.1007/s11606-021-06856-9 ◽

2021 ◽

Author(s):

Lillian Gelberg ◽

Samuel T. Edwards ◽

Elizabeth R. Hooker ◽

Meike Niederhausen ◽

Andrew Shaner ◽

...

Keyword(s):

Mental Health ◽

Health Services ◽

Vulnerable Populations ◽

Health Professionals ◽

Health Services Utilization ◽

Psychological Needs ◽

Care Utilization ◽

Post Intervention ◽

Ambulatory Clinic ◽

Services Utilization

Abstract PURPOSE High-quality, comprehensive care of vulnerable populations requires interprofessional ambulatory care teams skilled in addressing complex social, medical, and psychological needs. Training health professionals in interprofessional settings is crucial for building a competent future workforce. The impacts on care utilization of adding continuity trainees to ambulatory teams serving vulnerable populations have not been described. We aim to understand how the addition of interprofessional trainees to an ambulatory clinic caring for Veterans experiencing homelessness impacts medical and mental health services utilization. METHODS Trainees from five professions were incorporated into an interprofessional ambulatory clinic for Veterans experiencing homelessness starting in July 2016. We performed clinic-level interrupted time series (ITS) analyses of pre- and post-intervention utilization measures among patients enrolled in this training continuity clinic, compared to three similar VA homeless clinics without training programs from October 2015 to September 2018. RESULTS Our sample consisted of 37,671 patient- months. There was no significant difference between the intervention and comparison groups’ post-intervention slopes for numbers of primary care visits (difference in slopes =−0.16 visits/100 patients/month; 95% CI −0.40, 0.08; p=0.19), emergency department visits (difference in slopes = 0.08 visits/100 patients/month; 95% CI −0.16, 0.32; p=0.50), mental health visits (difference in slopes = −1.37 visits/month; 95% CI −2.95, 0.20; p= 0.09), and psychiatric hospitalizations (−0.005 admissions/100 patients/month; 95% CI −0.02, 0.01; p= 0.62). We found a clinically insignificant change in medical hospitalizations. CONCLUSIONS Adding continuity trainees from five health professions to an interprofessional ambulatory clinic caring for Veterans experiencing homelessness did not adversely impact inpatient and outpatient care utilization. An organized team-based care approach is beneficial for vulnerable patients and provides a meaningful educational experience for interprofessional trainees by building health professionals’ capabilities to care for vulnerable populations.

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Multidimensional Social Support and Health Services Utilization Among Noninstitutionalized Older Persons in Ghana

Journal of Aging and Health ◽

10.1177/0898264318816217 ◽

2018 ◽

Vol 32 (3-4) ◽

pp. 227-239 ◽

Cited By ~ 12

Author(s):

Razak M. Gyasi ◽

David R. Phillips ◽

Padmore Adusei Amoah

Keyword(s):

Social Support ◽

Older Adults ◽

Health Care ◽

Health Services ◽

Health Services Utilization ◽

Community Dwelling ◽

Health Care Use ◽

Care Utilization ◽

Health Seeking ◽

Services Utilization

Objectives: This study examines multidimensional social supports as predictors of health services utilization among community-dwelling older Ghanaians. Method: Using data from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-Seeking Behavior Study ( N = 1,200), Poisson regression models estimated the associations of aspects of informal social support and health facility utilization among older people. Results: Findings suggest that regular contacts with family/close friends (odds ratio [OR] = 1.299; 95% confidence interval [CI] = [1.111, 1.519]), social participation (OR = 1.021; 95% CI = [1.140, 1.910]), and remittances from adult children (OR = 1.091; 95%CI = [1.086, 1.207]) were associated with increased health services utilization with some gender variations. Having caregivers increased health care use generally (OR = 1.108; 95% CI = [1.016, 1.209]) and among men (OR = 1.181; 95% CI = [1.015, 1.373]). However, we found decrease in health care use among those who received pecuniary assistance (OR = 0.893; 95% CI = [0.805, 0.990]). Discussion: Perceived structural and functional social support domains appear influential in health care utilization among older adults in Ghana. The findings underscore the need for intervention programs and social policies targeted at both micro-factors and wider social factors, including the novel area of remittances to older adults.

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Depressive symptoms and health service utilization among Chinese middle-aged and older adults: a national population-based longitudinal survey

International Journal of Mental Health Systems ◽

10.1186/s13033-020-00421-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Jing Guo ◽

Dexia Kong ◽

Liming Fang ◽

Yingxue Zhu ◽

Bo Zhang

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Health Service ◽

Health Services ◽

Service Utilization ◽

Health Service Utilization ◽

Health Services Utilization ◽

Middle Aged ◽

Cross Sectional ◽

Services Utilization

Abstract Objectives This study aimed to (1) examine the cross-sectional and longitudinal relationships between depressive symptoms and health services utilization among Chinese middle-aged and older adults; and (2) evaluate whether there exists a rural–urban difference in such relationships. Methods Data was obtained from China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015, a nationally representative survey of 13,551 adults aged 45 years and above in China. Results Depressive symptoms were positively associated with a greater likelihood of outpatient and inpatient health services utilization. This association was consistent across rural and urban settings, indicating the robustness of such findings across geographic areas. Conclusions Findings indicate that depressive symptoms are significantly associated with both in-patient and out-patient health service utilization among Chinese adults. Screening for depressive symptoms needs to be incorporated in these care settings in China.

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Health services utilization and out-of-pocket (OOP) expenditures in public and private facilities in Pakistan: An empirical analysis of the 2013-14 OOP Health Expenditure Survey

10.21203/rs.3.rs-30500/v3 ◽

2021 ◽

Author(s):

Faraz Khalid ◽

Wajeeha Raza ◽

David R. Hotchkiss ◽

Rieza H. Soelaeman

Keyword(s):

Logistic Regression ◽

Health Services ◽

Private Sector ◽

Health Expenditure ◽

Health Services Utilization ◽

Private Provider ◽

Care Utilization ◽

Public And Private ◽

Services Utilization ◽

Expenditure Survey

Abstract Background As low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study. Methods We used data from 2013-14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan’s National Health Accounts. The analysis included 7,969 encounters from 4,293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient). Results Most encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6,660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region. Conclusions This is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.

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Health services utilization and out-of-pocket (OOP) expenditures in public and private facilities in Pakistan: an empirical analysis of the 2013–14 OOP health expenditure survey

BMC Health Services Research ◽

10.1186/s12913-021-06170-4 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

F. Khalid ◽

W. Raza ◽

D. R. Hotchkiss ◽

R. H. Soelaeman

Keyword(s):

Logistic Regression ◽

Health Services ◽

Private Sector ◽

Health Expenditure ◽

Health Services Utilization ◽

Private Provider ◽

Care Utilization ◽

Public And Private ◽

Services Utilization ◽

Expenditure Survey

Abstract Background As low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study. Methods We used data from 2013 to 14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan’s National Health Accounts. The analysis included 7969 encounters from 4293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient). Results Most encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region. Conclusions This is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.

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Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa

Ciência & Saúde Coletiva ◽

10.1590/1413-81232018235.20422016 ◽

2018 ◽

Vol 23 (5) ◽

pp. 1561-1576

Author(s):

Davi Silva Carvalho Curi ◽

Andreia Cristina Leal Figueiredo ◽

Silvia Regina Jamelli

Keyword(s):

Health Services ◽

Dental Care ◽

Critical Appraisal ◽

Health Services Utilization ◽

Dental Health ◽

Care Utilization ◽

Services Utilization ◽

Dental Health Services ◽

Dental Care Utilization ◽

Child Preschool

Resumo O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: (“dental care/utilization” OR “dental health services/utilization”) AND (child OR “child, preschool”) AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

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Assessment of maternal health services utilization in Pakistan: the role of socio-demographic characteristics

Asian Biomedicine ◽

10.1515/abm-2020-0002 ◽

2020 ◽

Vol 14 (1) ◽

pp. 3-7

Author(s):

Muhammad Aslam ◽

Maryam Sadiq ◽

Tahir Mehmood

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Health Care Utilization ◽

Negative Binomial ◽

Health Services Utilization ◽

Maternal Health Care ◽

Care Utilization ◽

Services Utilization ◽

Maternal Health Care Utilization

AbstractBackgroundHigh-quality prenatal care has a significant positive impact on maternal and infant health as it helps timely diagnosis and treatment of pregnancy complications.ObjectiveTo examine factors associated with the utilization of maternal health care using the optimal count regression model.MethodsA sample of 16,314 women of reproductive ages (15–49) was used. Andersen and Newman's behavioral model of health services utilization was employed for the selection of covariates. Poisson, negative binomial, zero-inflated Poisson, zero-inflated negative binomial (ZINB), Poisson hurdle, and negative binomial hurdle models were fitted and compared to identify the best model. Maternal health care utilization is found associated with maternal age and education, area of residence, domestic violence, the income level of family, access to media, knowledge about AIDS, parity, birth order, and having a child who later died.ResultsZINB model is found to be best fitted for the observed data resulting strong influence of mother's education and income level of the family on maternal health care utilization.ConclusionInterventions to improve maternal care services utilization should address individuals and systems to reduce social and economic marginalization.

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Depressive symptoms and health service utilization among Chinese middle aged and older adults: A national population-based longitudinal survey

10.21203/rs.3.rs-27279/v2 ◽

2020 ◽

Author(s):

Jing Guo ◽

Dexia Kong ◽

Liming Fang ◽

Anao Zhang ◽

Yingxue Zhu ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Health Service ◽

Health Services ◽

Service Utilization ◽

Health Service Utilization ◽

Health Services Utilization ◽

Middle Aged ◽

Cross Sectional ◽

Services Utilization

Abstract Objectives: This study aimed to 1) examine the cross-sectional and longitudinal relationships between depressive symptoms and health services utilization among Chinese middle-aged and older adults; and 2) evaluate whether there exists a rural-urban difference in such relationships. Methods: Data was obtained from China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015, a nationally representative survey of 13,551 adults aged 45 years and above in China. Results: Depressive symptoms were positively associated with a greater likelihood of outpatient and inpatient health services utilization. This association was consistent across rural and urban settings, indicating the robustness of such findings across geographic areas. Conclusions: Findings indicate that depressive symptoms are significantly associated with both in-patient and out-patient health service utilization among Chinese adults. Screening for depressive symptoms needs to be incorporated in these care settings in China.

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