Healthcare utilisation after discharge in patients admitted with gout in Western Australia

Abstract Objectives Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable. Understanding the drivers of health care costs in patients with gout will allow more targeted intervention. The objective was to examine factors associated with high health service utilisation and costs in patients admitted to hospital with gout. Methods Hospital and emergency department data was obtained for patients who had been admitted to hospital with a diagnosis of gout for the first time between 2002 and 2009. The total number, cost and potentially preventable events for the follow-up period was calculated for up to five years post the initial gout hospitalisation. The association between patient characteristics with health service utilisation and health care costs was examined using generalised linear models. Results The cohort included 4,379 individuals, that had 22,222 ED attendances (median cost: $1,826 per patient, IQR: $433 - $4,414), and 58,920 hospital admissions (median cost: $25,009 per patient, IQR: $6,844 - $60,535). Gout was not a primary driver of ED attendances or hospitalisations. A history of smoking and comorbidities including cardiovascular disease, diabetes and mental health disorders were associated with an increase health service utilisation and costs. Conclusion The presence of comorbidities play an important role the risk of health service utilization in people with gout and represents an opportunity to both improve the health-related outcomes for these patients and reduce re-presentations and associated health care costs for the health care system.

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POS1147 COSTS AND FACTORS AFFECTING HEALTH SERVICE UTILISATION IN PATIENTS WITH GOUT: A LONGITUDINAL, POPULATION-LEVEL LINKED DATA STUDY IN WESTERN AUSTRALIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4166 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 852.2-853

Author(s):

E. Kelty ◽

J. Nossent ◽

W. Raymond ◽

P. Robinson ◽

C. Hill ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Data Collection ◽

Health Service ◽

Health Care Costs ◽

Hospital Admissions ◽

Health Service Utilisation ◽

Service Utilisation ◽

Median Cost ◽

Care Costs

Background:Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable (1). Understanding the driver of health care costs will allow more targeted intervention.Objectives:To examine factors associated with high health service utilisation and cost in patients admitted to hospital with gout, using whole-population linked hospital, WA cancer registration, Emergency Department (ED) and death data (2).Methods:The study included patients (18 to 84 years) who had been admitted to hospital with a primary or co-diagnosis of gout for the first time between 1 Jan 02 and 31 Dec 09 Hospital costs were calculated per patient using DRG codes and ED costs were calculated from URG codes. Costs are presented in Australian dollars. Follow-up was completed at five years post their initial gout hospitalisation, at death, or at the 31th of December 2014. Both univariable and multivariable analysis was conducted for each patient characteristic. Independent variables were assessed for collinearity. Collinearity was assumed present where the correlation co-efficient was greater than 0.7.Results:4,379 individuals were included. In the following five years, there was 22,222 ED attendances (median cost, $1826 per patient (IQR: $433 - $4,414)), and 58,920 hospital admissions, (median cost, $25,009 per patient (IQR: $6,844 - $60,535)). 4,059 (18.3%) ED attendances and 3,834 (6.5%) hospital admissions were potentially preventable. Gout was not a major driver of events, with 341 (1.5%) ED attendances and 620 (1.1%) hospital admissions coded with a primary diagnosis of gout. In the univariable analysis (Table 1), Aboriginality and smoking were associated with an increased number of both ED attendances and hospital admissions. Increased socio-economic status was associated with a reduction in ED attendances, however, this was not reflected in hospital admissions.Conclusion:Patients admitted to hospital with gout are highly likely to be re-admitted or attend ED in the following 5 years. Many of these contacts are preventable, but are usually driven by comorbidities rather than gout.References:[1]Loh K, . Intern Med J. 2020 Mar;50(3):386.[2]https://www.datalinkage-wa.org.au.Acknowledgements:The authors wish to thank the staff at the Western Australian Data Linkage Branch and the Hospital Morbidity Data Collection, and the Death Registrations and the Emergency Department Data Collection.Disclosure of Interests:None declared.

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Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews

Australian Health Review ◽

10.1071/ah18108 ◽

2020 ◽

Vol 44 (1) ◽

pp. 132 ◽

Cited By ~ 1

Author(s):

Jamuna Parajuli ◽

Dell Horey

Keyword(s):

Health Care ◽

Health Service ◽

Health Services ◽

Systematic Reviews ◽

Health Professionals ◽

Health Service Utilisation ◽

Barriers And Facilitators ◽

Service Utilisation ◽

Knowledge And Skills ◽

Overview Of Systematic Reviews

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

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Health Care Costs Associated to Type of Feeding in the First Year of Life

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134719 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4719

Author(s):

Carolina Lechosa-Muñiz ◽

María Paz-Zulueta ◽

María Sáez de Adana Herrero ◽

Elsa Cornejo del Rio ◽

Sonia Mateo Sota ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Infectious Diseases ◽

Emergency Room ◽

Health Care Costs ◽

Medical Records ◽

Hospital Admissions ◽

First Year ◽

First Year Of Life ◽

Care Costs

Background: Breastfeeding is associated with lower risk of infectious diseases, leading to fewer hospital admissions and pediatrician consultations. It is cost saving for the health care system, however, it is not usually estimated from actual cohorts but via simulation studies. Methods: A cohort of 970 children was followed-up for twelve months. Data on mother characteristics, pregnancy, delivery and neonate characteristics were obtained from medical records. The type of neonate feeding at discharge, 2, 4, 6, 9 and 12 months of life was reported by the mothers. Infectious diseases diagnosed in the first year of life, hospital admissions, primary care and emergency room consultations and drug treatments were obtained from neonate medical records. Health care costs were attributed using public prices and All Patients Refined–Diagnosis Related Groups (APR–DRG) classification. Results: Health care costs in the first year of life were higher in children artificially fed than in those breastfed (1339.5€, 95% confidence interval (CI): 903.0–1775.0 for artificially fed vs. 443.5€, 95% CI: 193.7–694.0 for breastfed). The breakdown of costs also shows differences in primary care consultations (295.7€ for formula fed children vs. 197.9€ for breastfed children), emergency room consultations (260.1€ for artificially fed children vs. 196.2€ for breastfed children) and hospital admissions (791.6€ for artificially fed children vs. 86.9€ for breastfed children). Conclusions: Children artificially fed brought about more health care costs related to infectious diseases than those exclusively breastfed or mixed breastfed. Excess costs were caused in hospital admissions, primary care consultations, emergency room consultations and drug consumption.

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Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

Health Services Research ◽

10.1111/1475-6773.13096 ◽

2018 ◽

Vol 54 (2) ◽

pp. 337-345 ◽

Cited By ~ 7

Author(s):

Janessa M. Graves ◽

Jessica L. Mackelprang ◽

Megan Moore ◽

Demetrius A. Abshire ◽

Frederick P. Rivara ◽

...

Keyword(s):

Health Care ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Health Service ◽

Service Utilization ◽

Mild Traumatic Brain Injury ◽

Health Care Costs ◽

Health Service Utilization ◽

Care Costs

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Direct health care costs of hospital admissions due to adverse events in the Netherlands

European Journal of Public Health ◽

10.1093/eurpub/cku037 ◽

2014 ◽

Vol 24 (6) ◽

pp. 1028-1033 ◽

Cited By ~ 10

Author(s):

Fabienne J. H. Magdelijns ◽

Patricia M. Stassen ◽

Coen D. A. Stehouwer ◽

Evelien Pijpers

Keyword(s):

Health Care ◽

The Netherlands ◽

Adverse Events ◽

Health Care Costs ◽

Hospital Admissions ◽

Care Costs

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EX1 The Effects of Polypharmacy on Health Care Costs and Hospital Admissions in Thai Elderly Population: Multivariate Two-Part Models

Value in Health ◽

10.1016/j.jval.2012.08.038 ◽

2012 ◽

Vol 15 (7) ◽

pp. A607

Author(s):

R. Sruamsiri ◽

N. Jeanpeerapong ◽

K. Jampachaisri ◽

N. Chaiyakunapruk

Keyword(s):

Health Care ◽

Health Care Costs ◽

Elderly Population ◽

Hospital Admissions ◽

Care Costs

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Using Linked Data to Estimate the True Number of Individuals Impacted by Residential Fire

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1558 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Nargess Ghassempour ◽

Lara A Harvey ◽

W. Kathy Tannous

Keyword(s):

Emergency Department ◽

Health Service ◽

Health Services ◽

Hospital Admissions ◽

Population Based ◽

Health Service Utilisation ◽

Service Utilisation ◽

Residential Fire ◽

True Number ◽

Residential Fires

IntroductionResidential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian population-based surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call fire services, and studies from the US and New Zealand highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. Objectives and ApproachThis population-based study aimed to quantify the total number of residential fires, fire-related injuries and associated health service utilisation. The cohort included all persons residing at a residential address in New South Wales, Australia, which experienced a fire between 1 January 2005 - 31 December 2014. The cohort comprised linked person-level data from eight administrative datasets and includes information about nature of fire, first responder use (Fire and Rescue (FRNSW) and ambulance services), health service utilisation (emergency department, hospital and burns outpatient clinic) and health outcomes. ResultsOver the study period, FRNSW responded to 42,491 residential-fire incidents, involving 42,160 individuals with some individuals reporting multiple times. In total, 3,382 individuals used one or more health service and 154 individuals died. Of individuals who contacted FRNSW, 1,661 (3.9%) used health services;ambulance (n=1,101), emergency department (n=1,114), hospital admissions (n=168). There were 95 deaths. There were 1,721 (51%) additional individuals who used one or more health service as a result of a residential-fire that did not contact FRNSW and 59 additional deaths were identified. Conclusion / ImplicationsThis study found that more than half of individuals who used health services for residential fire-related injuries did not have an associated fire report, highlighting the importance of data linkage for accurate communication to policy makers and the public on the prevalence and impact of residential-fires.

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Health Care Costs attributable to Hospital-diagnosed Back Pain: A Longitudinal Register-based Study of the Danish Population

Journal of Health Economics and Outcomes Research ◽

10.36469/9872 ◽

2014 ◽

Vol 1 (3) ◽

pp. 266-275 ◽

Cited By ~ 1

Author(s):

Rikke Søgaard ◽

Jan Sørensen

Keyword(s):

Health Care ◽

Back Pain ◽

Health Care Costs ◽

Reference Values ◽

Service Use ◽

Hospital Admissions ◽

Chronic Back Pain ◽

Disease Stage ◽

Absolute Difference ◽

Care Costs

Background: Back pain is one of most frequent musculoskeletal conditions with enormous impact to health care systems and society. Analytical studies that guide the management of this disease are strongly needed, but there is a lack of cost estimates for the attributable cost of severe or chronic back pain in particular. Objective: The objective of this study was to estimate the health care costs attributable to hospitaldiagnosed back pain across strata of age-, gender- and diagnostic entity. Methods: All adult Danes (N=4.3 million) were included in this longitudinal, controlled register-based study. One-year prevalence was defined according to a previously published and validated algorithm, which was applied to the Danish national patient registry. Data from other relevant health service use registries was appended along with data from the national cause of death registry in order to calculate cost rates per life year (2011 price year). The attributable health care cost was defined as the absolute difference in cost rates between individuals with versus individuals without hospital-diagnosed back pain, whereas the ratio between the two groups was used for the reporting of reference values. Results: The health care costs attributable to hospital-diagnosed back pain were estimated at Danish Crowns (DKK) 22,700 per year for the youngest age strata (16-24 years) and increased up to DKK 72,700 per year for the oldest age strata of males (>85 years). Hospital admissions and outpatient visits accounted for the majority of these costs. The ratio of health care costs for individuals with versus individuals without the condition ranged from less than 1 to almost 6, depending on the type of service use, age and gender. Conclusion: At the disease stage where back pain leads to contact with specialised health care, diseased individuals appear to use on average three times more health care than non-diseased individuals. This study provides detailed reference values, which can be used to inform health economic models.

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Health Care Costs Associated with Ankylosing Spondylitis in Turkey: An Analysis from Nationwide Real-World Data

International Journal of Rheumatology ◽

10.1155/2013/139608 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Onur Baser ◽

Abdulkadir Burkan ◽

Erdem Baser ◽

Rasim Koselerli ◽

Emre Ertugay ◽

...

Keyword(s):

Health Care ◽

Ankylosing Spondylitis ◽

Health Care Costs ◽

Linear Models ◽

Office Visit ◽

Real World Data ◽

Treatment Type ◽

Comorbidity Scores ◽

Incident Cases ◽

Care Costs

Objectives. To explore health care costs associated with ankylosing spondylitis (AS) in Turkey.Methods. Research-identified data from a system that processes claims for all Turkish health insurance funds were analyzed. Adult prevalent and incident AS patients with two AS visits at least 60 days apart, identified between June 1, 2010 and December 31, 2010, with at least 1 year of continuous health plan enrollment for the baseline and follow-up years were included in the study. Pharmacy, outpatient, and inpatient claims were compiled over the study period for the selected patients. Generalized linear models were used to estimate the expected annual costs, controlling for baseline demographic and clinical characteristics.Results. A total of 2.986 patients were identified, of which 603 were incident cases and 2.383 prevalent cases. The mean ages were 39 and 41 years, respectively, and 44% and 38% were women for incident and prevalent cases. Prevalent patients had higher comorbidity scores (5.01 versus 2.24,P<0.001) and were more likely to be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) (77% versus 72%,P<0.001) or biologics (35% versus 8%,P<0.006) relative to incident patients. Seventy-seven percent of prevalent patients were prescribed NSAIDs, followed by biologic and disease-modifying antirheumatic drugs (DMARDs). Total annual medical costs for incident AS patients were €2.253 and €4.233 for prevalent patients. Pharmacy costs accounted for a significant portion of total costs (88% for prevalent patient, 77% for incident patient), followed by physician office visit costs. Prior comorbidities and treatment type also significantly contributed to overall costs.Conclusion. Annual expenditures for AS patients in Turkey were comparable relative to European countries. Pharmaceutical expenditures cover a significant portion of the overall costs. Comparative effectiveness studies are necessary to further decrease health care costs of AS treatment.

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