Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study

Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This study aimed to analyse the association of continuity of GP care with utilisation of general practitioner and specialist services in China. Method: A cross-sectional mixed methods study was conducted in 10 urban communities in Hangzhou. Quantitative data were collected from a random sample of 624 residents adopting the self-developed questionnaire. Measurement of continuity of GP care included informational continuity (IC), managerial continuity (MC) and relational continuity (RC). With adjustment for characteristics of residents, multivariate regression models were established to examine the association of continuity of GP care with the intention to visit GP, frequency of GP and specialist visitations. Qualitative data were collected from 26 respondents using an in-depth interview, and thematic content analysis for qualitative data was conducted. Results: Quantitative analysis showed that the IC was positively associated with the intention to visit GP and frequency of GP visitations. Those people who gave a high rating for RC also used GP services more frequently than their counterparts. MC was negatively associated with frequency of specialist visitations. Qualitative analysis indicated that service capabilities, doctor–patient interaction and time provision were regarded as three important reasons why patients chose GPs or specialists. Conclusions: Overall, high IC and RC are independently associated with more GP service utilisation, but a high MC might reduce specialist visitations. Continuity of GP care should be highlighted in designing a Chinese GP system.

Download Full-text

Socio-Economic Status and Visits to Physicians by Adults in Ontario, Canada

Journal of Health Services Research & Policy ◽

10.1177/135581969700200207 ◽

1997 ◽

Vol 2 (2) ◽

pp. 94-102 ◽

Cited By ~ 33

Author(s):

Warren McLsaac ◽

Vivek Goel ◽

David Naylor

Keyword(s):

General Practitioner ◽

Medical Care ◽

Economic Status ◽

Population Based ◽

Cross Sectional ◽

Socio Economic Status ◽

Specialist Services ◽

Sectional Analysis ◽

Universal Health ◽

Population Based Survey

Objectives: To examine the association between socio-economic status, need for medical care and visits to physicians in a universal health insurance system. Methods: Cross-sectional analysis of the 1990 Ontario Health Survey, a population-based survey utilizing a multistage, randomized cluster sample. The analysis considered only those respondents who were 16 years of age or older from the province of Ontario, Canada: 21 272 males and 24 738 females. Results: There was no difference by education or income in persons having made at least one visit to a general practitioner in the previous year. High income persons were less likely to have made six or more visits to a general practitioner — odds ratio (OR) = 0.67, 95% CI = 0.52, 0.87 for men; OR = 0.66, 95% CI = 0.58, 0.75 for women — but more likely to have made at least one visit to a specialist — OR = 1.42, 95% CI = 1.15, 1.76 for men; OR = 1.25, 95% CI = 1.07, 1.45 for women. A person's need for medical care was the most important determinant of a physician visit. Conclusions: Self-reported visits to general practitioners in Canada are strongly influenced by a person's need for medical care and are appropriately related to socio-economic status. However, there is a residual association between higher socio-economic levels and greater use of specialist services.

Download Full-text

Perceived Overprotection and Its Association With Quality of Life in Dementia

GeroPsych ◽

10.1024/1662-9647/a000207 ◽

2019 ◽

Vol 32 (3) ◽

pp. 125-134

Author(s):

Mechthild Niemann-Mirmehdi ◽

Andreas Häusler ◽

Paul Gellert ◽

Johanna Nordheim

Keyword(s):

Quality Of Life ◽

Patient Autonomy ◽

Positive Association ◽

Well Being ◽

Negative Association ◽

Significant Positive Association ◽

Cross Sectional ◽

People With Dementia ◽

Mental Well Being

Abstract. To date, few studies have focused on perceived overprotection from the perspective of people with dementia (PwD). In the present examination, the association of perceived overprotection in PwD is examined as an autonomy-restricting factor and thus negative for their mental well-being. Cross-sectional data from the prospective DYADEM study of 82 patient/partner dyads (mean age = 74.26) were used to investigate the association between overprotection, perceived stress, depression, and quality of life (QoL). The analyses show that an overprotective contact style with PwD has a significant positive association with stress and depression, and has a negative association with QoL. The results emphasize the importance of avoiding an overprotective care style and supporting patient autonomy.

Download Full-text

Product Brand Loyalty and Purchase Decision

International Journal of Entrepreneurial Research ◽

10.31580/ijer.v3i3.1504 ◽

2020 ◽

Vol 3 (3) ◽

pp. 76-87

Author(s):

Muhammad Naeem ◽

Abdul Sami

Keyword(s):

Brand Loyalty ◽

Quantitative Research ◽

Research Study ◽

Positive Association ◽

Perceived Quality ◽

Purchase Decision ◽

Cross Sectional ◽

Business World ◽

Multiple Variables ◽

The Relationship

The present study was an examination of the relationship between product brand loyalty and purchase decision of automotive customers. The study focused on comparative analysis of two famous brands of automobile i-e Honda City and Toyota Corolla Xli and the various effects of product brand loyalty on purchase decision of automotive customers. A cross sectional quantitative research design was employed in the research study. In today’s competitive business world, now most of the marketers and manufacturers of various brands have encountered with multiple variables through which they can not only influence the purchase decision of their customers but also secure their buying preferences. The variables that are used and relevant to this study are product brand loyalty, perceived quality, price, and purchase decision. During examination of the relationship between these variables, study investigated that there is a positive association between product brand loyalty, product perceived quality, price and purchase decision.

Download Full-text

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

British Journal of General Practice ◽

10.3399/bjgp18x697349 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697349

Author(s):

Anna Lalonde ◽

Emma Teasdale ◽

Ingrid Muller ◽

Joanne Chalmers ◽

Peter Smart ◽

...

Keyword(s):

Mixed Methods ◽

Information Needs ◽

Qualitative Data ◽

Information Provision ◽

Mixed Methods Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Face To Face ◽

Patient Information Needs ◽

History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

Download Full-text

Association between Blood Pressure and Serum Thyroid-Stimulating Hormone Concentration within the Reference Range: A Population-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-2208 ◽

2007 ◽

Vol 92 (3) ◽

pp. 841-845 ◽

Cited By ~ 119

Author(s):

Bjørn O. Åsvold ◽

Trine Bjøro ◽

Tom I. L. Nilsen ◽

Lars J. Vatten

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Outcome Measures ◽

Odds Ratio ◽

Reference Range ◽

Positive Association ◽

Population Based ◽

Thyroid Stimulating Hormone ◽

Cross Sectional ◽

Population Based Study

Abstract Context: The association between thyroid function and blood pressure is insufficiently studied. Objective: The objective of the investigation was to study the association between TSH within the reference range and blood pressure. Design and Setting: This was a cross-sectional, population-based study. Subjects: A total of 30,728 individuals without previously known thyroid disease were studied. Main Outcome Measures: The main outcome measures were mean systolic and diastolic blood pressure and pulse pressure and odds ratio for hypertension (>140/90 mm Hg or current or previous use of antihypertensive medication), according to categories of TSH. Results: Within the reference range of TSH (0.50–3.5 mU/liter), there was a linear increase in blood pressure with increasing TSH. The average increase in systolic blood pressure was 2.0 mm Hg [95% confidence interval (CI) 1.4–2.6 mm Hg] per milliunit per liter increase in TSH among men, and 1.8 mm Hg (95% CI 1.4–2.3 mm Hg) in women. The corresponding increase in diastolic blood pressure was 1.6 mm Hg (95% CI 1.2–2.0 mm Hg) in men and 1.1 mm Hg (95% CI 0.8–1.3 mm Hg) in women. Comparing TSH of 3.0–3.5 mU/liter (upper part of the reference) with TSH of 0.50–0.99 mU/liter (lower part of the reference), the odds ratio for hypertension was 1.98 (95% CI 1.56–2.53) in men and 1.23 (95% CI 1.04–1.46) in women. Conclusion: Within the reference range of TSH, we found a linear positive association between TSH and systolic and diastolic blood pressure that may have long-term implications for cardiovascular health.

Download Full-text

Social media engagement, service complexity, and experiential quality in US hospitals

Journal of Services Marketing ◽

10.1108/jsm-09-2019-0359 ◽

2020 ◽

Vol 34 (6) ◽

pp. 833-845 ◽

Cited By ~ 1

Author(s):

Youngsu Lee ◽

Joonhwan In ◽

Seung Jun Lee

Keyword(s):

Social Media ◽

Demographic Data ◽

Positive Association ◽

Customer Engagement ◽

Service Firms ◽

Multiple Sources ◽

Cross Sectional ◽

Content Type ◽

Social Media Engagement ◽

Experiential Quality

Purpose As social media platforms become increasingly popular among service firms, many US hospitals have been using social media as a means to improve their patients’ experiences. However, little research has explored the implications of social media use within a hospital context. The purpose of this paper is to investigate a hospital’s customer engagement through social media and its association with customers’ experiential quality. Also, this study examines the role of a hospital’s service characteristics, which could shape the nature of the interactions between patients and the hospital. Design/methodology/approach Data from 669 hospitals with complete experiential quality and demographic data were collected from multiple sources of secondary data, including the rankings of social media friendly hospitals, the Hospital Compare database, the Center for Medicare and Medicaid (CMS) cost report, the CMS impact file, the Healthcare Information and Management Systems Society Analytics database and the Dartmouth Atlas of Health Care. Specifically, the authors designed the instrumental variable estimate to address the endogeneity issue. Findings The empirical results suggest a positive association between a hospital’s social media engagement and experiential quality. For hospitals with a high level of service sophistication, the association between online engagement and experiential quality becomes more salient. For hospitals offering various services, offline engagement is a critical predictor of experiential quality. Research limitations/implications A hospital with more complex services should make efforts to engage customers through social media for better patient experiences. The sample is selected from databases in the US, and the databases are cross-sectional in nature. Practical implications Not all hospitals may be better off improving the patient experience by engaging customers through social media. Therefore, practitioners should exercise caution in applying the study’s results to other contexts and in making causal inferences. Originality/value The current study delineates customer engagement through social media into online and offline customer engagement. This study is based on the theory of customer engagement and reflects the development of mobile technology. Moreover, this research may be considered as pioneering in that it considers the key characteristics of a hospital’s service operations (i.e., service complexity) when discovering the link between customers’ engagement through a hospital’s social media and experiential quality.

Download Full-text

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

BMJ Open ◽

10.1136/bmjopen-2020-045992 ◽

2021 ◽

Vol 11 (5) ◽

pp. e045992

Author(s):

Eugene Budu ◽

Bright Opoku Ahinkorah ◽

Richard Gyan Aboagye ◽

Ebenezer Kwesi Armah-Ansah ◽

Abdul-Aziz Seidu ◽

...

Keyword(s):

Healthcare Utilisation ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Childhood Vaccination ◽

Outcome Variable ◽

Service Utilisation ◽

Sectional Study ◽

Maternal Healthcare ◽

Cross Sectional ◽

Sub Saharan

ObjectiveThe objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.DesignOur study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa.ParticipantsA total of 60 964 mothers of children aged 11–23 months were included in the study.Outcome variablesThe main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC).ResultsThe average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended.ConclusionThe study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.

Download Full-text

The Relationships Between Serum DHEA-S and AMH Levels in Infertile Women: A Retrospective Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm10061211 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1211

Author(s):

Li-Te Lin ◽

Kuan-Hao Tsui

Keyword(s):

Generalized Linear Models ◽

Large Scale ◽

Linear Models ◽

Positive Association ◽

Cross Sectional Study ◽

Dehydroepiandrosterone Sulphate ◽

Sectional Study ◽

Cross Sectional ◽

Infertile Women ◽

The Relationship

The relationship between serum dehydroepiandrosterone sulphate (DHEA-S) and anti-Mullerian hormone (AMH) levels has not been fully established. Therefore, we performed a large-scale cross-sectional study to investigate the association between serum DHEA-S and AMH levels. The study included a total of 2155 infertile women aged 20 to 46 years who were divided into four quartile groups (Q1 to Q4) based on serum DHEA-S levels. We found that there was a weak positive association between serum DHEA-S and AMH levels in infertile women (r = 0.190, p < 0.001). After adjusting for potential confounders, serum DHEA-S levels positively correlated with serum AMH levels in infertile women (β = 0.103, p < 0.001). Infertile women in the highest DHEA-S quartile category (Q4) showed significantly higher serum AMH levels (p < 0.001) compared with women in the lowest DHEA-S quartile category (Q1). The serum AMH levels significantly increased across increasing DHEA-S quartile categories in infertile women (p = 0.014) using generalized linear models after adjustment for potential confounders. Our data show that serum DHEA-S levels are positively associated with serum AMH levels.

Download Full-text

Fatigue among Long-Term Breast Cancer Survivors: A Controlled Cross-Sectional Study

Cancers ◽

10.3390/cancers13061301 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1301

Author(s):

Saskia W. M. C. Maass ◽

Daan Brandenbarg ◽

Liselotte M. Boerman ◽

Peter F. M. Verhaak ◽

Geertruida H. de Bock ◽

...

Keyword(s):

Breast Cancer ◽

Logistic Regression ◽

General Practitioner ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Breast Cancer Diagnosis ◽

Reference Population ◽

Cross Sectional ◽

Symptoms Of Depression

Background: Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, long-term prevalence of fatigue, among breast cancer survivors, needs further investigation. Aim: To compare fatigue experienced by long-term breast cancer survivors with that in a reference population and to evaluate the determinants of that fatigue. Design and Setting: A cross-sectional cohort study of 350 breast cancer survivors ≥5 years after diagnosis and a reference population of 350 women matched by age and general practitioner. Method: Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and for cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors. Results: Breast cancer survivors (median 10 years after diagnosis), more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 [95%CI, 1.4–2.9]), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 [95%CI, 7.1–40.5]) or anxiety (41.9% versus 10.1%; OR, 6.4 [95%CI, 3.6–11.4]). Conclusion: One in four breast cancer survivors experience multidimensional fatigue and fatigue occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.

Download Full-text

SAT0450 GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A MULTIVARIATE LINEAR REGRESSION ANALYSIS IDENTIFYING PREDICTIVE FACTORS FOR LOW BONE MASS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4427 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1182.2-1182

Author(s):

E. Wiebe ◽

D. Freier ◽

D. Huscher ◽

R. Biesen ◽

S. Hermann ◽

...

Keyword(s):

Bone Mass ◽

Rheumatic Diseases ◽

Positive Association ◽

Fragility Fractures ◽

Life Time ◽

Inflammatory Rheumatic Diseases ◽

Low Bone Mass ◽

Cross Sectional ◽

Chronic Inflammatory Rheumatic Diseases ◽

Prevalence Of Osteoporosis

Background:Rheumatic diseases are associated with increased systemic bone loss and fracture risk related to chronic inflammation, disease-specific, general and demographic risk factors as well as treatment with glucocorticoids (GC). Yet, there is evidence that GCs may, by adequately suppressing systemic inflammation, also have a positive effect on bone mineral density (BMD) and fracture risk1.Objectives:The purpose of this study was to investigate the prevalence of osteoporosis and fragility fractures in patients with inflammatory rheumatic diseases and to analyze the impact that treatment with GCs, other known risk factors and preventive measures have on bone health in these patients.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic inflammatory rheumatic diseases and psoriasis treated with GCs. In this cross-sectional analysis, we evaluated the initial visit of 1091 patients. A multivariate linear regression model with known or potentially influential factors adjusted for age and sex was used to identify predictors of BMD as measured by dual-energy X-ray absorptiometry (DXA). Multiple imputation was applied for missing baseline covariate data.Results:In the total cohort of 1091 patients (75% female of which 87.5% were postmenopausal) with a mean age of 62.1 (±13.2) years, the prevalence of osteoporosis by DXA was 21.7%, while fragility fractures have occurred in 31.2% of the study population (6.7% vertebral, 27.7% non-vertebral). Current GC therapy was common (64.9%), with a median daily dose of 5.0mg [0.0;7.5], a mean life-time total GC dose of 17.7g (±24.6), and a mean GC therapy duration of 7.8 years (±8.5). Bisphosphonates were the most commonly used anti-osteoporotic drug (12.6%).Multivariate analysis showed that BMD as expressed by the minimum T-Score at all measured sites was negatively associated with higher age, female sex and menopause as well as Denosumab and Bisphosphonate treatment. A positive association with BMD was found for body mass index as well as current and life-time (cumulative) GC dose. While comedication with proton-pump-inhibitors significantly predicted low bone mass, concomitant use of non-steroidal anti-inflammatory drugs showed a positive association with BMD. Of the measured bone-specific laboratory parameters, higher alkaline phosphatase levels were determinants of low DXA-values, while the association was positive for gamma-glutamyltransferase.BMD was neither predicted by duration of GC treatment nor by treatment with disease modifying anti-rheumatic drugs.Predictive variables for BMD differed at the respective anatomical site. While treatment with Denosumab predicted low bone mass at the lumbar spine and not at the femoral neck, the opposite was true for health assessment questionnaire (HAQ) score. Current and life-time GC-dose as well as direct sun-exposure of more than 30 minutes daily were positively associated with bone mass at the femoral sites only.Conclusion:This cross-sectional analysis of a prospective cohort study quantified the prevalence of osteoporosis and identified predictive variables of BMD in patients with rheumatic diseases.Multivariate analyses corroborated low BMD to be predicted by traditional factors like age, female sex and menopause but showed current and well as life-time GC dose to be positively associated with BMD in our cohort of patients with chronic inflammatory rheumatic diseases. This suggests that optimal management of disease activity with GCs might be beneficial in order to avoid bone loss due to inflammation.References:[1]Güler-Yüksel et al. “Glucocorticoids, Inflammation and Bone.” Calcified Tissue International (January 08 2018).Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

Download Full-text