The Impact of Pharmaceutical Home Care on Medical Utilization for Frequent Users of Outpatient Services in Taiwan

Due to the high-accessibility and low-copayment of healthcare system in Taiwan, the clinical visit frequency of people is relatively high, which often leads to an excessively high healthcare expenditure. The aim of this research was to explore the effectiveness of pharmaceutical home care for frequent users of outpatient service and to analyze the impact of pharmaceutical home care on medical utilization. The study was based on the Taiwan National Health Insurance Research Database. Patients with over 100 clinical visits during 2010 to 2012 were selected as subjects. Whether these patients participate the experimental plan of pharmaceutical home care in the following year and the medical utilization of the research subjects were analyzed to compare the difference between participating group and non-participating group in this plan. The generalized estimating equation was employed to examine the difference of medical utilization. A total of 3943 subjects were included in this study, including 591 patients (14.99%) participating in the experimental plan. The average number of physician visits during the following year of the participating group was higher than that of the non-participating group by 0.12 visits, and the outpatient medical expense was lower than the non-participating group by 18,302 points (1 point = 0.03 US dollars). After participating in the plan, the average number of clinical visits of frequent users of outpatient services was significantly reduced by 6.63 visits, and the outpatient expense was significantly decreased by 9871 points. After joining the experimental plan of pharmaceutical home care, the average number of outpatient visits decreased significantly and the medical expense was lower when compared with those who did not participate in the plan.

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The Impact of the COVID-19 Pandemic on Physician Visits in Japan

Frontiers in Public Health ◽

10.3389/fpubh.2021.743371 ◽

2021 ◽

Vol 9 ◽

Author(s):

Narimasa Kumagai

Keyword(s):

Preschool Children ◽

Fixed Effects ◽

Social Insurance ◽

Smooth Transition ◽

Financial Strain ◽

Outpatient Services ◽

State Of Emergency ◽

Physician Visits ◽

Compensation Program ◽

The Impact

Background: Emerging from the coronavirus disease 2019 (COVID-19) scenario, fears of social distancing and contagion have led to a decline in the number of physician visits in Japan, placing severe financial strain on most hospitals and clinics. In this context, this study examined the impact of the spread of COVID-19 on the utilization of outpatient services.Methods: This study used monthly data drawn from the monthly statistics report of the social insurance medical fee payment fund in Japan and estimated fixed-effects models.Results: The results showed that the decline in the number of physician visits because of the first state of emergency declaration in Japan was greater than that caused by COVID-19's spread during the same period. However, there was a decline in the impact of the declaration over time. After the second state of emergency declaration, the decline in the number of physician visits caused by the spread reduced by almost half. The nationwide preschool closure under the declaration of the first state of emergency also adversely impacted the number of physician visits. The reduced healthcare per capita costs of preschool children were greater among prefectures taking specific precautions. The results showed non-negligible regional differences in physician visits of preschool children during the sample period.Conclusions: The findings imply that we should not overestimate the negative impacts of the state of emergency declaration without lockdown on physician visits. To restore the number of physician visits to its pre-pandemic level, it is crucial to facilitate a smooth transition of COVID-19 patients between hospitals and an effective compensation program for hospitals with COVID-19 patients.

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Preventive activity and national health insurance among Taiwan’s elderly people

The Singapore Economic Review ◽

10.1142/s0217590820500228 ◽

2020 ◽

pp. 1-32

Author(s):

Chun-Wei Lin ◽

Chi-Chuan Lee ◽

Chien-Chiang Lee

Keyword(s):

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Probit Model ◽

Preventive Behavior ◽

Outpatient Services ◽

Preventive Behaviors ◽

Education Levels ◽

The Difference ◽

The Impact

In this paper, we evaluate the preventive behaviors for middle age people in Taiwan through survey wave comparisons for the period 1993–2007. We first investigate the determinants of preventive behavior and how their effects change over time by using the seemingly unrelated bivariate probit model. Evidence shows that income and education levels do have a significantly positive relation with preventive behavior models, while reported poor health, inpatient and outpatient services, and regions are essential determinants of preventive behaviors. Then, we investigate the impact of Taiwan’s National Health Insurance (NHI) on preventive behaviors based on the difference-in-difference (DID) analysis. The results show a lack of evidence for the moral hazard effect on preventive care and regular exercise panels over the period 1993–2007.

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Sex Difference in the Risk of Dementia in Patients with Atrial Fibrillation

Diagnostics ◽

10.3390/diagnostics11050760 ◽

2021 ◽

Vol 11 (5) ◽

pp. 760

Author(s):

Yung-Lung Chen ◽

Joseph Chen ◽

Hui-Ting Wang ◽

Ya-Ting Chang ◽

Shaur-Zheng Chong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Heart Surgery ◽

Demographic Data ◽

Research Database ◽

Female Sex ◽

Diagnosis Of Dementia ◽

The Difference ◽

New Diagnosis ◽

The Impact

Atrial fibrillation (AF) is one of the risk factors for dementia. Female sex is an inconsistent risk factor for dementia after adjusting for age in the general population, and there lacks research on its impact in developing dementia in patients with AF. This paper aims to investigate whether female sex is a risk factor for dementia in AF patients. Data of patients with newly diagnosed AF between 2001–2013 were retrieved from Taiwan’s National Health Insurance Research Database. Exclusion criteria were: patients with incomplete demographic data, age < 20 years, rheumatic heart disease, hyperthyroidism, past valvular heart surgery, and a history of dementia. Propensity score matching (PSM) between sexes was performed, including comorbidities, medications and index date stratified by age. The primary outcome was a new diagnosis of dementia at follow-up. A total of 117,517 men and 156,705 women were eligible for analysis. After 1:1 PSM, both 100,065 men and women (aged 72.5 ± 12.5 years) were included for analysis. Dementia risk varied with age in women compared with men. The difference was negligible for ≤55 years (sub distribution HR (SHR) = 0.89, 95% CI 0.73–1.07), but increased between 56–65 years (SHR = 1.13, 95% CI 1.02–1.25), 66–75 years (SHR = 1.14, 95% CI 1.09–1.20), 75–85 years (SHR = 1.11, 95% CI 1.07–1.15) and >85 years (SHR 1.10, 95% CI 1.04–1.16) for females. This study establishes that female sex increases the risk of developing dementia compared to male sex in AF patients aged >56 years. However, the impact of female sex on dementia in AF patients differs between dementia types.

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Association of Anxiety and Depression with Reported Disease Severity in Patients Undergoing Evaluation for Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940711600703 ◽

2007 ◽

Vol 116 (7) ◽

pp. 491-497 ◽

Cited By ~ 48

Author(s):

Ajay Wasan ◽

Ephrem Fernandez ◽

Robert N. Jamison ◽

Neil Bhattacharyya

Keyword(s):

Chronic Rhinosinusitis ◽

Resource Utilization ◽

Psychiatric Comorbidity ◽

Depression Scale ◽

Medical Utilization ◽

Anxiety And Depression ◽

High Anxiety ◽

Physician Visits ◽

Anxiety Levels ◽

The Impact

Objectives: We sought to determine the impact of psychiatric comorbidity on symptom density and resource utilization in chronic rhinosinusitis (CRS). Methods: A prospective cohort of patients who sought evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed to determine the interactions among psychiatric comorbidity, symptom reporting, and resource utilization in CRS. Results: We studied 143 patients (mean age, 43.4 years). Low, moderate, and high levels of anxiety were reported by 48.3%, 25.9%, and 25.9% of patients, respectively. Low, moderate, and high levels of depression were reported by 76.2%, 9.1%, and 14.7%. For the combined psychopathology group, 43.3%, 25.9%, and 30% had low, moderate, and high levels. Patients with high anxiety levels reported significant elevations of oropharyngeal symptoms (p = .013) and total symptoms (p = .030) in comparison with the low group. Patients with high depression levels reported higher oropharyngeal (p = .003), systemic (p = .001), and total symptom (p = .003) scores than did the low group. High combined psychopathology scores were associated with elevated facial, oropharyngeal, and systemic scores (p < .05). Regarding medical utilization, high anxiety levels or high combined psychopathology scores were associated with more frequent physician visits (p < .05). A high level of depression was associated with increased antibiotic use, missed workdays, and physician visits (p < .05). Conclusions: High levels of anxiety and depression are common in patients who undergo evaluation for CRS. Psychiatric comorbidity is associated with increased symptoms in CRS and increased health-care utilization. Anxiety and depression should be identified in these patients to structure appropriate treatment.

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Evaluation of the impact of public investment programs on social and economic performance of territories

Voprosy Ekonomiki ◽

10.32609/0042-8736-2019-1-109-123 ◽

2019 ◽

pp. 109-123

Author(s):

I. E. Limonov ◽

M. V. Nesena

Keyword(s):

Bayesian Modeling ◽

Positive Impact ◽

Public Investment ◽

Difference In Differences ◽

The Public ◽

Export Activity ◽

Regional Investment ◽

The Difference ◽

The Impact ◽

Development Institution

The purpose of this study is to evaluate the impact of public investment programs on the socio-economic development of territories. As a case, the federal target programs for the development of regions and investment programs of the financial development institution — Vnesheconombank, designed to solve the problems of regional development are considered. The impact of the public interventions were evaluated by the “difference in differences” method using Bayesian modeling. The results of the evaluation suggest the positive impact of federal target programs on the total factor productivity of regions and on innovation; and that regional investment programs of Vnesheconombank are improving the export activity. All of the investments considered are likely to have contributed to the reduction of unemployment, but their implementation has been accompanied by an increase in social inequality.

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The Use of Multimedia and its Impact on Bangladeshi EFL Learners at Tertiary Level

International Journal of Language Education ◽

10.26858/ijole.v4i2.12150 ◽

2020 ◽

Vol 4 (2) ◽

pp. 150

Author(s):

Farzana Sharmin Pamela Islam

Keyword(s):

Language Learning ◽

Academic Writing ◽

Teaching And Learning ◽

English Language ◽

Capital City ◽

Tertiary Level ◽

Language Classroom ◽

The Difference ◽

The Government ◽

The Impact

As 21st century is the era of modern technologies with different aspects, it offers us to make the best use of them. After tape recorder and overhead projector (OHP), multimedia has become an important part of language classroom facilities for its unique and effective application in delivering and learning lesson. Although in many parts of Bangladesh, a South Asian developing country, where English enjoys the status of a foreign language, the use of multimedia in teaching and learning is viewed as a matter of luxury. However, nowadays the usefulness and the necessity of it are well recognized by the academics as well as the government. The study aims to focus on the difference between a traditional classroom void of multimedia and multimedia equipped classrooms at university level by explaining how multimedia support the students with enhanced opportunity to interact with diverse texts that give them more in-depth comprehension of the subject. It also focuses on audio-visual advantage of multimedia on the students’ English language learning. The study has followed a qualitative method to get an in-depth understanding of the impact of using multimedia in an English language classroom at tertiary level. For this purpose, the data have been collected from two different sources. Firstly, from students’ written response to an open ended question as to their comparative experience of learning lessons with and without multimedia facilities; and secondly, through observation of English language classes at a private university of Dhaka, the capital city of Bangladesh. The discussion of the study is limited to the use of multimedia in English language classroom using cartoons, images and music with a view to enhance students’ skills in academic writing, critical analysis of image and critical appreciation of music. For this purpose, cartoons in English language, images from Google and music from You Tube have got focused discussion in this paper.

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Case study: Prediction and field tests of railway noise and effects of a low-height noise barrier

Noise Control Engineering Journal ◽

10.3397/1/376826 ◽

2020 ◽

Vol 68 (4) ◽

pp. 303-314

Author(s):

Yuna Park ◽

Hyo-In Koh ◽

University of Science and Technology, Transpo ◽

...

Keyword(s):

High Speed ◽

Field Tests ◽

Residential Areas ◽

Railway Systems ◽

Railway Noise ◽

Sound Levels ◽

Noise Barrier ◽

The Difference ◽

Reduction Effect ◽

The Impact

Railway noise is calculated to predict the impact of new or reconstructed railway tracks on nearby residential areas. The results are used to prepare adequate counter- measures, and the calculation results are directly related to the cost of the action plans. The calculated values were used to produce noise maps for each area of inter- est. The Schall 03 2012 is one of the most frequently used methods for the production of noise maps. The latest version was released in 2012 and uses various input para- meters associated with the latest rail vehicles and track systems in Germany. This version has not been sufficiently used in South Korea, and there is a lack of standard guidelines and a precise manual for Korean railway systems. Thus, it is not clear what input parameters will match specific local cases. This study investigates the modeling procedure for Korean railway systems and the differences between calcu- lated railway sound levels and measured values obtained using the Schall 03 2012 model. Depending on the location of sound receivers, the difference between the cal- culated and measured values was within approximately 4 dB for various train types. In the case of high-speed trains, the value was approximately 7 dB. A noise-reducing measure was also modeled. The noise reduction effect of a low-height noise barrier system was predicted and evaluated for operating railway sites within the frame- work of a national research project in Korea. The comparison of calculated and measured values showed differences within 2.5 dB.

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Soil Moisture Dynamics in Response to Precipitation and Thinning in a Semi-Dry Forest in Northern Mexico

Water ◽

10.3390/w13010105 ◽

2021 ◽

Vol 13 (1) ◽

pp. 105

Author(s):

Argelia E. Rascón-Ramos ◽

Martín Martínez-Salvador ◽

Gabriel Sosa-Pérez ◽

Federico Villarreal-Guerrero ◽

Alfredo Pinedo-Alvarez ◽

...

Keyword(s):

Soil Moisture ◽

Forest Management ◽

Water Availability ◽

Dry Forest ◽

Rainfall Events ◽

Rainfall Characteristics ◽

Northern Mexico ◽

The Difference ◽

The Impact ◽

Moisture Dynamics

Understanding soil moisture behavior in semi-dry forests is essential for evaluating the impact of forest management on water availability. The objective of the study was to analyze soil moisture based in storm observations in three micro-catchments (0.19, 0.20, and 0.27 ha) with similar tree densities, and subject to different thinning intensities in a semi-dry forest in Chihuahua, Mexico. Vegetation, soil characteristics, precipitation, and volumetric water content were measured before thinning (2018), and after 0%, 40%, and 80% thinning for each micro-catchment (2019). Soil moisture was low and relatively similar among the three micro-catchments in 2018 (mean = 8.5%), and only large rainfall events (>30 mm) increased soil moisture significantly (29–52%). After thinning, soil moisture was higher and significantly different among the micro-catchments only during small rainfall events (<10 mm), while a difference was not noted during large events. The difference before–after during small rainfall events was not significant for the control (0% thinning); whereas 40% and 80% thinning increased soil moisture significantly by 40% and 53%, respectively. Knowledge of the response of soil moisture as a result of thinning and rainfall characteristics has important implications, especially for evaluating the impact of forest management on water availability.

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216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.260 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S110-S110

Author(s):

Christina Maguire ◽

Dusten T Rose ◽

Theresa Jaso

Keyword(s):

Urinary Tract ◽

Antimicrobial Therapy ◽

Source Control ◽

Clostridioides Difficile ◽

Days Of Therapy ◽

Before And After ◽

The Difference ◽

Tract Infections ◽

Length Of Therapy ◽

The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

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Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

Vascular and Endovascular Surgery ◽

10.1177/15385744211023281 ◽

2021 ◽

pp. 153857442110232

Author(s):

Spyridon N. Mylonas ◽

Konstantinos G. Moulakakis ◽

Nikolaos Kadoglou ◽

Constantinos Antonopoulos ◽

Thomas E. Kotsis ◽

...

Keyword(s):

Arterial Stiffness ◽

Surgical Repair ◽

Open Repair ◽

Abdominal Aortic ◽

Gender And Age ◽

Baseline Values ◽

The Difference ◽

The Impact ◽

Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

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