Retrospective analysis of North West London healthcare utilisation by children during the COVID-19 pandemic

ObjectiveTo explore the impact of the measures taken to combat COVID-19 on the patterns of acute illness in children presenting to primary and secondary care for North West London.Design/setting/participantsRetrospective analysis of 8 309 358 primary and secondary healthcare episodes of children <16 years registered with a North West London primary care practice between 2015 and 2021.Main outcome measuresNumbers of primary care consultations, emergency department (ED) attendances and emergency admissions during the pandemic were compared with those in the preceding 5 years. Trends were examined by age and for International Statistical Classification of Diseases and Related Health Problems 10th Revision-coded diagnoses of: infectious diseases, and injuries and poisonings for admitted children.ResultsComparing 2020 to the 2015–2019 mean, primary care consultations were 22% lower, ED attendances were 38% lower and admissions 35% lower. Following the first national lockdown in April 2020, primary care consultations were 39% lower compared with the April 2015–2019 mean, ED attendances were 72% lower and unscheduled hospital admissions were 63% lower. Admissions >48 hours were on average 13% lower overall during 2020, and 36% lower during April 2020. The reduction in admissions for infections (61% lower than 2015–2019 mean) between April and August 2020 was greater than for injuries (31% lower).ConclusionThe COVID-19 pandemic was associated with an overall reduction in childhood illness presentations to health services in North West London, most prominent during periods of national lockdown, and with a greater impact on infections than injuries. These reductions demonstrate the impact on children of measures taken to combat COVID-19 across the health system.

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Introduction: Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as “gate-keepers” to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. Methods: Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. Results: Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. Conclusion: Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs. Keywords: Emergency medicine, healthcare use, oncology, palliative care, unplanned cancer admission

Predictors of Healthcare-Seeking Behaviour, Health Services Access and Utilization in Ajebo Community, South-West, Nigeria

Background: Health is a fundamental requirement for living a socially and economically productive life. Poor health inflicts great hardships on households, including debilitation, substantial monetary expenditures, loss of productivity and sometimes, death. Objectives: To describe healthcare-seeking behaviour, access to health services and utilisation, and their predictors in a southwestern Nigerian community. Methods: A descriptive, cross-sectional study was conducted in Ajebo community, Obafemi/Owode Local Government Area in Ogun State. A total of 420 respondents were studied using an interviewer-administered questionnaire to collect quantitative data. Results: More than half (54.0%) of the respondents had access to public health facilities, 41.7% had access to private health facilities, while patent medicine stores were accessed by 4.3% of the respondents. Out of the 249 (59.3%) who were ill in the preceding three months, 92.4% of them sought healthcare. More males utilized government-owned health services s than females (χ² = 3.878, p = 0.049). More than half (56.4%) travelled >10 minutes to access healthcare services. Lack of formal education was not a hindrance to seeking healthcare (OR = 31.392, p = 0.003, CI = 3.323-2.347). Income earning <30,000 Naira was the strongest predictor of healthcare utilization (OR = 3.304, p =0.001, 95% CI = 2.007-5.441). Education with OR = 31.392 (p = 0.003, 95% CI = 3.323-96.570) was the strongest predictor of healthcare-seeking behaviour. Conclusion: Healthcare-seeking behaviour was not limited by lack of formal education. The utilisation of public health facilities was high among the respondents. State of employment and income were strong predictors of healthcare utilisation in Ajebo community.

Impact of Catheter Ablation on Quality of Life and Healthcare Utilisation

Impairment of quality of life (QoL) is a well-known complication of AF. Because of the association of AF with older age and many other cardiovascular comorbidities, there are multiple factors that could influence QoL score even after successful AF intervention. However, substantial improvement in QoL has been reported following catheter ablation for AF regardless of ablation outcomes. In terms of healthcare resource utilisation, the expenses associated with AF are very high because of the hospitalisations for AF-related thromboembolic complications, aggravation of heart failure, AF interventions, and emergency room visits for incessant arrhythmia episodes, and they represent a large economic burden worldwide. Several trials have shown a drastic reduction in healthcare costs following successful AF ablation. In this review, the authors discuss this evidence systematically.

Towards Zero Suicide for older adults: implications of healthcare service use for implementation

Objective: Implementing the Towards Zero Suicide (TZS) approach to suicide prevention in older adults requires evidence-based adaptation. This paper aims to highlight important differences and opportunities in healthcare service use by older adults relevant to implementation. Conclusion: The TZS approach may prevent suicide in older adults, but only if implementation aligns with systemic differences in healthcare utilisation by older people. Of greatest importance in older adults are (1) most mental healthcare is delivered outside of specialist mental health services; (2) physical conditions and disability are major modifiable contributors to suicide that must be addressed within TZS; and (3) older people have very low use of Medicare-funded psychological services. Primary healthcare providers, who may be seeing older people at risk of suicide, are often neither equipped to provide expert assessment and care planning for often complex needs, nor may see this as their role. However, they are essential in providing pathways to care, which may prevent suicide. Leaders must recognise TZS for older people will usually involve multiple transitions. This requires engagement of key services with clear roles, targeted training, rapid access to specialist older persons mental health support and development of a new TZS element: the navigator.

Emerging spectrum of post-COVID-19 syndrome

‘Post-COVID-19 syndrome’ refers to symptoms in the convalescent phase following initial COVID-19 infection. This term encompasses a wide array of presentation involving lungs, heart and the neuromuscular system. Pulmonary manifestations include post-COVID-19 fibrosis, which is akin to post acute respiratory distress syndrome fibrosis and may reflect the permanent damage to the lungs following an initial bout of infection. Cardiovascular system is often involved, and the presentation can be in terms of acute coronary syndrome, myocarditis and heart failure. Clinical manifestations are often varied and non-specific, which entails a detailed workup and a multidisciplinary approach. Post-COVID-19 syndrome adds to the overall disease morbidity and leads to a prolonged hospital stay, greater healthcare utilisation and loss of productivity marring the country’s dwindling economy. Thus, it is imperative that post-COVID-19 syndrome be prevented and identified early followed by a prompt treatment.

Identifying and delineating the type 2 diabetes population in the Netherlands using an all-payer claims database: characteristics, healthcare utilisation and expenditures

ObjectivesWe aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an all-payer claims database.DesignRetrospective observational cohort study based on an all-payer claims database of the Dutch population.SettingThe Netherlands.ParticipantsThe whole Dutch type 2 diabetes population (n=900 522 in 2018), determined based on bundled payment codes for integrated diabetes care and medication use indicating type 2 diabetes.Outcome measuresAnnual prevalence of type 2 diabetes, comorbidities and characteristics of the type 2 diabetes population, as well as the distribution of healthcare utilisation and expenditures were analysed descriptively.ResultsIn 2018, 900 522 people (6.5% of adults) were identified as having type 2 diabetes. The most common comorbidity in the population was heart disease (12.1%). Additionally, 16.2% and 5.6% of patients received specialised care for microvascular and macrovascular diabetes-related complications, respectively. Most patients with type 2 diabetes received pharmaceutical care (99.1%), medical specialist care (97.0%) and general practitioner consultations (90.5%). In total, €8173 million, 9.4% of total healthcare expenditures, was reimbursed for the type 2 diabetes population. Medical specialist care accounted for the largest share of spending (38.1%), followed by district nursing (12.4%), and pharmaceutical care (11.5%).ConclusionsAll-payer claims databases can be used to delineate healthcare use: this insight can inform health policy and practice and, thereby, support better decisions to promote long-term sustainability of healthcare systems. The healthcare utilisation of the Dutch type 2 diabetes population is distributed across the health system and utilisation of medical specialist care is high. This is likely to be due to presence of concurrent morbidities and complications. Therefore, a shift from a disease-specific approach to a person-centred and integrated care approach could be beneficial in the treatment of type 2 diabetes.