Impact of the first COVID-19 outbreak on mental health service utilisation at a Dutch mental health centre: retrospective observational study

Background Previous studies into mental health service utilisation during the COVID-19 pandemic are limited to a few countries or specific type of service. In addition, data on changes in telepsychiatry are currently lacking. Aims We aimed to investigate whether the COVID-19 pandemic is associated with changes in mental health service utilisation, including telepsychiatry, and how these changes were distributed among patients with mental illness during the first COVID-19 outbreak. Method This retrospective study obtained routinely assessed healthcare data from a large Dutch mental healthcare institute. Data from the second quarter of 2020 (the first COVID-19 outbreak period) were compared with the pre-pandemic period between January 2018 and March 2020. Time-series analyses were performed with the quasi-Poisson generalised linear model, to examine the effect of the COVID-19 lockdown and the overall trend of mental health service utilisation per communication modality and diagnostic category. Results We analysed 204 808 care contacts of 28 038 patients. The overall number of care contacts in the second quarter of 2020 remained the same as in the previous 2 years, because the number of video consultations significantly increased (B = 2.17, P = 0.488 × 10−3) as the number of face-to-face out-patient contacts significantly decreased (B = −0.98, P = 0.011). This was true for all different diagnostic categories, although this change was less pronounced in patients with psychotic disorders. Conclusions Diminished face-to-face out-patient contacts were well-compensated by the substantial increase of video consultations during the first COVID-19 outbreak in The Netherlands. This increase was less pronounced for psychotic disorders. Further research should elucidate the need for disorder-specific digital mental healthcare delivery.

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

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.

Health service utilisation associated with chronic breathlessness: random population sample

Most health service utilisation studies are of people with specific diagnoses or demographic characteristics, and rarely of specific chronic symptoms. Does population-level health service utilisation increase in people with chronic breathlessness?MethodsCross-sectional analysis of the South Australian Health Omnibus Survey (HOS) 2017, a multi-stage, clustered area systematic sampling survey of adults where questions are administered face-to-face in respondents’ homes. Self-report of health service utilisation in the previous 3 months (medical consultations, ED, hospital admission), chronic breathlessness (severity, duration; modified Medical Research Council (mMRC) breathlessness scale) and demographic data were used to predict self-reported health service utilisation.ResultsA total of 2898 people were included (49.0% men; median age 48.0 years (IQR 32.0, 63.0); 64.1% educated beyond school; 55.4% in work; 73.5% had outpatient contact; 6.3% had a hospital admission in the previous three months). Chronic breathlessness (mMRC ≥1) was reported by 8.8% of respondents. In bivariable analyses, people with greater contact with health services were older, and a higher proportion were overweight/obese and had more severe chronic breathlessness. In multivariable analyses, chronic breathlessness and older age were positively associated with outpatient care and inpatient care, and people with chronic breathlessness were hospitalised for longer, incidence rate ratio 2.5 (95%CI: 1.4, 4.5).AnswerThere is a significant association between worse chronic breathlessness and increased health service utilisation. There is a need for greater understanding of factors that initiate contact with health services.

517Challenges in data linkage – experiences from an upper gastrointestinal cancer data linkage study

Background Linked, population-level data is valuable for mapping patterns of care and evaluating health service utilisation, particularly in difficult-to-reach populations. Upper gastrointestinal (UGI) cancers have a dismal prognosis, creating difficulties engaging patients in research. The utility of a linked dataset in this population is of high value. Methods Key objectives included identifying the operational and feasibility issues associated with linking Australian state-based administrative and registry data for understanding health service utilisation in UGI cancers. Datasets pertained to hospital admissions, radiotherapy, community health, primary care, palliative care, Medicare and Pharmaceutical Benefits Schedule’s and UGI cancers. Results From a logistical perspective, data access request approval processes varied, with some requiring consent to be sought from individual services contributing data. The availability of unique person-level identifying information varied widely. Additionally, the time period of data capture differed between and within datasets, limiting the quality of the linked data. Significant costs were associated with linking with primary care and Medicare and Pharmaceutical Benefits Schedule’s. Federal dataset linkage required at least a one-year waiting period. Conclusions Whilst in theory data linkage is a powerful mechanism for obtaining population-level data, in reality, there are many logistical and financial barriers to linking multiple datasets. Consequently, critical data, which has the potential to inform policy and improve patient outcomes, cannot be procured. Key messages Logistical and financial challenges are associated with linking administrative and registry datasets for research, limiting the potential of data linkage.

Health service utilisation among African migrants in China: a nationwide cross-sectional study

ObjectivesTo assess the health utilisation status and associated factors among African migrants in China.DesignA national cross-sectional study was conducted among African migrants in China in 2019.SettingParticipants were recruited online and offline to participate in a self-report survey. Online participants were recruited through WeChat across China, and offline participants were recruited in Guangzhou.ParticipantsWe recruited participants who were from an African country; had spent at least 1 month cumulatively in China; were at least 18 years old; were willing to provide informed consent. A total of 1025 participants were recruited online and offline, 19 of them were excluded due to invalid response and 1006 people were finally included in the analysis.Outcome measuresThe primary outcome was health service utilisation and associated factors among African migrants during their stay in China in the past 12 months. The potential factors include the predisposing factors (demographic characteristics and social structure variables), enabling factors (annual income, health insurance in China) and need factors (non-communicable chronic and infectious diseases, depression) which determined by Anderson framework were measured.ResultsEight hundred and seven online and 218 offline participants completed the survey, including 624 males and 382 females, with an average age of 26.4±8.9 years. Around 28.5% reported health utilization in the past 12 months. Results showed that longer duration in China, migration to China for business (aOR=2.23, 95% CI:1.13-4.40) and study (aOR=5.00, 95% CI:2.74-9.11), living in apartment (aOR=2.59, 95% CI:1.62-4.14) or dormitory (aOR=3.22, 95% CI:2.17-4.80) in China, suffering from chronic diseases, communicable diseases, and greater depressive symptoms (aOR=1.91, 95% CI:1.42-2.56) facilitated health service utilization.ConclusionsThe healthcare service that African migrants received in China is low. The existing public health policies and intervention measures need to be improved to make health utilisation more accessible and feasible for African migrants.