Health Care Utilization

The aim of this population-based study was to (1) describe living conditions and actual health care utilization among 85 year olds; (2) determine factors that affect hospital admissions in this age. The study was conducted on 85-year-old residents in Linköping municipality, Sweden. The data collected included medical records, health care utilization during the preceding 12 months and a postal questionnaire on assistance, assistive technology, functional impairment, feelings of loneliness, worries and health-related quality of life measured by the EQ-5D. Out of 650 eligible individuals, 496 (78% of those alive) participated. Despite the prevalence of multi-morbidity (68%) and mental discomfort, the majority managed self-care (85%), usual activities (74%) and had high (>60/100) self-rated health evaluated by a visual analog scale (VAS). The non-hospitalized group reported a better health status than the hospitalized group in terms of medical aspects, living conditions and subjectiv...

This study examines the correlates of self-diagnosis of chronic medical and mental health conditions in under-served minority populations. The Behavioral Model for Vulnerable Populations was employed to compare the predisposing and enabling characteristics of two groups: the first group consisted of individuals who self-reported their medical conditions without a presumptive or definitive physician diagnosis, while the second group consisted of individuals who self-reported their medical conditions with a presumptive or definitive physician diagnosis of their condition. The sample consisted of 287 African American and Latino heads of household. This sample was obtained from a geographically defined random sample of 418 households from three urban public housing communities in Los Angeles County, California. This study was a cross-sectional, face-to-face, semistructured interview survey. Using logistic regression techniques and controlling for demographic characteristics, the results...

For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. To evaluate outcomes of a chronic disease self-management program in a real-world" setting. Before-after cohort study. Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building. Health behavior, self-efficacy (confidence in abil...

Objectives To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the “equal access” Veterans Affairs (VA) health care system. Methods We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA. Results Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients’ medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups. Conclusions Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.

Best evidence synthesis.To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders.No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade.We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis.Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.

With the increase in the number of multinational and multicultural research projects, the need to adapt health status measures for use in other than the source language has also grown rapidly. 1,4,27 Most questionnaires were developed in English-speaking countries, 11 but even within these countries, researchers must consider immi- grant populations in studies of health, especially when their exclusion could

Obstructive sleep apnea (OSA) has been historically described as a disease primarily of men. However, it is now widely recognized that OSA in women is not as rare as was originally believed. The alarming degree to which OSA is clinically underdiagnosed in women raises the critical concern that women manifest OSA differently. The purpose of this review is to examine the issue of clinically significant gender differences in OSA disease manifestation, which pose unique challenges to diagnosis and management. Within this review, current findings regarding gender differences in OSA polysomnographic features and demographic factors, symptom presentation, functional status, comorbidities, health care utilization, and therapeutic management have been reviewed. Further research in this field is proposed to examine the impact of gender on functional status in individuals with OSA, and the potential gender differences in therapeutic management, particularly the response to continuous positive airway pressure (CPAP) treatment. Additional studies describing the clinical manifestations in men and women at different levels of OSA severity may substantially contribute to the ability to identify and treat OSA in women across a wide spectrum of disease severity.

This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at

Rationale: Chronic obstructive pulmonary disease (COPD) remains undiagnosed in many individuals with persistent airflow limitation. These individuals may be susceptible to exacerbation-like respiratory events that consume health care resources. Objectives: To compare exacerbation-like respiratory events, event prevalence, and differences in the odds of using medication and/or health services between subjects with diagnosed and undiagnosed COPD. Methods: Subjects sampled from the general population participating in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study, with at least 12 months of exacerbation-event follow-up who were classified as having physician-diagnosed or undiagnosed COPD were assessed. Exacerbation-like respiratory events were captured using a questionnaire administered every 3 months. Measurements and Main Results: A total of 355 subjects were undiagnosed and 150 were diagnosed with COPD. Undiagnosed subjects were less symptomatic and functionally impaired, had been prescribed fewer respiratory medications, and had better health status. The incidence of reported exacerbation-like events was higher in diagnosed subjects and increased in both groups with the severity of airflow obstruction. Although subjects with diagnosed COPD were more often prescribed medication for exacerbation events, health service use for exacerbation events was similar in both groups. Conclusions: Most subjects with COPD in Canada remain undiagnosed. These subjects are less symptomatic and impaired, which may partly explain lack of diagnosis. Although patients with undiagnosed COPD experience fewer exacerbations than those with diagnosed COPD, they use a similar amount of health services for exacerbation events; thus, the overall health system burden of exacerbations in those with undiagnosed COPD is considerable.

Background: Good health is a fundamental human right, a valued asset, and a prerequisite for improved productivity. However, high poverty can lead to under utilization or lack of utilization of health care leading to poor health. Thus, poverty reduction and improvement of health care utilization are important in ensuring enjoyment of good health. Since 1982, poverty has remained above 40 per cent despite Kenya's commitment to poverty reduction. Kenya's health indicators have also not been impressive and health care utilization has remained low. Evidence shows that those who fell sick and reported lack of finances as the main reason for not seeking medical attention constituted 44 per cent, 38 per cent and 21.4 per cent in 2003, 2007 and 2013, respectively. These statistics point to poor health care utilization due to poverty. In Kenya, studies have concentrated on small segments of the population or parts of the country hence limiting generalization of the findings. Objective: The objective of this paper was to determine the effect of poverty on health care utilization in Kenya. Methods: The study used a Negative Binomial Regression and the 2013 Kenya Household Expenditure and Utilization Survey dataset. The study also used Two Stage Residual Inclusion approach and a Control Function Approach to test and control for potential endogeneity and unobserved heterogeneity problems, respectively. Results: The estimation results showed that increase in wealth leading to reduction in poverty increased health care utilization. Other factors that had a positive effect on health care utilization were household size, early levels of education, and distance to the nearest health facility. Conclusion: The study concludes that health care utilization is negatively affected by poverty other factors held constant. Thus, policies and strategies

The drastic cut in government expenditure on health with the extension of the 'user pays' principle to health care utilization in Nigeria following the adoption of the Structural Adjustment Program is probably having its greatest effect on the family. Contrary to what happened in the past, when the cost of treatment was usually borne by the mother of a sick child, the role of the father is becoming increasingly significant. Before the introduction of the 'user pays' principle to health care, treatment in many government hospitals was free. Intra-household variations in response to and treatment of child illness, especially in polygynous Yoruba households in Nigeria, occurred for a number of other reasons. Probably because the mother and her children usually form a social unit within a polygynous union, meeting the cost of treatment and some other minor daily needs of the child has always been the responsibility of the mother, although the economic independence of mos...

This report is a survey of current capitation methods in health care finance in developed countries. It was commissioned as part of the fundamental review by UK Ministers of the formula used to allocate health care finance to local areas in England, being carried out under the auspices of the Advisory Committee on Resource Allocation (ACRA). The study was commissioned

For patients with painful functional bowel disorders (FBD), physicians frequently make diagnostic and treatment decisions based on the severity of the pain reported; patients with severe painful complaints may receive extensive diagnostic tests and treatments. Therefore, it would be important to determine what clinical factors contribute to the judgment of severity among patients with FBD. The aim of this study was to identify the psychosocial, behavioral, and physiological (visceral sensitivity) factors that predicted severity in patients with moderate to severe FBD. Two hundred eleven female patients with moderate or severe FBD, as determined by the Functional Bowel Disorder Severity Index, entered a multicenter treatment trial at the University of North Carolina and the University of Toronto. Patients filled out diary cards and were given questionnaires and physiological testing (rectal sensitivity using barostat). Analysis of covariance and logistic regression adjusting for demo...