A 10-year population-based study of people with multiple sclerosis in Stockholm, Sweden: use of and satisfaction with care and the value of different factors in predicting use of care.
The national strategy for treatment of chronic diseases - including MS - and changes in the Swedish welfare system, call for analyses of the use of, and patient satisfaction with, care in a long-term perspective. The aim was therefore to explore the use of care and the predictive value of personal factors, disease-specific factors and functioning on the use of care and to explore patient satisfaction with care in a 10-year perspective.
Information regarding personal factors, disease-specific factors, functioning and satisfaction with care was collected by home-visits; use of care was collected from the Stockholm County Council computerised register.
Data from 121 people with MS (PwMS) was collected. Primary care accounted for the majority of all care. Neurology and Rehabilitation Departments together accounted for two-thirds of all hospital outpatient care. Rehabilitation Departments accounted for one-third of the total number of inpatient days. Lower coping capacity, impaired manual dexterity and activity of daily living dependency at baseline, together with progress in MS disability predicted a higher use of care. Overall, patient satisfaction with care was stable over time.
The extensive use of care offers challenges to care coordination. Implementation of person-centred care could be a strategy to increase efficacy/outcome of care.
The debate on health care reform in the United States has been greatly influenced by various national studies showing a strong relationship between lack of public or private health care coverage and inadequate access to health services. There is also much concern about deficiencies in the availability and delivery of services to certain population groups--especially for those living in the most remote and sparsely populated areas of the country. However, national studies have generally not demonstrated that the use of health services is strongly associated with urban/rural residence or the supply of medical providers. In this study, we show that national studies can obscure the problems of certain population groups including American Indians and Alaska Natives. Using data from the 1987 National Medical Expenditure Survey, the findings show that the availability of medical providers as well as place of residence were strongly associated with the use of health care by American Indians and Alaska Natives. Although American Indians and Alaska Natives included in this study were eligible to receive health care free of charge from the Indian Health Service (IHS), financial factors were also significantly associated with use due to the use of services other than those provided or sponsored by IHS. Also, the results show that while geographic and supply factors have only modest effects on the average travel time to medical providers for the U.S. population as a whole, travel times are dramatically longer for American Indians and Alaska Natives living in rural areas and where there are few medical providers. In addition, there appear to be fewer hospitalizations in areas where there are IHS outpatient services. We conclude by discussing the need for health care reform to take into account the diversity of a large country such as the U.S., and the special needs of population groups that are usually not adequately represented in national studies.
To validate algorithms using administrative data that characterize ambulatory physician care for patients with a chronic disease.
Seven-hundred and eighty-one people with diabetes were recruited mostly from community pharmacies to complete a written questionnaire about their physician utilization in 2002. These data were linked with administrative databases detailing health service utilization.
An administrative data algorithm was defined that identified whether or not patients received specialist care, and it was tested for agreement with self-report. Other algorithms, which assigned each patient to a primary care and specialist physician, were tested for concordance with self-reported regular providers of care.
The algorithm to identify whether participants received specialist care had 80.4 percent agreement with questionnaire responses (kappa=0.59). Compared with self-report, administrative data had a sensitivity of 68.9 percent and specificity 88.3 percent for identifying specialist care. The best administrative data algorithm to assign each participant's regular primary care and specialist providers was concordant with self-report in 82.6 and 78.2 percent of cases, respectively.
Administrative data algorithms can accurately match self-reported ambulatory physician utilization.
Notes
Cites: Med Care. 2004 Oct;42(10):960-515377928
Cites: Am J Public Health. 1981 Feb;71(2):145-97457683
Cites: Am J Epidemiol. 1989 Feb;129(2):233-482643301
Cites: Med Care. 1993 Jun;31(6):498-5078501997
Cites: Int J Methods Psychiatr Res. 2004;13(3):165-7515297900
Cites: J Ambul Care Manage. 1998 Jan;21(1):24-3410181337
An examination of the temporal and geographical patterns of psychiatric emergency service use by multiple visit patients as a means for their early detection.
Frequent users of the psychiatric emergency service (PES) place a heavy burden upon the mental health care delivery system. The aim of this study was to identify distinct temporal or geographical patterns of PES use by these patients as potential markers for their early detection.
Diagnostic profiles were obtained for patients making an intermediate (4 to 10) or a high (11 or more) number of visits to a general hospital PES in Montreal (Canada) between 1985 and 2004. Between-group comparisons were made with regards to several parameters. These included the time intervals between consecutive visits, visit clustering (single, repeating, and the time interval to the first cluster) and visits made to three other services where data was similarly acquired from 2002 to 2004.
The two multiple visit groups differed with regards to diagnostic profiles and actual time between consecutive visits (significantly shorter in patients with 11 or more visits). Patients with 11 or more visits were more likely to have a single cluster (3 or more visits/3 months) or repeating clusters (4 visits/3 months) in their patterns of use. Personality disorders were more prevalent in patients with single clusters as they were, along with schizophrenia, in those with repeating clusters. In addition, clusters were found to occur sufficiently early so as to be potentially useful as markers for early detection. Ten percent of those with 11 or more visits and 16% of those with an intermediate number of visits frequented at least one other PES. A small number of patients, primarily those with substance abuse, made over 50% of their visits to other services.
Temporal and geographical patterns of use differed significantly between the multiple visit groups. These patterns, combined with distinct diagnostic profiles, could potentially lead to the more rapid identification and treatment of specific sub-groups of multiple visit patients.
This study is an exploration of engagement in outpatient medical care, medication utilization, and barriers to treatment utilization among 24 predominantly low-income, ethnic minority adults who were admitted to an urban hospital for HIV-related illnesses. A semi-structured interview was administered during the sample's hospital stay to explore patterns of service use and identify barriers to care. The majority of the sample was connected to an outpatient provider and satisfied with the care they received; however, most missed treatment appointments and skipped medication dosages. Health and treatment-related barriers, competing demands, and co-occurring mental health symptoms and illicit substance use were identified as barriers to care. Multiple obstacles indigenous to the individual, their treatment, and the environment prevented consistent treatment use among an economically disadvantaged ethnic minority sample: Implications and future directions in engaging vulnerable populations into health care for HIV are discussed.
Asthma comorbidity, such as depression and obesity, has been associated with greater healthcare use, decreased quality of life and poor asthma control. Treating this comorbidity has been shown to improve asthma outcomes as well as overall health. Despite this, asthma comorbidity remains relatively under-recognised and understudied-perhaps because most asthma occurs in young people who are believed to be healthy and relatively free of comorbidity. The aim of this study was to quantify empirically the amount of comorbidity associated with asthma.
A population-based cohort study was conducted using the health administrative data of the 12 million residents of Ontario, Canada in 2005. A validated health administrative algorithm was used to identify individuals with asthma.
The amount of comorbidity among individuals with asthma, as reflected in rates of hospitalisations, emergency department visits and ambulatory care claims, was found to be substantial and much greater than that observed among individuals without asthma. Together, asthma and asthma comorbidity (the extra comorbidity found in individuals with asthma compared with those without asthma) were associated with 6% of all hospitalisations, 9% of all emergency room visits and 6% of all ambulatory care visits that occurred in Ontario.
Asthma comorbidity places a significant burden on individuals and the healthcare system and should be considered in the management of asthma. Further research should focus on which types of asthma comorbidity are responsible for the greatest burden and how such comorbidity should be prevented and managed.
In this study the question whether increased resources in community based primary care lead to decreased utilization of in-patient care has been analysed. Two alternative types of analysis were compared: a municipality-based analysis and a cartographic analysis based on non-administrative reference areas. The study material consisted of person-based data from Uppsala County in Sweden. The cartographic analyses revealed important characteristics of the utilization pattern, which would not have been possible to ascertain using traditional methods such as analyses based on administrative areas. Thus, the cartographic analysis gave some support to the hypothesis that increased resources to primary care will reduce the utilization of in-patient care.
The determinants of use of physician services in Finland in 1987 and 1996 were studied to evaluate how the utilisation altered over this period, which saw fairly radical changes in Finnish health care and the entire economy. We used econometric methods to describe the changes in structure and level of utilisation. The study was based on the Finnish Health Care Surveys of 1987 and 1996, which were nationally representative cross-sectional samples of the total non-institutionalised population. Visits to a doctor were analysed using a two-part model (logit +truncated negative binomial regression). Structural changes were tested by a Chow-type test and changes in utilisation level by a dummy variable indicating the year of study. Analyses were made separately for four different age groups: children aged 0-6 and 7-17, and adults aged 18-64 and over 64 years. The change in utilisation of physician services over the nine-year period was a product of both structural and level changes. Except in the youngest age group, both types of changes occurred in the second part of the utilisation model, which implies that they were more associated with supply side factors than demand factors. Among young children, the type of day-care seems to have been an important determinant of physician utilisation. Although its effect decreased considerably over the period, the total number of visits to a doctor in 1996 was still about 30% greater among children in nursery care than those at home. The rise in self-reported chronic illness was an important explanation of the increase in utilisation of doctors' services, especially among children. Among adults aged 18-64, the most important structural change was an increase of the effect of self-rated health status variables on utilisation. Inequity in utilisation of services persisted with respect to income. In conclusion it can be stated that Finland's tax-based and locally decentralised health care system adapted quite well to the radical changes experienced during the study period.
