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Abdominal symptoms, visits to the doctor, and medicine consumption among the elderly. A population based study.

https://arctichealth.org/en/permalink/ahliterature73151
Source
Dan Med Bull. 1994 Sep;41(4):466-9
Publication Type
Article
Date
Sep-1994
Author
L. Kay
Author Affiliation
Medical Department C, Glostrup County Hospital.
Source
Dan Med Bull. 1994 Sep;41(4):466-9
Date
Sep-1994
Language
English
Publication Type
Article
Keywords
Abdominal Pain - drug therapy - epidemiology - therapy
Aged
Aged, 80 and over
Aging - physiology - psychology
Cohort Studies
Denmark - epidemiology
Drug Therapy - utilization
Female
Gastrointestinal Diseases - complications - epidemiology - therapy
Health services needs and demand
Health Services for the Aged - utilization
Humans
Male
Office Visits - utilization
Prevalence
Questionnaires
Research Support, Non-U.S. Gov't
Abstract
Abdominal symptoms are frequent in the normal elderly population, but only a minority contact doctors. The present study was performed to assess the impact of abdominal symptoms on primary health care and medicine consumption and, in addition, to describe factors that relate to resource consumption. A postal questionnaire was mailed to a random cohort of 859 Danish people at the age of 75. Seventy-nine percent returned the questionnaire. A total of 31% of the men and 42% of the women had experienced at least one abdominal symptom within the past year. Among these 25% had visited a doctor and a little less had taken medicine. The total expenses used on primary health care and medicine were 22,000 U.S. Dollars per 1000 persons. Factors related to visiting a doctor were not only the presence of symptoms but also the subject's concept of the symptom as a health problem. As a consequence, efforts to control expenses should also focus on why some subjects consider their symptoms a health-problem while others do not.
PubMed ID
7813253 View in PubMed
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Access to heart failure care post emergency department visit: do we meet established benchmarks and does it matter?

https://arctichealth.org/en/permalink/ahliterature114344
Source
Am Heart J. 2013 May;165(5):725-32
Publication Type
Article
Date
May-2013
Author
Debbie Ehrmann Feldman
Thao Huynh
Julie Des Lauriers
Nadia Giannetti
Marc Frenette
François Grondin
Caroline Michel
Richard Sheppard
Martine Montigny
Serge Lepage
Viviane Nguyen
Hassan Behlouli
Louise Pilote
Author Affiliation
Université de Montréal, Montreal, Quebec, Canada. debbie.feldman@umontreal.ca
Source
Am Heart J. 2013 May;165(5):725-32
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Benchmarking
Continuity of Patient Care - standards
Emergencies
Emergency Service, Hospital - organization & administration
Female
Heart Failure - therapy
Humans
Male
Office Visits - utilization
Quebec
Abstract
The Canadian Cardiology Society recommends that patients should be seen within 2 weeks after an emergency department (ED) visit for heart failure (HF). We sought to investigate whether patients who had an ED visit for HF subsequently consult a physician within the current established benchmark, to explore factors related to physician consultation, and to examine whether delay in consultation is associated with adverse events (AEs) (death, hospitalization, or repeat ED visit).
Patients were recruited by nurses at 8 hospital EDs in Québec, Canada, and interviewed by telephone within 6 weeks of discharge and subsequently at 3 and 6 months. Clinical variables were extracted from medical charts by nurses. We used Cox regression in the analysis.
We enrolled 410 patients (mean age 74.9 ± 11.1 years, 53% males) with a confirmed primary diagnosis of HF. Only 30% consulted with a physician within 2 weeks post-ED visit. By 4 weeks, 51% consulted a physician. Over the 6-month follow-up, 26% returned to the ED, 25% were hospitalized, and 9% died. Patients who were followed up within 4 weeks were more likely to be older and have higher education and a worse quality of life. Patients who consulted a physician within 4 weeks of ED discharge had a lower risk of AEs (hazard ratio 0.59, 95% CI 0.35-0.99).
Prompt follow-up post-ED visit for HF is associated with lower risk for major AEs. Therefore, adherence to current HF guideline benchmarks for timely follow-up post-ED visit is crucial.
PubMed ID
23622909 View in PubMed
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Accuracy of syndrome definitions based on diagnoses in physician claims.

https://arctichealth.org/en/permalink/ahliterature138094
Source
BMC Public Health. 2011;11:17
Publication Type
Article
Date
2011
Author
Geneviève Cadieux
David L Buckeridge
André Jacques
Michael Libman
Nandini Dendukuri
Robyn Tamblyn
Author Affiliation
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. genevieve.cadieux@mail.mcgill.ca
Source
BMC Public Health. 2011;11:17
Date
2011
Language
English
Publication Type
Article
Keywords
Clinical Coding - methods
Community Health Services - utilization
Data Collection
Diagnostic Techniques and Procedures - standards
Exanthema - classification - diagnosis
Female
Fever - classification - diagnosis
Humans
International Classification of Diseases
Male
Nervous System Diseases - classification - diagnosis
Office Visits - utilization
Population Surveillance - methods
Quebec
Registries
Respiratory Tract Infections - classification - diagnosis
Sensitivity and specificity
Abstract
Community clinics offer potential for timelier outbreak detection and monitoring than emergency departments. However, the accuracy of syndrome definitions used in surveillance has never been evaluated in community settings. This study's objective was to assess the accuracy of syndrome definitions based on diagnostic codes in physician claims for identifying 5 syndromes (fever, gastrointestinal, neurological, rash, and respiratory including influenza-like illness) in community clinics.
We selected a random sample of 3,600 community-based primary care physicians who practiced in the fee-for-service system in the province of Quebec, Canada in 2005-2007. We randomly selected 10 visits per physician from their claims, stratifying on syndrome type and presence, diagnosis, and month. Double-blinded chart reviews were conducted by telephone with consenting physicians to obtain information on patient diagnoses for each sampled visit. The sensitivity, specificity, and positive predictive value (PPV) of physician claims were estimated by comparison to chart review.
1,098 (30.5%) physicians completed the chart review. A chart entry on the date of the corresponding claim was found for 10,529 (95.9%) visits. The sensitivity of syndrome definitions based on diagnostic codes in physician claims was low, ranging from 0.11 (fever) to 0.44 (respiratory), the specificity was high, and the PPV was moderate to high, ranging from 0.59 (fever) to 0.85 (respiratory). We found that rarely used diagnostic codes had a higher probability of being false-positives, and that more commonly used diagnostic codes had a higher PPV.
Future research should identify physician, patient, and encounter characteristics associated with the accuracy of diagnostic codes in physician claims. This would enable public health to improve syndromic surveillance, either by focusing on physician claims whose diagnostic code is more likely to be accurate, or by using all physician claims and weighing each according to the likelihood that its diagnostic code is accurate.
Notes
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PubMed ID
21211054 View in PubMed
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[Assessment of the incidence of psoriasis based on data from office visits and medical examinations].

https://arctichealth.org/en/permalink/ahliterature239485
Source
Vestn Dermatol Venerol. 1985 Jan;(1):46-8
Publication Type
Article
Date
Jan-1985

The burden of inflammatory bowel disease on health care utilization and quality of life.

https://arctichealth.org/en/permalink/ahliterature124483
Source
Scand J Gastroenterol. 2013 Jan;48(1):51-7
Publication Type
Article
Date
Jan-2013
Author
Ellinoora Nurmi
Johanna Haapamäki
Eija Paavilainen
Anja Rantanen
Markku Hillilä
Perttu Arkkila
Author Affiliation
School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland.
Source
Scand J Gastroenterol. 2013 Jan;48(1):51-7
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cost of Illness
Cross-Sectional Studies
Female
Finland
Health Services - utilization
Health status
Humans
Inflammatory Bowel Diseases - complications - psychology - therapy
Irritable Bowel Syndrome - complications - psychology - therapy
Male
Middle Aged
Office Visits - utilization
Quality of Life
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
The aim of this study was to explore the utilization of health services by Finnish adults with inflammatory bowel disease (IBD) and to assess the associated demographic and health-related quality of life (HRQoL) factors.
556 Finnish IBD patients eligible for reimbursement for IBD medication according to the Social Insurance Institution in Finland answered our postal cross-sectional survey. The study questionnaire included questions about demographic characteristics of the patients, health care resource use, and HRQoL. The number of doctor visits was compared with those of irritable bowel syndrome patients.
During the previous year, more than three quarters of the respondents reported disturbing IBD symptoms. The majority (64%) had seen a doctor due to their IBD, women more often than men (p
PubMed ID
22577851 View in PubMed
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Clinical, economic, and humanistic burden of asthma in Canada: a systematic review.

https://arctichealth.org/en/permalink/ahliterature105825
Source
BMC Pulm Med. 2013;13:70
Publication Type
Article
Date
2013
Author
Afisi S Ismaila
Amyn P Sayani
Mihaela Marin
Zhen Su
Author Affiliation
Medical Affairs, GlaxoSmithKline Canada, Mississauga, ON, Canada. afisi.s.ismaila@gsk.com.
Source
BMC Pulm Med. 2013;13:70
Date
2013
Language
English
Publication Type
Article
Keywords
Asthma - economics - psychology
Canada
Cost of Illness
Drug Prescriptions - statistics & numerical data
Emergency Service, Hospital - utilization
Health Care Costs - statistics & numerical data
Health Services - economics - utilization
Hospitalization - statistics & numerical data
Humans
Office Visits - utilization
Quality of Life
Abstract
Asthma, one of the most common chronic respiratory diseases, affects about 3 million Canadians. The objective of this study is to provide a comprehensive evaluation of the published literature that reports on the clinical, economic, and humanistic burden of asthma in Canada.
A search of the PubMed, EMBASE, and EMCare databases was conducted to identify original research published between 2000 and 2011 on the burden of asthma in Canada. Controlled vocabulary with "asthma" as the main search concept was used. Searches were limited to articles written in English, involving human subjects and restricted to Canada. Articles were selected for inclusion based on predefined criteria like appropriate study design, disease state, and outcome measures. Key data elements, including year and type of research, number of study subjects, characteristics of study population, outcomes evaluated, results, and overall conclusions of the study, were abstracted and tabulated.
Thirty-three of the 570 articles identified by the clinical and economic burden literature searches and 14 of the 309 articles identified by the humanistic burden literature searches met the requirements for inclusion in this review. The included studies highlighted the significant clinical burden of asthma and show high rates of healthcare resource utilization among asthma patients (hospitalizations, ED, physician visits, and prescription medication use). The economic burden is also high, with direct costs ranging from an average annual cost of $366 to $647 per patient and a total annual population-level cost ranging from ~ $46 million in British Columbia to ~ $141 million in Ontario. Indirect costs due to time loss from work, productivity loss, and functional impairment increase the overall burden. Although there is limited research on the humanistic burden of asthma, studies show a high (31%-50%) prevalence of psychological distress and diminished QoL among asthma patients relative to subjects without asthma.
As new therapies for asthma become available, economic evaluations and assessment of clinical and humanistic burden will become increasingly important. This report provides a comprehensive resource for health technology assessment that will assist decision making on asthma treatment selection and management guidelines in Canada.
PubMed ID
24304726 View in PubMed
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Determinants of ambulatory physician utilization among adults with chronic diseases in Quebec.

https://arctichealth.org/en/permalink/ahliterature206381
Source
J Health Serv Res Policy. 1998 Apr;3(2):82-91
Publication Type
Article
Date
Apr-1998
Author
E. Baris
F. Champagne
M. Rivard
Author Affiliation
International Development Research Centre, Ottawa.
Source
J Health Serv Res Policy. 1998 Apr;3(2):82-91
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Ambulatory Care - utilization
Chronic Disease - therapy
Female
Forecasting
Hospitalization
Humans
Male
Middle Aged
Models, Statistical
Office Visits - utilization
Patient Acceptance of Health Care - statistics & numerical data
Quebec - epidemiology
Sex Factors
Socioeconomic Factors
Abstract
To test the explanatory power of a model of ambulatory service use and to determine the relative roles of the main determinants of physician utilization for two chronic medical conditions in adults in Quebec.
A behavioral model based on Andersen's model was developed and tested by linking two databases: the Quebec health survey as regards patient characteristics, and the Quebec health insurance board data on physician characteristics and service use. Path analysis was used for data analysis.
The model explained a little less than 20% of the variation in service use. The number of hospitalizations, physician's specialty and perceived health were the most important predictors of the volume of visits.
Further specification of utilization, relating it to a particular medical condition, does not necessarily lead to an increase in the explanatory power of the model. We recommend that future research should put more emphasis on provider-related determinants rather than focusing on the type and purpose of utilization.
PubMed ID
10180667 View in PubMed
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Electronic patient-provider communication: will it offset office visits and telephone consultations in primary care?

https://arctichealth.org/en/permalink/ahliterature68833
Source
Int J Med Inform. 2005 Sep;74(9):705-10
Publication Type
Article
Date
Sep-2005
Author
Trine S Bergmo
Per Egil Kummervold
Deede Gammon
Lauritz Bredrup Dahl
Author Affiliation
Norwegian Centre for Telemedicine, University Hospital of North Norway, N-9038 Tromsø, Norway. trine.bergmo@telemed.no
Source
Int J Med Inform. 2005 Sep;74(9):705-10
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Adult
Electronic Mail - utilization
Female
Health Care Surveys
Humans
Male
Norway - epidemiology
Office Visits - utilization
Physician-Patient Relations
Primary Health Care - statistics & numerical data
Remote Consultation - utilization
Research Support, Non-U.S. Gov't
Telephone - utilization
Abstract
BACKGROUND AND AIM: Electronic patient-provider communication promises to improve efficiency and effectiveness of clinical care. This study aims to explore whether a secure web-based messaging system is an effective way of providing patient care in general practices. METHOD: We conducted a randomised controlled trail and recruited 200 patients from the waiting area in one primary clinic in Norway. Participants were randomised to either the intervention group, which received access to a secure messaging system, or the control group receiving standard care without such access. Primary outcome measures were number of online consultations, telephone consultations and office visits in the two groups. Data were derived from patient records and collected 1 year prior to (baseline), and 1 year after the intervention. RESULTS: Forty-six percent of the patients who were given access to the messaging system (n=99) used the online communication system on at least one occasion (ranging from 1 to 17 messages per patient per year). A total of 147 electronic messages were sent to six general practitioners during a 1-year trial period. Eleven percent of the messages were to schedule an appointment. In 10% of the messages, the GP was unable to respond adequately and recommended an office visit. The reduction in office visits over time was greater for the intervention group than for the control group (P=0.034). There was however no significant difference in the number of telephone consultations between the groups during the study (P=0.258). CONCLUSION: The use of a secure electronic messaging system reduced the number of office visits at the general practice, but not phone consultations.
PubMed ID
16095961 View in PubMed
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Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to services?

https://arctichealth.org/en/permalink/ahliterature167233
Source
BMC Health Serv Res. 2006;6:123
Publication Type
Article
Date
2006
Author
Pekka Virtanen
Mika Kivimäki
Jussi Vahtera
Markku Koskenvuo
Author Affiliation
School of Public Health, University of Tampere, Tampere, Finland. pekka.j.virtanen@uta.fi
Source
BMC Health Serv Res. 2006;6:123
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Dental Care - utilization
Employment - classification - statistics & numerical data
Female
Finland
Health Care Surveys
Health Services - utilization
Health Services Needs and Demand - statistics & numerical data
Humans
Insurance Coverage
Male
Middle Aged
Occupational Health Services - utilization
Odds Ratio
Office Visits - utilization
Outpatient Clinics, Hospital - utilization
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - utilization
Private Practice - utilization
Regression Analysis
Abstract
The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets.
A total of 16,000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models.
Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53-0.81) and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14-0.31). A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73) and also low odds ratios for dentists (ORs between 0.45 and 0.91), whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39).
The use of physician services varies according to labour market status, being relatively low among the non-permanently employed and the unemployed. This underuse is emphasised when clinical need is taken into account. The main reasons for the variance evidently lie in the structures of the Finnish health service system. The result may indicate non-optimal health care of the population on the periphery of the labour market, but it may also reflect the importance of employment status as a context for need and the decision to visit a physician.
Notes
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PubMed ID
17014702 View in PubMed
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67 records – page 1 of 7.