1
|
Jahan N, Akter S, Heme MA, Chandra D, Polly A, Siddiqua L, Rahman R, Mohsin KF, Hossain MT. Healthcare-seeking behaviour of marginalised older people in urban slums: a cross-sectional survey study in Khulna City, Bangladesh. BMJ Open 2022; 12:e066376. [PMID: 36368763 PMCID: PMC9660562 DOI: 10.1136/bmjopen-2022-066376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to measure healthcare-seeking behaviour and determine its associated factors among older people in the slums of the Khulna City Corporation (KCC) areas of Bangladesh. DESIGN Cross-sectional survey. SETTINGS Four slums in the KCC areas of Bangladesh. PARTICIPANTS The participants were selected following a two-stage area probability sampling with the following specifications: they must be aged ≥60 years and must have lived in the slums of KCC for at least 5 consecutive years. OUTCOME MEASURES A semistructured interview schedule was administered to determine participants' healthcare-seeking behaviour, with healthcare-seeking behaviour measured through a dichotomous response of 'yes' or 'no'. RESULTS 636 participants were included in the study. Gastrointestinal problems (75.3%) and aches and pains (71.5%) were the two most common health problems among older people in the slums of KCC. Older adults in their 80s had higher adjusted odds of attaining healthcare services (adjusted OR (AOR)=2.028; 95% CI: 1.140 to 3.609; p<0.05) than other older people, while educated older people (AOR=0.664; 95% CI: 0.441 to 1.000; p<0.05) and those with greater satisfaction with domains of life (SDL index; AOR=0.860; 95% CI: 0.811 to 0.912; p<0.01) were less inclined to seek healthcare services than their counterparts. Additionally, widows/widowers (AOR=2.218; 95% CI: 1.080 to 4.556; p<0.05) and married people (AOR=2.750; 95% CI: 1.329 to 5.689; p<0.01) had higher adjusted odds of seeking healthcare services than those who were divorced/separated. CONCLUSION Age, education, marital status and SDL index were significant predictors for the healthcare-seeking behaviour of older people in KCC slums. Effective strategies need to be implemented to reduce existing access barriers to healthcare services for older people in the slum areas of urban Bangladesh.
Collapse
Affiliation(s)
- Nusrat Jahan
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Shahinur Akter
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Morsheda Akter Heme
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Dipika Chandra
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Afsana Polly
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Laila Siddiqua
- Architecture Discipline, Science, Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Rumana Rahman
- English Discipline, Arts and Humanities School, Khulna, Bangladesh
| | - Kaniz Fatima Mohsin
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Md Tanvir Hossain
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| |
Collapse
|
2
|
Chien CY, Chaou CH, Yeh CC, Hsu KH, Gao SY, Ng CJ. Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department. BMC Emerg Med 2022; 22:86. [PMID: 35590239 PMCID: PMC9118587 DOI: 10.1186/s12873-022-00646-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 05/09/2022] [Indexed: 12/20/2022] Open
Abstract
Background Owing to societal ageing, the number of older individuals visiting emergency departments (EDs) has increased in recent years. For this patient population, accurate triage systems are required. This retrospective cohort study assessed the accuracy of a computerised five-level triage system, the Taiwan Triage and Acuity System (TTAS), by determining its ability to predict in-hospital mortality in older adult patients and compare it with the corresponding rate in younger adult patients presenting to EDs. The association between frailty, which the current triage system does not consider, was also investigated. Methods The medical records of adult patients admitted to a single ED between 2016 and 2017 were reviewed. Data collected included information on demographics, triage level, frailty status, in-hospital mortality, and medical resource utilisation. The patients were divided into four age groups: two older adult groups (older: 65–84 years and very old: ≥85 years) and two younger adult groups (young: 18–39 and middle-aged: 40–64 years). Results Our study included 265,219 ED adult patients, of whom 64,104 and 16,009 were in the older and very old groups, respectively. The in-hospital mortality rate at each triage level increased with age. The ability of the TTAS to predict in-hospital mortality decreased with age (area under the receiver operating characteristic curve [AUROC]: young: 0.86; middle-aged, 0.84; and older and very old: 0.79). Frailty was associated with in-hospital mortality (odds ratio, 2.20; 95% confidence interval, 2.03–2.38). Adding mobility status as a frailty indicator to TTAS only slightly improved its ability to predict in-hospital mortality (AUROC: 0.74–0.77) in patients ≥65 years of age. Conclusions The ability of the current triage system to predict in-hospital mortality decreases with age. Although frailty as mobility was associated with in-hospital mortality, its addition to the TTAS only slightly improved the accuracy with which in-hospital mortality in older patients presenting to EDs was predicted. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00646-0.
Collapse
Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing St., Gueishan Dist, Taoyuan City, 333, Taiwan.,Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan.,Graduate Institute of Management, Chang Gung University, Taoyuan, 333, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing St., Gueishan Dist, Taoyuan City, 333, Taiwan.,Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan
| | - Chung-Cheng Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing St., Gueishan Dist, Taoyuan City, 333, Taiwan.,Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, 333, Taiwan.,Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, 333, Taiwan.,Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, 243, Taiwan
| | - Shi-Ying Gao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing St., Gueishan Dist, Taoyuan City, 333, Taiwan.
| |
Collapse
|
3
|
Emergency Department Visits and Disease Burden Attributable to Ambulatory Care Sensitive Conditions in Elderly Adults. Sci Rep 2019; 9:3811. [PMID: 30846843 PMCID: PMC6405841 DOI: 10.1038/s41598-019-40206-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50-5.58); UTI (aOR: 4.44, 95% CI 3.97-4.98); sepsis (aOR: 3.54, 95% CI 3.06-4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63-3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.
Collapse
|
4
|
Lu H, Wang W, Xu L, Li Z, Ding Y, Zhang J, Yan F. Healthcare seeking behaviour among Chinese elderly. Int J Health Care Qual Assur 2017; 30:248-259. [PMID: 28350225 DOI: 10.1108/ijhcqa-10-2015-0132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.
Collapse
Affiliation(s)
- Hui Lu
- Key Laboratory of Health Technology Assessment (Ministry of Health), Department of Social Medicine, School of Public Health, Fudan University , Shanghai, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University , Nanjing, China
| | - Wei Wang
- Key Laboratory of Health Technology Assessment (Ministry of Health), Department of Social Medicine, School of Public Health, Fudan University , Shanghai, China
| | - Ling Xu
- Department of Sampling and Survey, Center for Health, Statistics and Information, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Zhenhong Li
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Division of Chronic Diseases Prevention and Control, Bureau of Disease Prevention and Control, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yan Ding
- Division of Chronic Diseases Prevention and Control, Bureau of Disease Prevention and Control, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Jian Zhang
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University , Statesboro, Georgia, USA
| | - Fei Yan
- Key Laboratory of Health Technology Assessment (Ministry of Health), Department of Social Medicine, School of Public Health, Fudan University , Shanghai, China
| |
Collapse
|