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Patient Payment and Unhealthy Behavior: A Comparison across European Countries. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2615105. [PMID: 28261606 PMCID: PMC5316444 DOI: 10.1155/2017/2615105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Prior research has documented that unhealthy behaviors result in greater health care use and greater health care costs. However, there are few studies on out-of-pocket expenditure paid by those engaging in unhealthy behaviors. We provide cross-country evidence on the association of smoking, alcohol consumption, and obesity with health care use and health care cost as well as out-of-pocket payments among the elderly in Europe. Method. Using SHARE dataset for 13 European countries, the study uses a sequential logit model to analyze use and payments for outpatient and inpatient health care service in addition to a two-part model for the analysis of use and payments for prescribed drugs. Results. Former smoking is associated with a higher rate of health care use. However, current smoking is associated with lower health care use. Former smoking is also associated with paying higher amount of out-of-pocket payments. Alcohol consumption is associated with lower health care use. Conclusion. We do not find systematic evidence that unhealthy behaviors among elderly (50+) are associated with more utilization of health care and more out-of-pocket payments. The results can be of interest for policies that aim to make people more responsible toward their health behaviors.
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Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos-Rey K, Vas J, von Ammon K, Hegyi G, Dragan S, Uehleke B, Fønnebø V, Lewith G. A systematic literature review of complementary and alternative medicine prevalence in EU. Complement Med Res 2014; 19 Suppl 2:18-28. [PMID: 23883941 DOI: 10.1159/000342708] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies suggest that complementary and alternative medicine (CAM) is widely used in the European Union (EU). We systematically reviewed data, reporting research quality and the prevalence of CAM use by citizens in Europe; what it is used for, and why. METHODS We searched for general population surveys of CAM use by using Ovid MEDLINE (1948 to September 2010), Cochrane Library (1989 to September 2010), CINAHL (1989 to September 2010), EMBASE (1980 to September 2010), PsychINFO including PsychARTICLES (1989 to September 2010), Web of Science (1989 to September 2010), AMED (1985 to September 2010), and CISCOM (1989 to September 2010). Additional studies were identified through experts and grey literature. Cross-sectional, population-based or cohort studies reporting CAM use in any EU language were included. Data were extracted and reviewed by 2 authors using a pre-designed extraction protocol with quality assessment instrument. RESULTS 87 studies were included. Inter-rater reliability was good (kappa = 0.8). Study methodology and quality of reporting were poor. The prevalence of CAM use varied widely within and across EU countries (0.3-86%). Prevalence data demonstrated substantial heterogeneity unrelated to report quality; therefore, we were unable to pool data for meta-analysis; our report is narrative and based on descriptive statistics. Herbal medicine was most commonly reported. CAM users were mainly women. The most common reason for use was dissatisfaction with conventional care; CAM was widely used for musculoskeletal problems. CONCLUSION CAM prevalence across the EU is problematic to estimate because studies are generally poor and heterogeneous. A consistent definition of CAM, a core set of CAMs with country-specific variations and a standardised reporting strategy to enhance the accuracy of data pooling would improve reporting quality.
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Affiliation(s)
- Susan Eardley
- Complementary and Integrated Medicine Research Unit, University of Southampton, UK
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Wolfenstetter SB, Menn P, Holle R, Mielck A, Meisinger C, von Lengerke T. Body weight changes and outpatient medical care utilisation: Results of the MONICA/KORA cohorts S3/F3 and S4/F4. PSYCHO-SOCIAL MEDICINE 2012; 9:Doc09. [PMID: 23133503 PMCID: PMC3488805 DOI: 10.3205/psm000087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: To test the effects of body weight maintenance, gain, and loss on health care utilisation in terms of outpatient visits to different kinds of physicians in the general adult population. Methods: Self-reported utilisation data were collected within two population-based cohorts (baseline surveys: MONICA-S3 1994/95 and KORA-S4 1999/2001; follow-ups: KORA-F3 2004/05 and KORA-F4 2006/08) in the region of Augsburg, Germany, and were pooled for present purposes. N=5,147 adults (complete cases) aged 25 to 64 years at baseline participated. Number of visits to general practitioners (GPs), internists, and other specialists as well as the total number of physician visits at follow-up were compared across 10 groups defined by body mass index (BMI) category maintenance or change. Body weight and height were measured anthropometrically. Hierarchical generalized linear regression analyses with negative binomial distribution adjusted for sex, age, socioeconomic status (SES), survey, and the need factors incident diabetes and first cancer between baseline and follow-up were conducted. Results: In fully adjusted models, compared to the group of participants that maintained normal weight from baseline to follow-up, the following groups had significantly higher GP utilisation rates: weight gain from normal weight (+36%), weight loss from preobesity (+39%), maintained preobesity (+34%), weight gain after preobesity (+43%), maintained moderate obesity (+48%), weight gain from moderate obesity (+107%), weight loss from severe obesity (+114%), and maintained severe obesity (+83%). Regarding internists, those maintaining moderate obesity reported +107% more visits; those with weight gain from moderate obesity reported +91%. The latter group also had +41% more consultations with other physicians. Across all physicians, mean number of visits were estimated at 7.8 per year for maintained normal weight, 9 for maintained preobesity, 11 for maintained moderate obesity, and 12 for maintained severe obesity. Among those with weight loss, the mean number of visits were 8.7, 10.6 and 10.8 for baseline preobesity, moderate obesity, and severe obesity, respectively. Finally, those with weight gain from normal weight and preobesity reported 9.4 and 9.3 visits, respectively, and those with baseline moderate and follow-up severe obesity reported 13.1 visits (the most overall). Women reported higher GP and other physician utilisation. While all utilisation rates increased with age, GP utilisation was lower in middle to high SES groups. Conclusion: Compared to maintained normal weight over a 7- to 10-year period, maintained overweight, weight gain and weight loss are associated with higher outpatient physician utilisation in adults, especially after baseline obesity. These effects only partly became insignificant after inclusion of incident diabetes or first cancer into the model. Future research should further elucidate the associations between weight development and health care utilisation by BMI status and the mechanisms underlying these associations.
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Affiliation(s)
- Silke B Wolfenstetter
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Alexander E, Rosenthal S, Evans C. Achieving consensus on recommendations for the clinical management of overweight and obese adults for canadian physiotherapy practice. Physiother Can 2012; 64:42-52. [PMID: 23277684 PMCID: PMC3280708 DOI: 10.3138/ptc.2010-39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to reach consensus on the importance and feasibility of clinical practice guideline (CPG) recommendations for physiotherapy practice for the prevention and management of overweight and obesity in Canadian adults. METHODS We used a modified Delphi method to achieve consensus. Participants rated the importance and feasibility of recommendations using a nine-point scale in two rounds of electronic surveys and a conference call. The mean and distribution of ratings were analyzed to determine consensus. RESULTS Twenty-one physiotherapists experienced in the management of patients with obesity and representing diverse regions of Canada and areas of practice participated. Seventeen (81.0%) completed survey 1. Ten (47.6%) participated in the conference call and survey 2. Eight of 34 strategies received mean ratings of 7.00 or more for both importance and feasibility from at least two-thirds of participants. These strategies were related to physical activity prescription and assessment. CONCLUSIONS A sample of physiotherapists in Canada agreed that obesity-related CPGs contain recommendations that are important to physiotherapy practice. These findings, along with the Canadian Physiotherapy Association's position statement on obesity, provide support for the argument that physiotherapists, as direct-access practitioners or members of multidisciplinary teams, should play a role in the health care of people with obesity and overweight.
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Affiliation(s)
| | | | - Cathy Evans
- Eramosa Physiotherapy Associates, Guelph, Ont. (at time of study)
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Wildenschild C, Kjøller M, Sabroe S, Erlandsen M, Heitmann BL. Change in the prevalence of obesity and use of health care in Denmark: an observational study. Clin Epidemiol 2011; 3:31-41. [PMID: 21326657 PMCID: PMC3035604 DOI: 10.2147/clep.s15230] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the influence of the increasing prevalence of obesity on the development of health care utilization in Denmark in the period 1987-2005. PATIENTS AND METHODS From a random sample of adult Danes (19,142 women and 18,335 men) who participated in the Danish Health Interview Surveys in 1987, 1994, 2000, and 2005, self-reported data on type of health care utilization within the previous 3 months and on height and weight were obtained. RESULTS Adjusted odds ratios (ORs) showed that an increased use of health care among obese men compared with those of normal weight was pronounced and significant for those aged 45-64 years, whereas it was weaker and borderline significant for those aged 25-44 and 65+ years. Among obese men, there was an increasing use of health care until 2005. Among women, there was also an increased use of health care among the obese women in comparison with the normal weight women. An increase in the use of health care was found among obese women during 1987-2000, followed by a leveling of utilization during 2000-2005. CONCLUSIONS In conclusion, this study showed that the increase in health care utilization in Denmark could, in part, be attributed to an increase in prevalence of obesity and to an increase in health care utilization among obese men in particular.
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Affiliation(s)
- Cathrine Wildenschild
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Kjøller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Svend Sabroe
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Mogens Erlandsen
- Department of Biostatistics, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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von Lengerke T, John J, Mielck A. Excess direct medical costs of severe obesity by socioeconomic status in German adults. PSYCHO-SOCIAL MEDICINE 2010; 7:Doc01. [PMID: 20421952 PMCID: PMC2858876 DOI: 10.3205/psm000063] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Excess direct medical costs of severe obesity are by far higher than of moderate obesity. At the same time, severely obese adults with low socioeconomic status (SES) may be expected to have higher excess costs than those with higher SES, e.g. due to more comorbidities. This study compares excess costs of severe obesity among German adults across different SES groups. Methods: In a subsample (N=947) of the KORA-Survey S4 1999/2001 (a cross-sectional health survey in the Augsburg region, Germany; age group: 25–74 years), visits to physicians, inpatient days in hospital, and received and purchased medication were assessed via computer-assisted telephone interviews (CATI) over half a year. Body mass index (BMI in kg/m²) was measured anthropometrically. SES was determined via reports of education, income, and occupational status from computer-assisted personal interviews (CAPI) (used both as single indicators, and as indexed by the Helmert algorithm); due to small subsample sizes all were median-split. Data of respondents in normal weight (18.5 ≤ BMI < 25), preobese (25 ≤ BMI < 30), moderately (class 1:30 ≤ BMI < 35) and severely obese (classes 2–3: BMI ≥ 35) range were analysed by generalized linear models with mixed poisson-gamma (Tweedie) distributions. Physician visits and inpatient days were valuated as recommended by the Working Group Methods in Health Economic Evaluation (AG MEG), and drugs were valuated by actual costs. Sex, age, kind of sickness fund (statutory/private) and place of residence (urban/rural) were adjusted for, and comorbidities were considered by the Physical Functional Comorbidity Index (PFCI). Results: Excess costs of severe obesity were higher in respondents with high SES, regardless of the SES indicator used. For instance, annual excess costs were almost three times higher in those with an above-median SES-Index as compared with those with a median or lower SES-Index (plus € 2,966 vs. plus € 1,012; contrast significant at p<.001). Mediation of excess costs of severe obesity by physical comorbidities pertained to the low SES-Index and the low occupational status groups: differences in costs between severe obesity and normal weight were still positive, but statistically insignificant, in the lower status groups after adjusting for the PFCI, but still positive and significant given higher SES. For example, severe obesity’s excess costs were € 2,406 after PFCI-adjustment in the high SES-Index group (p<.001), but € 539 in the lower status group (p=.17). At the same time, physical comorbidities as defined by the PCFI increased with BMI and decreased with SES, however the factors BMI and SES did not significantly interact in this context. Conclusions: To our knowledge, this is the first study to show in Germany that excess direct medical costs of severe obesity are not distributed equitably across different SES groups, do not reflect comorbidity status, and are significantly higher in those with high SES than in those with lower SES. Thus, allocation of health care resources spent on severely obese adults seems to be in need of readjustment towards an equitable utilization across all socioeconomic groups.
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Affiliation(s)
- Thomas von Lengerke
- Hannover Medical School, Medical Psychology Unit, Hannover, Germany Helmholtz Center Munich - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Wiczinski E, Döring A, John J, von Lengerke T. Obesity and health-related quality of life: does social support moderate existing associations? Br J Health Psychol 2009; 14:717-34. [PMID: 19187576 DOI: 10.1348/135910708x401867] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Obesity has been shown to be negatively related to physical health-related quality of life (HQOL) much more strongly than mental HQOL. This is remarkable given findings on obesity-related social stigmata and associations with depression. Considering obesity as a stressor, this study tests for a moderating role of social support for obesity/HQOL associations among women and men. DESIGN Data come from N=2,732 participants aged 35-74 years in a 2004-2005 general population survey in the Augsburg region, Germany. METHODS Body weight and height were assessed by anthropometric measurements (classified by body mass index using WHO standards), social support by the Social Support Questionnaire 14-item Short-Form (F-SozU-K14) and HQOL by the 12-item Short-Form Health Survey (SF-12). In multiple regression and general linear models, age, education, family status, health insurance, and place of residence were adjusted for. RESULTS Among both genders, obesity was associated with reduced physical but not mental HQOL. Among men reporting strong social support, physical HQOL was impaired neither in the moderately nor the severely obese group (compared with normal weight), while it was given less social support. Among women, poor physical HQOL was associated with obesity regardless of social support. CONCLUSIONS In this adult population sample, no association was found for obesity with mental HQOL. In contrast, a negative association with physical HQOL exists for all subgroups except men with strong social support, indicating that social support buffers obesity-related impairments in physical HQOL in men but not in women. This suggests that obese women and men with strong social support represent distinct populations, with possible implications for obesity care.
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Affiliation(s)
- Eileen Wiczinski
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
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Von Lengerke T, John J. Excess use of general practitioners by obese adults: Does health-related quality of life account for the association? PSYCHOL HEALTH MED 2007; 12:536-44. [PMID: 17828674 DOI: 10.1080/13548500701203425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As general practitioners (GP) are seeing, and are likely to continue to see, increasing numbers of obese patients in their practices, it is relevant to know with which needs these patients enter general practice. The present study aims to determine whether besides physical comorbidities, health-related quality of life (HRQOL) accounts for associations of obesity with GP use. In a general population survey in Augsburg, Germany (KORA-Survey S4 1999/2001), anthropometric body mass (BMI in kg/(m(2))), physical comorbidities, HRQOL (the 12-item Short Form; SF-12), and visits to GP were assessed, and analyzed by logistic and zero-truncated negative binomial regressions (two-part model). Gender, age, socio-economic status, marital status, health insurance, and place of residence were adjusted for. The sample consisted of N = 942 residents aged 25 - 74, who had been randomly sampled from 17 cluster-sampled communities, and were either normal-weight, overweight, moderately obese, or severely obese. The moderately obese group had higher odds than the normal-weight to report any GP use; however, while being predictive, neither physical comorbidity nor HRQOL mediated this. In contrast, with regard to number of GP visits among users, the severely obese group (BMI >/= 35) reported significantly more visits than the normal-weight group, and both physical comorbidity and physical (but not mental) HRQOL accounted for this. In conclusion, physical comorbidity and HRQOL mediate excess use of GP by severely obese users in terms of number of visits. Thus, for this group, subjective physical health seems to be important besides physical comorbidities, suggesting for general practice to focus both on evaluated and perceived needs of these patients.
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Karampoiki V, Flores FJR, Altinoz H, Chojnacka M, Karentzou I, Dambrosio M, Colichi C, Oxiuzova T, Kanavoura E, de Sousa BAMDSA, Ivanova D, Mauri J, Alexiou G, Mauri D, Kamposioras K, Maragkaki A, Peponi C. Screening Evaluation System--Europe (SESy_Europe) met skin cancer screening. Cent Eur J Public Health 2007; 15:71-3. [PMID: 17645221 DOI: 10.21101/cejph.a3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Skin tumors are the most frequent malignancies in the white population worldwide and have reached the proportion of an epidemic disease. Since non-melanocytic skin cancers can be cured when timely detected, given that still malignant melanoma may have good prognosis if early diagnosed, and considering the key role of primary care in cancer screening advising and implementation, the international PACMeR study group (trial_01.3) adjourned SESy_Europe database in a version comprehensive of skin-malignancies screening indexing. The novel database provides standardized pre-codified translations of 2,331 parameters in eight languages (English, French, German, Greek, Italian, Romanian, Spanish and Turkish) and records the time elapsed from last skin examination, cause and frequency of skins examinations and stratifies skin cancer risk patterns by a systematic registering of risk factors. A comprehensive indexing of skin cancer screening practices among European countries may in fact turn helpful in programming future health policy and tailoring interventions.
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General practitioners’ opportunities for preventing ill health in healthy vs morbid obese adults: a general population study on consultations. J Public Health (Oxf) 2007. [DOI: 10.1007/s10389-006-0086-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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