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Fricke LM, Krüger K. Subgroup analyses and patterns of multiple sclerosis health service utilisation: A cluster analysis. Mult Scler J Exp Transl Clin 2024; 10:20552173241260151. [PMID: 38910839 PMCID: PMC11191614 DOI: 10.1177/20552173241260151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Previous investigations of multiple sclerosis (MS)-related healthcare have focused on utilisation of specific individual health services (e.g. hospital care, office-based neurologists) by people with MS (PwMS). Meanwhile, little is known about possible patterns of utilisation across health services and their potential differences across patient characteristics. Objective To comprehensively analyse and identify patterns of MS-related health service utilisation and detect patient characteristics explaining such patterns. Methods In 2021, we invited all PwMS insured by the largest insurance company in Lower Saxony, Germany, to take part in an online survey. We merged respondents' survey and health insurance claims data. We analysed MS-related health service utilisation and defined individual characteristics for subgroup analyses based on Andersen's Behavioural Model. We executed non-parametric missing value imputation and conducted hierarchical clustering to find patterns in health service utilisation. Results Of 6928 PwMS, 1935 responded to our survey and 1803 were included in the cluster analysis. We identified four distinct health service utilisation clusters: (1) regular users (n = 1130), (2) assistive care users (n = 443), (3) low users (n = 195) and (4) special services users (n = 35). Clusters differ by patient characteristics (e.g. age, impairment). Conclusion Our findings highlight the complexity of MS-related health service utilisation and provide relevant stakeholders with information allowing them to tailor healthcare planning according to utilisation patterns.
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Affiliation(s)
- Lara Marleen Fricke
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Kathrin Krüger
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
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McPeake J, Bateson M, Christie F, Robinson C, Cannon P, Mikkelsen M, Iwashyna TJ, Leyland AH, Shaw M, Quasim T. Hospital re-admission after critical care survival: a systematic review and meta-analysis. Anaesthesia 2022; 77:475-485. [PMID: 34967011 DOI: 10.1111/anae.15644] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.
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Affiliation(s)
- J McPeake
- Intensive Care Unit, Glasgow Royal Infirmary and School of Medicine, Dentistry and Nursing, University of Glasgow, UK
| | - M Bateson
- University of the West of Scotland, Glasgow, UK
| | - F Christie
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C Robinson
- Belfast Health and Social Care Trust, Belfast, UK
| | - P Cannon
- University of Glasgow Library, Glasgow, UK
| | - M Mikkelsen
- Center for Clinical Epidemiology and Biostatistics, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - T J Iwashyna
- Centre for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
| | - A H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Shaw
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - T Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.,Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
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Estrup S, Thygesen LC, Poulsen LM, Gøgenur I, Mathiesen O. Health care use before and after intensive care unit admission-A nationwide register-based study. Acta Anaesthesiol Scand 2021; 65:381-389. [PMID: 33174207 DOI: 10.1111/aas.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/23/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to describe healthcare utilization of patients admitted to ICU before and after ICU admission. METHODS Register-based study including adult patients discharged from ICU between January 1st, 2011 and December 31st, 2014. Reference group was a sex- and age-matched population not admitted to an ICU in the study period. Outcomes were hospital admissions, contacts to general practitioner or emergency services and municipality services from 1 year before ICU admission and up to 3 years after. RESULTS The study included 82 384 patients and an equal number of reference persons. Of patients with ICU admission, 48% were married (reference group 57%), 48% had elementary school education (reference group 38%) and 18% had a Charlson co-morbidity score of 5+ (4% in reference group). We found that 51% of patients with an ICU admission had been admitted to hospital in the year before ICU admission (reference group 15%) and 97% had a contact to a general practitioner (reference group 89%) in the same period. CONCLUSIONS Patients admitted to an ICU had increased use of both primary and secondary health care both before and for years after ICU treatment, even after adjustment for comorbidities and socio-economic factors.
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Affiliation(s)
- Stine Estrup
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Køge Denmark
| | - Lau C Thygesen
- National Institute of Public HealthUniversity of Southern Denmark København Denmark
| | - Lone M Poulsen
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Køge Denmark
| | - Ismail Gøgenur
- Department of Gastrointestinal Surgery Center for Surgical ScienceZealand University Hospital Køge Køge Denmark
| | - Ole Mathiesen
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Køge Denmark
- Department of Clinical Medicine Copenhagen University København Denmark
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4
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Hietanen S, Herajärvi J, Lahtinen S, Käkelä R, Ala-Kokko T, Liisanantti J. Utilization of health care resources, long-term survival and causes of death after intensive care unit admission in relation to high-risk alcohol consumption. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1838636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Siiri Hietanen
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Johanna Herajärvi
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Sanna Lahtinen
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Riikka Käkelä
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Tero Ala-Kokko
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Janne Liisanantti
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
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Mendizabal A, Thibault DP, Crispo JA, Paley A, Willis AW. Comorbid disease drives short-term hospitalization outcomes in patients with multiple sclerosis. Neurol Clin Pract 2020; 10:255-264. [PMID: 32642327 DOI: 10.1212/cpj.0000000000000838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/10/2020] [Indexed: 11/15/2022]
Abstract
Objective Readmission is used as a quality indicator and is the primary target outcome for disease-modifying therapy (DMT) for multiple sclerosis (MS). However, data on readmissions for patients with MS are limited. Methods Using the US Nationwide Readmissions Database, we performed a retrospective cohort study of adults hospitalized for MS in 2014. Primary study outcomes were within 30- and 90-day readmissions. Descriptive analyses compared patient, clinical, and hospital variables readmission status. Multivariable logistic regression models estimated the associations between these variables and readmission. Results Of 16,629 individuals meeting the study criteria, most were women (73.7%), aged 35-54 years (48.0%), and Medicare program participants (36.8%). In total, 49.7% of inpatients with MS had 1-2 comorbid medical conditions and 23.7% had 3 or more. Having 3 or more comorbidity conditions associated with increased adjusted odds of the 30-day readmission (adjusted odds ratio [AOR] 1.92, 1.34-2.74). Anemia (AOR 1.62, 1.22-2.14), rheumatoid arthritis/collagen vascular diseases (AOR 2.20, 1.45-3.33), congestive heart failure (AOR 2.43, 1.39-4.24), chronic pulmonary disease (AOR 1.35, 1.02-1.78), diabetes with complications (AOR 2.27, 1.45-3.56), hypertension (AOR 1.25, 1.03-1.53), obesity (AOR 1.35, 1.05-1.73), and renal failure (AOR 1.68, 1.06-2.67) were associated with the 30-day readmission. Medicare insurance and nonroutine discharge were also associated with readmission, whereas patient characteristics (sex, age, and socioeconomic status) were not. The most frequent (26.7%) reason for readmission was multiple sclerosis. Ninety-day analyses produced similar findings. Conclusions Comorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management.
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Affiliation(s)
- Adys Mendizabal
- Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Dylan P Thibault
- Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - James A Crispo
- Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Adina Paley
- Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Allison W Willis
- Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Al-Sakran L, Marrie RA, Blackburn D, Knox K, Evans C. Association between disease-modifying therapies for multiple sclerosis and healthcare utilisation on a population level: a retrospective cohort study. BMJ Open 2019; 9:e033599. [PMID: 31772108 PMCID: PMC6887031 DOI: 10.1136/bmjopen-2019-033599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Disease-modifying therapy (DMT) use in multiple sclerosis (MS) has increased significantly. However, the impact of DMTs on healthcare use is limited and conflicting, and rarely examined at a population level. This study examined the association between DMTs and healthcare utilisation at the population level. DESIGN Retrospective cohort. SETTING Health administrative data from Saskatchewan, Canada (1997-2016). PARTICIPANTS To test for associations at the population level, we identified two cohorts. The general population cohort included all Saskatchewan residents ≥18 years who were drug plan beneficiaries. The MS cohort included individuals ≥18 years, identified using a validated definition (≥3 hospital, physician or drug claims for MS). MAIN OUTCOME MEASURES AND METHODS To test for an association between the total number of DMT dispensations per year and the total number of hospitalisations we used negative binomial regression fitted with generalised estimating equations (GEE); only hospitalisations that occurred after the date of MS diagnosis (date of first claim for MS or demyelinating disease) were extracted. To test for an association between the number of DMT dispensations and physician claims, negative binomial distributions with GEE were fit as above. Results were reported as rate ratios (RR), with 95% CIs, and calculated for every 1000 DMT dispensations. RESULTS The number of DMT dispensations was associated with a decreased risk for all-cause (RR=0.994; 95% CI 0.992 to 0.996) and MS-specific (RR=0.909; 95% CI 0.880 to 0.938) hospitalisations. The number of DMT dispensations was not associated with the number of all-cause (RR=1.006; 95% CI 0.990 to 1.022) or MS-specific (RR=0.962; 95% CI 0.910 to 1.016) physician claims. CONCLUSION Increased DMT use in Saskatchewan was associated with a reduction in hospitalisations, but did not impact the number of physician services used. Additional research on cost-benefit and differing treatment strategies would provide further insight into the true impact of DMTs on healthcare utilisation at a population level.
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Affiliation(s)
- Lina Al-Sakran
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ruth Ann Marrie
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine Knox
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Roddam H, Rog D, Janssen J, Wilson N, Cross L, Olajide O, Dey P. Inequalities in access to health and social care among adults with multiple sclerosis: A scoping review of the literature. Mult Scler Relat Disord 2019; 28:290-304. [DOI: 10.1016/j.msard.2018.12.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/11/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
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McCann MR, Hill WF, Yan J, Rehou S, Jeschke MG. Burn injury and multiple sclerosis: A retrospective case-control study. Burns 2018; 45:247-252. [PMID: 30477818 DOI: 10.1016/j.burns.2018.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether having a previous diagnosis of multiple sclerosis (MS) changed acute care needs in burn-injured patients. METHODS This was a retrospective case-control study that included adult (aged ≥18years) patients with an acute burn injury. Control patients were matched with eleven patients with a history of MS at a 4:1 ratio. Outcomes included fluid resuscitation volumes, temperature, heart rate, mean arterial pressure, in-hospital complications, and hospital length of stay (LOS). RESULTS There were fifty-five patients included and of those, eleven had a documented history of MS. Fluid resuscitation volumes, temperature, heart rate, and mean arterial pressure were similar between groups during the resuscitation period (p>0.05). LOS was similar between both groups (12, IQR: 2-17 vs. median 16, IQR: 12-21; p=0.090). However, when normalized to % TBSA burn, patients with MS had a significantly higher median LOS/% TBSA burned (1.2, IQR: 0.7-2.0 vs. 2.1, IQR: 1.1-7.1; p=0.031). CONCLUSIONS Patients with concurrent burn injuries and MS have a significantly longer LOS/% TBSA burn suggesting that more time is required to heal their wounds. Surprisingly, there were no other significant differences in the after the burn acute phase between these two cohorts.
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Affiliation(s)
| | | | - Jinhui Yan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Rehou
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Garland A, Metz LM, Bernstein CN, Peschken CA, Hitchon CA, Marrie RA. Hospitalization is associated with subsequent disability in multiple sclerosis. Mult Scler Relat Disord 2017; 14:23-28. [PMID: 28619426 DOI: 10.1016/j.msard.2017.03.009] [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] [Received: 02/13/2017] [Revised: 03/13/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although an increasing amount of research has evaluated interactions between MS and comorbid chronic disease, few data exist regarding the interactions between MS and acute illness. As compared to age and sex-matched persons without MS, persons with MS experience higher rates of hospitalization and critical illness, and higher mortality rates and health care utilization following critical illness. We aimed to determine whether acute illness requiring hospitalization is associated with progression of multiple sclerosis (MS). METHODS We conducted this population-based, retrospective cohort study by linking data from the regional MS Clinic in Calgary, Canada with the Canadian Discharge Abstract Database to identify non-obstetric hospitalizations. We included individuals with a confirmed diagnosis of MS, at least one recorded Expanded Disability Status Scale (EDSS) measurement, and known age of symptom onset of age 10 years or older. Using data from 2009 to 2014, we used generalized linear models with generalized estimating equations to establish the association within individuals between hospitalization and the time course of MS-related disability (as measured by the EDSS), adjusting for sex, age, disease course at onset, and use of disease-modifying therapies. RESULTS We included 2104 individuals with MS in the analysis, who had a median of 4 EDSS measurements each. Of these 491 (23.3%) had at least one hospitalization. Most subjects were female, with a relapsing disease course at onset, and a mean (SD) age at symptom onset of 33.0 (10.0) years. The underlying rate of disability progression averaged 0.9 EDSS points per decade. Following hospitalization, there was a step increase in EDSS, averaging 0.23 points, equivalent to 2.5 years of time-related disease progression. Hospitalization did not alter the subsequent temporal rate of disability progression. The findings did not differ in those hospitalized for MS versus other reasons. CONCLUSIONS Acute illness requiring hospitalization is associated with a worsening of MS-related disability.
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Affiliation(s)
- Allan Garland
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Canada
| | - Luanne M Metz
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Canada
| | - Christine A Peschken
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada.
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10
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Salinsky M, Storzbach D, Goy E, Kellogg M, Boudreau E. Health care utilization following diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav 2016; 60:107-111. [PMID: 27206227 DOI: 10.1016/j.yebeh.2016.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/21/2016] [Accepted: 04/02/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The long-term outcome of patients with psychogenic nonepileptic seizures (PNES) is of importance given the disabling symptoms and tendency to affect patients early in their productive years. Health care utilization (HCU) is an important outcome measure reflecting overall health status and costs. There is little information regarding long-term HCU following diagnosis of PNES. METHODS We retrospectively reviewed records of Veterans diagnosed with PNES during epilepsy monitoring unit (EMU) evaluation. For the three-year period following diagnosis of PNES, we reviewed emergency department (ED) visits, hospitalizations, outpatient clinic visits, and radiology procedures. We compared the three years following PNES diagnosis with the three years preceding diagnosis. We also compared patients with PNES and patients with epileptic seizures (ES). RESULTS Emergency department visits and hospitalizations were more frequent in patients with PNES compared with those in patients with ES (p=0.01). There was no overall improvement in HCU during the three-year interval following diagnosis of PNES. A transient decrease during the year following diagnosis was not sustained over three-year follow-up. Pain complaints rather than seizures were the most common reason for presentation, whereas the opposite was true for patients with ES (p<0.01). There was a sharp decrease in neurology outpatient visits (p<0.001) and a decrease in primary care visits (p<0.05) after PNES was diagnosed. Total outpatient visits were unchanged. CONCLUSIONS Overall HCU did not improve during the three years following diagnosis of PNES, compared with three years preceding diagnosis. The results add to studies documenting poor seizure outcomes following diagnosis of PNES and underscore the need for more effective and comprehensive treatments, addressing comorbid symptoms.
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Affiliation(s)
- Martin Salinsky
- Portland Veterans Affairs Medical Center, Portland, OR, United States; Oregon Health & Sciences University, Portland, OR, United States.
| | - Daniel Storzbach
- Oregon Health & Sciences University, Portland, OR, United States
| | - Elizabeth Goy
- Oregon Health & Sciences University, Portland, OR, United States
| | - Marissa Kellogg
- Oregon Health & Sciences University, Portland, OR, United States
| | - Eilis Boudreau
- Portland Veterans Affairs Medical Center, Portland, OR, United States; Oregon Health & Sciences University, Portland, OR, United States
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11
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Banwell B, Giovannoni G, Hawkes C, Lublin F. Editors' Welcome. Mult Scler Relat Disord 2015. [PMID: 26195063 DOI: 10.1016/j.msard.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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