Health care worry is associated with worse outcomes in multiple sclerosis

Financial hardship after cancer: revision of a conceptual model and development of patient-reported outcome measures

Aim: This qualitative study refined a conceptual model of financial hardship and developed measures corresponding to model constructs. Methods: Eighteen women with breast cancer recruited through a comprehensive cancer center completed interviews. A qualitative framework analysis was conducted of the interviews. Results: Participants experienced varying levels of financial hardship. Protective factors included good health insurance, work accommodations and social support. Participants worried about cancer care costs and employment. Programs for alleviating financial hardship had high administrative burdens. Four preliminary financial hardship measures were developed: coping, impacts, depression and worry. Conclusion: Reducing administrative barriers to benefits could reduce financial hardship after cancer. More research is needed on the effects of out-of-network/formulary care and denials of coverage and to validate the measures.

The impact of medical insurance on health care access and quality for people with multiple sclerosis in the United States: A scoping review

BACKGROUND

In the United States, health insurance coverage and quality mediate access to health care, a key social determinant of health.

OBJECTIVE

To perform a scoping review regarding the impact of insurance coverage and benefit design on health care access and both clinical and quality of life outcomes in people with MS (pwMS).

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. A literature search was conducted from January 2010 to February 2022. Included studies were in English, peer-reviewed, US-based, and evaluated elements of insurance and their relationship with access and quality outcomes for adult pwMS.

RESULTS

Our search identified 1619 articles, of which 32 met inclusion criteria. Privately insured pwMS were more likely to be on disease-modifying therapy (DMT). Increased out-of-pocket spending was associated with lower DMT adherence and greater discontinuation rates. Access to specialty pharmacy programs was associated with improved DMT adherence.

CONCLUSION

Health insurance coverage and design strongly influences health care for pwMS in the United States and may be a modifiable social determinant of health. Increased pharmaceutical cost-sharing is associated with declines in DMT utilization and adherence. Further study is needed to better characterize the impacts of other core elements of health insurance, including prior authorization requirements and step therapy.

Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients

BACKGROUND

Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare.

OBJECTIVE

Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion.

KEY RESULTS

Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18).

CONCLUSIONS

Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.

A theoretical model of financial burden after cancer diagnosis

Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.

Association of healthcare utilization with financial worry and anxiety in a general population sample

This study examined the association of healthcare use (HCU) with financial outcomes in a general population sample (n = 395) to determine if HCU was associated with increased financial worry as most research has examined socioeconomic indicators and material financial problems. Participants reported six types of HCUin the previous year, financial anxiety (FA) and worry about affording healthcare (WAH) in an online survey. In bivariate comparisons, WAH was associated with all forms of HCU and FA was associated with all forms of HCU except outpatient visits. In multivariate analyses, WAH was associated with outpatient visits, emergency room visits, number of doctors, number of scans and number of blood tests (p's<0.05) but not urgent care visits. FA was associated with emergency room visits, urgent care visits, and number of doctors (p's<0.05) but not other forms of HCU in multivariate comparisons. As many forms of HCU were associated with more WAH and FA, policy initiatives and patient-level interventions should focus on managing costs rather than shifting from emergency to outpatient care. Results also suggest that the financial costs of healthcare, as indexed by HCU, may have an effect on anxiety and worry specific to healthcare even when controlling for socioeconomic factors.

Assessing Worry About Affording Healthcare in a General Population Sample

This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.

The Relationship Among Multiple Sclerosis-Related Symptoms, Sleep Quality, and Sleep Hygiene Behaviors

AIMS AND OBJECTIVES

The aim of this study was to examine the relationships among multiple sclerosis (MS)-related symptoms, sleep hygiene behaviors, and sleep quality in adults with MS who self-report fatigue.

BACKGROUND

Fatigue is a frequent, prevalent symptom among adults with MS. Few studies have examined the relationship among fatigue and other symptoms with sleep quality and sleep behaviors.

DESIGN

This is a descriptive correlational study.

METHODS

A convenience sample of 39 adults with MS were recruited for the study. Instruments used included the revised MS Related Symptom Scale and the Pittsburgh Sleep Quality Index. Correlations examined the relationships among fatigue and other MS symptoms with sleep quality and sleep hygiene behaviors.

RESULTS

The frequency of several symptoms correlated with poor sleep quality, and fatigue frequency was higher in those who used electronic devices and practiced poor sleep hygiene behaviors.

NURSING IMPLICATIONS

Nurses should incorporate interventions for symptoms that impact sleep quality. These findings suggest that sleep hygiene education should be a part of routine clinical care.

CONCLUSION

Adults with MS experience the burden of many symptoms that impact sleep quality. Interventions that include education to improve symptoms, sleep hygiene behaviors, and sleep quality are needed.

Psychometric Validation of the Multiple Sclerosis Environmental Supports Scale: A Brief Report

The main objective of this study was to evaluate the measurement structure of the Multiple Sclerosis Environmental Supports Scale (MSESS) with 248 individuals with multiple sclerosis (MS). Exploratory factor analysis yielded three reliable factors (health and mental health services; rehabilitation, social, and support services; and independent living supports). The MSESS appears to be a promising rehabilitation assessment tool for individuals with MS, one that can be used by rehabilitation counselors to evaluate environmental support factors in their interview, assessment, and rehabilitation planning protocols.

The Relationship Between Career Thoughts and Adjustment for Individuals With Multiple Sclerosis

The study investigated the relationship between the psychosocial adjustment and dysfunctional career thoughts for adults with multiple sclerosis. The Reactions to Impairment and Disability Inventory measured psychosocial adjustment, and the Career Thoughts Inventory measured dysfunctional career thoughts. The results found that (a) higher levels of depression were associated with higher levels of decision-making confusion and commitment anxiety and (b) higher levels of adjustment were associated with lower levels of decision-making confusion. Rehabilitation counselor implications are discussed.

Association between employee benefits and frailty in community-dwelling older adults

AIM

The phenotype of frailty has been associated with an increased vulnerability for the development of adverse health-related outcomes. The origin of frailty is multifactorial and financial issues could be implicated, as they have been associated with health status, well-being and mortality. However, the association between economic benefits and frailty has been poorly explored. Therefore, the objective was to determine the association between employee benefits and frailty.

METHODS

A cross-sectional study of 927 community-dwelling older adults aged 70 years and older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty was carried out. Employee benefits were established according to eight characteristics: bonus, profit sharing, pension, health insurance, food stamps, housing credit, life insurance, and Christmas bonus. Frailty was defined according to a slightly modified version of the phenotype proposed by Fried et al. Multinomial logistic regression models were run to determine the association between employee benefits and frailty adjusting by sociodemographic and health covariates.

RESULTS

The prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as "poor." Multinomial logistic regression analyses showed that employee benefits were statistically and independently associated with the frail subgroup (OR 0.85; 95% CI 0.74-0.98; P = 0.027) even after adjusting for potential confounders.

CONCLUSIONS

Fewer employee benefits are associated with frailty. Supporting spreading employee benefits for older people could have a positive impact on the development of frailty and its consequences. Geriatr Gerontol Int 2016; 16: 606-611.