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Cheng SH, Chung KP, Wang YC, Tsai HY. The Nudging Effect of a Reminder Letter to Reduce Duplicated Medications: A Randomized Controlled Trial. Med Care 2024; 62:326-332. [PMID: 38498873 DOI: 10.1097/mlr.0000000000001989] [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: 03/20/2024]
Abstract
BACKGROUND The increasing trend of multiple chronic conditions across the world has worsened the problem of medication duplication in health care systems without gatekeeping or referral requirement. Thus, to overcome this problem, a reminder letter has been developed in Taiwan to nudge patients to engage in medication management. OBJECTIVE To evaluate the effect of reminder letter on reducing duplicated medications. RESEARCH DESIGN A 2-arm randomized controlled trial design. SUBJECTS Patients with duplicated medications in the first quarter of 2019. MEASURES The Taiwanese single-payer National Health Insurance Administration identified the eligible patients for this study. A postal reminder letter regarding medication duplication was mailed to the patients in the study group, and no information was provided to the comparison group. Generalized estimation equation models with a difference-in-differences analysis were used to estimate the effects of the reminder letters. RESULTS Each group included 11,000 patients. Those who had received the reminder letter were less likely to receive duplicated medications in the subsequent 2 quarters (postintervention 1: odds ratio [OR]=0.95, 95% CI=0.87-1.03; postintervention_2: OR=0.99, 95% CI=0.90-1.08) and had fewer days of duplicated medications (postintervention 1: β=-0.115, P =0.015; postintervention 2 (β=-0.091, P =0.089) than those who had not received the reminder letter, showing marginal but significant differences. CONCLUSIONS A one-off reminder letter nudge could mildly decrease the occurrence of duplicated medications. Multiple nudges or nudges incorporating behavioral science insights may be further considered to improve medication safety in health systems without gatekeeping.
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Affiliation(s)
- Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Ying-Chieh Wang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yun Tsai
- Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
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Huang TC, Lin SK, Hung SH, Dang LH, Chang WW, Chiou TJ, Chen PY. Factors Affecting the Compliance of Curative-Intent Treatment in Patients With Head and Neck Cancer. EAR, NOSE & THROAT JOURNAL 2023:1455613231204206. [PMID: 37872806 DOI: 10.1177/01455613231204206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
Objectives: This study aims to investigate the factors that lead to poor compliance in initiating the treatment in patients with newly diagnosed head and neck cancers. Methods: A total of 193 patients from the head and neck cancer database dated from January 1, 2018 to September 30, 2020, were analyzed. Variables analyzed included age, gender, primary cancer site, T stage, N stage, M stage, overall stage (I-IV), patient's residential distance, and the impact of COVID-19. Univariate and multivariate analyses were used to assess the significance of these variables in relation to the time to receiving on-time treatment as recommended by specialists. Results: Upon multivariate analysis, the advanced stage and residential distance were significantly associated with initial compliance (P < .09). The impact of nasopharyngeal carcinoma (NPC) and COVID-19 shows a borderline significance (P = .224 and P = .184). Conclusions: The overall stage and patient living distance to the healthcare facility, patient with NPC, and the impact of COVID-19 might affect the compliance of initiating a curative-intent treatment in patients with newly diagnosed head and neck cancers.
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Affiliation(s)
- Ting-Chieh Huang
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Sheng-Kai Lin
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Luong Huu Dang
- Department of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- International Master/PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Wei-Wen Chang
- Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Tzeon-Jye Chiou
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Po-Yueh Chen
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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Cheng SH, Chen CC, Lin YY. Longitudinal care continuity and avoidable hospitalization: the application of claims-based measures. BMC Health Serv Res 2023; 23:554. [PMID: 37244982 DOI: 10.1186/s12913-023-09457-w] [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: 07/05/2022] [Accepted: 04/27/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Longitudinal continuity between a patient and his/her primary care physician is an important aspect in measuring continuity of care (COC). The majority of previous studies employed questionnaire surveys to patients to measure the continual relationship between patients and their physicians. This study aimed to construct a provider duration continuity index (PDCI) by using longitudinal claims data and to examine its agreement with commonly used COC measures. Then, this study investigated the effects of the various types of COC measure on the likelihood of avoidable hospitalization while considering the level of comorbidity. METHODS This study constructed a 4-year panel (from 2014 to 2017) of the nationwide health insurance claims data in Taiwan. In total, 328,044 randomly selected patients with 3 or more physician visits per year were analyzed. Two PDCIs were constructed to measure the duration of interaction between a patient and his/her physicians over time. The agreement between the PDCIs and three commonly used COC indicators, the Usual Provider of Care index, the Continuity of Care Index, and the Sequential Continuity Index, were examined. Generalized estimating equations were conducted to examine the association between COC and avoidable hospitalization by the level of comorbidity. RESULTS The results showed that the correlations among the three commonly used COC indicators were high (γ = 0.787 ~ 0.958) and the correlation between the two longitudinal continuity measures was moderate (γ = 0.577 ~ 0.579), but the correlations between the commonly used COC indicators and the two PDCIs were low (γ = 0.001 ~ 0.257). All COC measures, both the PDCIs and the three commonly used COC indicators, showed independent protective effects on the likelihood of avoidable hospitalization in three comorbidity groups. CONCLUSION The duration of interaction between patients and physicians is an independent domain in measuring COC and has a significant effect on health care outcomes.
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Affiliation(s)
- Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 618, 17, Hsu-Chow Road, Taipei, 100, Taiwan.
- Population Health Research Center, National Taiwan University, Taipei, Taiwan.
| | - Chi-Chen Chen
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Yueh-Yun Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 618, 17, Hsu-Chow Road, Taipei, 100, Taiwan
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Chen CC, Cheng SH. Does continuity of care improve patient satisfaction? An instrumental variable approach. Health Policy 2023; 130:104754. [PMID: 36893689 DOI: 10.1016/j.healthpol.2023.104754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
Numerous studies have investigated the relationship between continuity of care (COC) and patient satisfaction. However, COC and patient satisfaction were measured simultaneously; therefore, the direction of causality remains understudied. This study examined the effect of COC on the patient satisfaction of elderly individuals using an instrumental variable (IV) approach. Nationwide survey data acquired using a face-to-face interview were used to measure the patient-reported COC experiences of 1,715 participants. We applied an ordered logit model controlled for observed patient characteristics and a two-stage residual inclusion (2SRI) ordered logit model that accounted for unobserved confounding factors. Patient-perceived COC importance was used as an IV for patient-reported COC. The ordered logit models indicated that patients with high or intermediate patient-reported COC scores were more likely to perceive more patient satisfaction than those with low COC scores. Using the patient-perceived COC importance as an IV, we examined a strong significant association between the level of patient-reported COC and patient satisfaction. It is necessary to adjust for unobserved confounders to obtain more accurate estimates of the relationship between patient-reported COC and patient satisfaction. However, the results and policy implications of this study should be cautiously interpreted because the possibility of other bias could not be ruled out. These findings support policies aimed at improving patient-reported COC among older adults.
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Affiliation(s)
- Chi-Chen Chen
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy & Management, College of Public Health, and Population Health Research Center, National Taiwan University, Taipei, Taiwan.
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Continuity of Care and Coordination of Care: Can they Be Differentiated? Int J Integr Care 2023; 23:10. [PMID: 36819617 PMCID: PMC9936907 DOI: 10.5334/ijic.6467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Both care continuity and coordination are considered essential elements of health care system. However, little is known about the relationship between care continuity and coordination. This study aimed to differentiate the concepts of care continuity and coordination by developing and testing the reliability and validity of the Combined Outpatient Care Continuity and Coordination Assessment (COCCCA) questionnaire under the universal coverage health care system in Taiwan from a patient perspective. Methods Face-to-face interviews were conducted nationwide with community-dwelling older adults selected via stratified multistage systematic sampling with probability-proportional-to-size process. A total of 2,144 subjects completed the questionnaire, with a response rate of 44.67%. Results The 16 items of the COCCCA questionnaire were identified via item analysis and principal component analysis (PCA). The PCA generated five dimensions: three continuity-oriented (interpersonal, information sharing and longitudinal between patients and physicians) and two coordination-oriented (information exchange and communication/cooperation among multiple physicians). The second-order confirmatory factor analysis supported the factor structure and indicated that distinct constructs of care continuity and coordination can be identified. Conclusion The COCCCA instrument can differentiate the concepts of care continuity and care coordination and has been demonstrated to be valid and reliable in outpatient care settings from a patient perspective.
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Medical Utilization of Emergency Departments among Patients with Prostate Cancer: A Nationwide Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413233. [PMID: 34948836 PMCID: PMC8701110 DOI: 10.3390/ijerph182413233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/26/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional method based on the Registry for Catastrophic Illness Patient Database from Taiwan’s National Health Insurance Research Database. Patients with newly diagnosed prostate cancer between 1997 and 2013 were enrolled in the study and divided into four treatment-related groups. The rate of emergency department presentation, disease categorization of emergency department visits, emergency department-related medical expenditures, and temporal trends were investigated. (3) Results: A total of 18,728 patients with prostate cancer were identified between 1997 and 2013, for whom 13,098 emergency department visits were recorded. The number of emergency department visits increased during the study period. The incidence rate for the medical utilization of emergency department visits was 822 per 1000 people during the study period. The incidence rates for patients with prostate cancer in the radical prostatectomy, radiotherapy, androgen deprivation therapy, and chemotherapy groups were 549, 1611, 1101, and 372, respectively. The average medical expenditure per emergency department visit was TWD 3779.8 ± 5116.2, and the expenditure was recorded for the chemotherapy group at TWD 4690.8 ± 7043.3. The most common disease diagnoses among patients with prostate cancer who presented to the emergency department were injury/poisoning (16.79%), genitourinary disorders (10.66%), and digestive disorders (10.48%). (4) Conclusions: This nationwide population-based study examined the emergency department visits of patients with prostate cancer in Taiwan, providing useful information for improving the quality of medical care.
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The Impact of Pharmaceutical Home Care on Medical Utilization for Frequent Users of Outpatient Services in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147336. [PMID: 34299787 PMCID: PMC8303173 DOI: 10.3390/ijerph18147336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022]
Abstract
Due to the high-accessibility and low-copayment of healthcare system in Taiwan, the clinical visit frequency of people is relatively high, which often leads to an excessively high healthcare expenditure. The aim of this research was to explore the effectiveness of pharmaceutical home care for frequent users of outpatient service and to analyze the impact of pharmaceutical home care on medical utilization. The study was based on the Taiwan National Health Insurance Research Database. Patients with over 100 clinical visits during 2010 to 2012 were selected as subjects. Whether these patients participate the experimental plan of pharmaceutical home care in the following year and the medical utilization of the research subjects were analyzed to compare the difference between participating group and non-participating group in this plan. The generalized estimating equation was employed to examine the difference of medical utilization. A total of 3943 subjects were included in this study, including 591 patients (14.99%) participating in the experimental plan. The average number of physician visits during the following year of the participating group was higher than that of the non-participating group by 0.12 visits, and the outpatient medical expense was lower than the non-participating group by 18,302 points (1 point = 0.03 US dollars). After participating in the plan, the average number of clinical visits of frequent users of outpatient services was significantly reduced by 6.63 visits, and the outpatient expense was significantly decreased by 9871 points. After joining the experimental plan of pharmaceutical home care, the average number of outpatient visits decreased significantly and the medical expense was lower when compared with those who did not participate in the plan.
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Liang LL, Huang N, Shen YJ, Chen AYA, Chou YJ. Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan. BMC Health Serv Res 2020; 20:1050. [PMID: 33208148 PMCID: PMC7677770 DOI: 10.1186/s12913-020-05908-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background A common challenge for free-access systems is that people may bypass primary care and seek secondary care through self-referral. Taiwan’s government has undertaken various initiatives to mitigate bypass; however, little is known about whether the bypass trend has decreased over time. This study examined the extent to which patients bypass primary care for treatment of common diseases and factors associated with bypass under Taiwan’s free-access system. Methods This repeated cross-sectional study analyzed data from Taiwan’s National Health Insurance Research Database. A random sample of 1 million enrollees was drawn repeatedly from the insured population during 2000–2017. To capture visits beyond the community level, the bypass rate was defined as the proportion of self-referred visits to the top two levels of providers, namely academic medical centers and regional hospitals, among all visits to all providers. Subgroup analyses were conducted for visits with a single diagnosis. Logistic regressions were used to investigate factors associated with bypass. Results The standardized bypass rate for all diseases analyzed exhibited a decreasing trend. In 2017, it was low for common cold (0.7–1.3%), moderate for hypertension (14.0–29.5%), but still high for diabetes (32.0–47.0%). Moreover, the likelihood of bypass was higher for male, patients with higher salaries or comorbidities, and in areas with more physicians practicing in large hospitals or less physicians working in primary care facilities. Conclusions Although the bypass trend has decreased over time, continuing efforts may be required to reduce bypass associated with chronic diseases. Both patient sociodemographic and market characteristics were associated with the likelihood of bypass. These results may help policymakers to develop strategies to mitigate bypass. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05908-w.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, No. 70, Lienhai Rd, Kaohsiung, 804, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Yi-Jung Shen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Annie Yu-An Chen
- RAND Corporation, 1766 Main Street, Santa Monica, CA, USA.,Pardee RAND Graduate School, 1766 Main Street, Santa Monica, CA, USA
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Li-Nong St., Beitou Dist, Taipei, 112, Taiwan.
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Chen WW, Lin CW, Huang WI, Chao PH, Gau CS, Hsiao FY. Using real-world evidence for pharmacovigilance and drug safety-related decision making by a resource-limited health authority: 10 years of experience in Taiwan. Pharmacoepidemiol Drug Saf 2020; 29:1402-1413. [PMID: 32894792 DOI: 10.1002/pds.5084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/20/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Real-world evidence has become increasingly relevant in regulatory decision making. Compared to large regulatory bodies, the national pharmacovigilance system in Taiwan is still under development, and the aim of this study is to demonstrate how a resource-limited health authority utilizes real-world evidence in decision making. METHODS We described different sources of real-world data available in Taiwan and illustrated the structural framework that integrates real-world evidence into Taiwan's national pharmacovigilance system. Additionally, we reviewed real-world studies conducted in the past 10 years and provided examples to show how these studies influenced drug safety-related decision making in Taiwan. RESULTS During the past 10 years, real-world evidence used when making drug safety-related regulatory decisions in Taiwan was mainly generated from nationwide claims databases, but other sources of real-world data, such as national registries and large electronic hospital databases, also became available recently. Different types of real-world evidence, including drug utilization studies, risk evaluation studies, and risk minimization measure evaluation studies, have been used to support regulatory decisions in Taiwan. CONCLUSIONS Through collaborations between the government and academics, Taiwan has started to integrate real-world evidence into the national pharmacovigilance system. However, future efforts, including linkages between different sources of real-world data and improvements in procedural and methodological practices, are needed to generate more regulatory-quality real-world evidence.
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Affiliation(s)
| | - Chih-Wan Lin
- Taiwan Drug Relief Foundation, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-I Huang
- Taiwan Drug Relief Foundation, Taipei, Taiwan
| | - Pi-Hui Chao
- Taiwan Drug Relief Foundation, Taipei, Taiwan
| | - Churn-Shiouh Gau
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center for Drug Evaluation, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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Lin PA, Lee CY, Huang FC, Huang JY, Hung JH, Yang SF. Trend of Neovascular Glaucoma in Taiwan: A 15-year Nationwide Population-based Cohort Study. Ophthalmic Epidemiol 2020; 27:390-398. [PMID: 32326791 DOI: 10.1080/09286586.2020.1755445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the trends in epidemiological data in patients with neovascular glaucoma (NVG) in Taiwan. METHODS The data were obtained from the 2016 version of the Longitudinal Health Insurance Database, which contains data on two million randomly sampled patients. Patients with NVG diagnostic codes were enrolled in this study, after which we separated the study population according to different time periods. The demographic data, systemic and ocular comorbidities and treatments that were applied to manage NVG were collected from the database. RESULTS The overall age-standardized prevalence was 52.48 per 100,000 individuals, and the age-standardized incidence was 4.33 per 100,000 person-years in patients with NVG. In general, men had a higher prevalence and incidence, and the incidence was observed to fluctuate. The patients with the highest educational levels accounted for less than 5% of the NVG patients, and the patients with the highest income levels accounted for less than 15% of the NVG patients. Systemic comorbidities in NVG patients, especially metabolic syndrome, were observed to increase. The percentage of the patients receiving anti-vascular endothelial growth factor treatments increased by more than two-fold after 2008, whereas reductions in trabeculectomy and cyclodestruction procedures were observed. CONCLUSION The prevalence of NVG was observed to increase in men, and the incidence fluctuated during the study period. Furthermore, the systemic comorbidities, and the use of anti-vascular endothelial growth factor treatment increased; the latter may be associated with a decrease in the use of incisional glaucoma surgery for NVG in recent years.
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Affiliation(s)
- Po-An Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital , Changhua, Taiwan.,Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology , Tainan, Taiwan
| | - Fu-Chin Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan, Taiwan.,Department of Ophthalmology, College of Medicine, National Cheng Kung University , Tainan, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan, Taiwan.,Department of Ophthalmology, College of Medicine, National Cheng Kung University , Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University , Tainan, Taiwan
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital , Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University , Taichung, Taiwan
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Yang KT, Yin CH, Hung YM, Huang SJ, Lee CC, Kuo TJ. Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082913. [PMID: 32340141 PMCID: PMC7215569 DOI: 10.3390/ijerph17082913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.
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Affiliation(s)
- Kuang-Tsu Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Chun-Hao Yin
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung 80776, Taiwan
| | - Shih-Ju Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan
| | - Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Dental Technology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
- Correspondence: ; Tel.: +886-7-346-8214; Fax: +886-7-346-8392
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Wang LY, Wu CY, Chang YH, Lu TH. Health care utilization pattern prior to maltreatment among children under five years of age in Taiwan. CHILD ABUSE & NEGLECT 2019; 98:104202. [PMID: 31606006 DOI: 10.1016/j.chiabu.2019.104202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/02/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Several studies have hypothesized that the pattern of health care utilization among maltreated children differ from others without the experience. However, the conclusions have not been consistent. OBJECTIVE The study aims to examine whether the pattern of health care utilization among children 0-5 years old with maltreatment different from their counterparts without maltreatment in Taiwan. SUBJECTS AND SETTING All children born in 2007 in Taiwan. METHOD This is a population-based and case-controlled study. Cases are children under five years of ago with maltreatment-related diagnosis in the claims data of the National Health Insurance in Taiwan during the 2007-2013 period. For each case, there were 10 birth date-matched controls. Exposure variables include the number of injury or non-injury-related outpatients, emergency department (ED) visits, and hospitalization. Multivariate models were employed, with adjustment for sex, urbanization level, and comorbidities of children. RESULTS Of children born in 2007, 382 had maltreatment-related diagnosis during the age of 0-5. The adjusted odds ratio (aOR) for having two or more ED visits with or without injury-related diagnosis is 3.52 (95% CI 1.75-7.07) and 2.0-0 (95% CI 1.47-2.72), respectively. Children with maltreatment also had significantly higher number of hospitalization without injury-related diagnosis and aOR for those having two more hospitalizations stands at 2.47 (95% CI 1.59-3.83). CONCLUSIONS Children with maltreatment when 0-5 years old had higher number of ED visits with injury-related diagnosis, as well as hospitalization without injury-related diagnosis. Recognition of the health care utilization is conducive to early identification of children with risk for maltreatment.
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Affiliation(s)
- Liang-Yi Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Ying Wu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yi-Hsin Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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The Impact of a National Health Information Exchange Program Under a Single-payer System. Med Care 2019; 58:90-97. [PMID: 31688553 DOI: 10.1097/mlr.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of the PharmaCloud program, a health information exchange program implemented in 2013, on medication duplication under a single-payer, universal health insurance program in Taiwan. STUDY DESIGN This study employed a retrospective pre-post study design and used nationwide health insurance claim data from 2013 to 2015. A difference-in-difference analysis was conducted to evaluate the effects of inquiry rate on the probability of receiving duplicate medications and on the number of days of overlapping medication prescriptions after implementation of the PharmaCloud program. RESULTS The study subjects included patients receiving medications in 7 categories: antihypertension drugs, 217,200; antihyperlipidemic drugs, 69,086; hypoglycemic agents, 103,962; antipsychotic drugs, 15,479; antidepressant drugs, 12,057; sedative and hypnotic drugs, 56,048; and antigout drugs, 18,250. Up to 2015, the overall PharmaCloud inquiry rate has increased to 55.36%-69.16%. Compared with subjects in 2013, subjects in 2014 and 2015 had a significantly lower likelihood of receiving duplicate medication in all 7 medication groups; for instance, for antihypertension drug users, the odds ratio (OR) was 0.91 with 95% confidence interval (CI)=0.90-0.92 in 2014, and the OR was 0.81 with 95% confidence interval=0.81-0.82 in 2015. However, a higher inquiry rate led to a lower likelihood of receiving duplicate medication and shorter periods of overlapping medications only in some of the medication groups. CONCLUSIONS The health information exchange program has reduced medication duplication, yet the reduction was not entirely associated with record inquiries. The hospitals have responded to the challenge of medication duplication by enhancing internal prescription control via a prescription alert system, which may have contributed to the reduction in duplicate medications and is a positive, unintended consequence of the intervention.
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Kato D, Ryu H, Matsumoto T, Abe K, Kaneko M, Ko M, Irving G, Ramsay R, Kondo M. Building primary care in Japan: Literature review. J Gen Fam Med 2019; 20:170-179. [PMID: 31516802 PMCID: PMC6732569 DOI: 10.1002/jgf2.252] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 11/06/2022] Open
Abstract
Japan's health system is well known for achieving one of the world's highest life expectancy with universal health coverage. However, the country now faces challenges of a rapidly aging population and changes in patterns and burden of disease. Primary care is an important component of a well-functioning health system. In Japan, primary care services are provided in both the community and hospital settings. The distinction between primary and secondary care may not always be clear. This review is based on the framework from the 2015 WHO publication on primary care systems in Europe. Our aim is to describe the journey of primary care in Japan, with its past, present, and future as a valuable addition to the academic English literature. We also hope that this article would inspire readers outside of Japan who might face similar issues in their respective countries.
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Affiliation(s)
- Daisuke Kato
- Department of Family MedicineMie University Graduate School of MedicineTsuJapan
| | - Hikohaku Ryu
- Department of General Medicine and Primary CareUniversity of Tsukuba HospitalTsukubaJapan
| | | | - Kazuhiro Abe
- Department of Public Health, Graduate School of MedicineThe University of TokyoHongoJapan
| | - Makoto Kaneko
- Department of Family and Community MedicineHamamatsu University School of MedicineHamamatsuJapan
| | - Mezhen Ko
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - Greg Irving
- Institute of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Robin Ramsay
- Usher Institute of Population health Sciences and InformaticsUniversity of EdinburghEdinburghUK
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The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident's Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173167. [PMID: 31480260 PMCID: PMC6747353 DOI: 10.3390/ijerph16173167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 12/17/2022]
Abstract
Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents' healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40-49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.
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Li YC. Continuity of care for newly diagnosed diabetic patients: A population-based study. PLoS One 2019; 14:e0221327. [PMID: 31437219 PMCID: PMC6705849 DOI: 10.1371/journal.pone.0221327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/06/2019] [Indexed: 12/05/2022] Open
Abstract
This study explores whether continuity of care is associated with health care outcomes and medical care use among patients with newly diagnosed diabetes. A retrospective cohort analysis was performed using the Taiwanese National Health Insurance database, and cases were followed up from January 2010 to December 2012. Four thousand and seven patients with newly diagnosed diabetes were followed for 3 years. The continuity of care was measured using the continuity of care index (COCI) and the usual provider continuity score (UPCS) with high and low dichotomous categories. The probabilities of dementia, hospitalization, emergency room visits, and death were used as health care outcomes. Medical care use was defined as the number of hospital admissions, length of hospital stays, and number of emergency room visits. Adjusted odds ratios (ORs) were obtained using multivariate logistic regression; adjusted ORs for the probabilities of dementia, hospital admissions, and emergency room visits in the higher COCI patient group were 0.582 (p < 0.05), 0.623 (p < 0.001), and 0.650 (p < 0.001), respectively. Negative binomial regression models for medical resource use indicated that the group with higher COCI scores used fewer medical resources compared with the group with lower COCI scores. The findings of UPCS analysis showed that those in the high COCI group also fell into the high UPCS group. In this study, continuity of care was associated with favorable health care outcomes and less medical care uses among newly diagnosed diabetic patients. Long-term relationships between patients and health care providers should be enhanced to provide improved continuity of care.
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Affiliation(s)
- Ying-Chun Li
- Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail:
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Wang YJ, Liu HY, Chen TJ, Hwang SJ, Chou LF, Lin MH. The Provision of Health Care by Family Physicians in Taiwan as Illustrated With Population Pyramids. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019834830. [PMID: 30947595 PMCID: PMC6452580 DOI: 10.1177/0046958019834830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Family physicians serve as personal doctors for individuals and their families and also act as gatekeepers of the health care system. If no special status is accorded to family physicians, however, then the rates at which health care recipients utilize their service might be affected. In the present cross-sectional study, representative claims data sets for 2010 from Taiwan’s National Health Insurance program, a health care system in which beneficiaries are not required to register with a family physician, were used to investigate the provision of health care to the population by family physicians. Among 919 206 beneficiaries with a total of 13 713 199 ambulatory visits, 49.1% had visited family physicians, 34.1% had visited internists, 24.3% had visited pediatricians, and 38.9% had visited otolaryngologists. Women (χ2(1) = 538, P < .001) and patients aged 65 and above (χ2(1) = 16 000, P < .001) had a higher proportion of visiting family physicians rather than visiting other specialties. The onion-shaped population pyramid with family medicine visits was compatible with the general population, and the proportion of visiting family physicians increased with increasing age. Among 112 289 patients with essential hypertension, 63 379 patients with diabetes mellitus, and 80 090 patients with hyperlipidemia, only 35.3%, 32.0%, and 31.1%, respectively, had visited family physicians. The age and sex distributions of these patients were illustrated with population pyramids for data visualization and direct comparisons. Taken together, the results of this study indicate that the utilization of family physicians in Taiwan and the effectiveness of their associated role in chronic disease management still have room for improvement.
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Affiliation(s)
- Yi-Jen Wang
- 1 Department of Family Medicine, Taipei Veterans General Hospital.,2 School of Medicine, National Yang-Ming University, Taipei
| | - Hao-Yen Liu
- 1 Department of Family Medicine, Taipei Veterans General Hospital.,2 School of Medicine, National Yang-Ming University, Taipei
| | - Tzeng-Ji Chen
- 1 Department of Family Medicine, Taipei Veterans General Hospital.,2 School of Medicine, National Yang-Ming University, Taipei
| | - Shinn-Jang Hwang
- 1 Department of Family Medicine, Taipei Veterans General Hospital.,2 School of Medicine, National Yang-Ming University, Taipei
| | - Li-Fang Chou
- 3 Department of Public Finance,National Chengchi University, Taipei
| | - Ming-Hwai Lin
- 1 Department of Family Medicine, Taipei Veterans General Hospital.,2 School of Medicine, National Yang-Ming University, Taipei
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Ko MC, Lien HY, Woung LC, Chen CY, Chen YL, Chen CC. Difference in frequency and outcome of geriatric emergency department utilization between urban and rural areas. J Chin Med Assoc 2019; 82:282-288. [PMID: 30893267 DOI: 10.1097/jcma.0000000000000053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Elderly people are susceptible to develop multiple chronic diseases and are thus likely to utilize the emergency department (ED). Access to health care and health outcomes may differ between rural and urban areas. This study aims to compare the frequency and outcome of geriatric ED utilization between urban and rural areas. METHODS This population-based study obtained information from the health insurance database. The frequency and outcome of ED utilization in 2013 were compared among people aged ≥65 years living in urban and rural areas. The independent effect of various characteristics on the frequency and outcome of ED utilization was evaluated using multivariate logistic regression analysis. RESULTS Of the 6695 people living in urban areas, 1879 (28.07%) utilized the ED and accounted for 3859 ED visits. Meanwhile, 908 (29.75%) of the 3052 people living in rural areas utilized the ED and accounted for 1820 ED visits. No difference in the prevalence of ED utilization was found between the urban and rural areas. Urbanization did not affect the risk of frequent ED utilization among ED users. People living in rural areas had an increased risk of ED visits with a high acuity (adjusted odds ratio: 1.40, 95% CI: 1.12-1.75). Urbanization did not affect the risk of hospitalization or immediate death after ED visits. CONCLUSION The frequency of ED utilization showed no urban-rural difference. Elderly people living in rural areas had an increased risk of visiting the ED with a high acuity.
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Affiliation(s)
- Ming-Chung Ko
- Department of Urology, Taipei City Hospital, Taipei, Taiwan, ROC
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Hsin-Yi Lien
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
- Cross-Strait Medical and Management Communication Center, Taipei City Hospital, Taipei, Taiwan, ROC
- Superintendent Office, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Lin-Chung Woung
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
- Superintendent Office, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Chin-Yi Chen
- Auditing and Advising Division, Trust Association of Republic of China, Taipei, Taiwan, ROC
| | - Yu-Ling Chen
- Center for Big Data Analytics and Statistics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
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Official Websites of Local Health Centers in Taiwan: A Nationwide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030399. [PMID: 30708949 PMCID: PMC6388370 DOI: 10.3390/ijerph16030399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
Local health centers (LHCs) play a key role in public health. Because it has now become popular to seek health information on the Internet, an effective website is indispensable to an LHC. Our study aimed to survey the official websites of LHCs in Taiwan with an evaluation framework. All 369 LHCs in Taiwan were surveyed in March 2018. The evaluation indicators included health information, online interactive services, technical features, institutional information, links to external resources, website management, the last updated time, and number of visitors. The indicators were stratified by the urbanization levels of the LHCs. In total, 98.0% (n = 360) of the LHCs had official websites. The majority (n = 241) of the websites were updated within the past 30 days, and most of the websites (n = 353) provided health information. However, the information provided varied considerably. Few LHCs (n = 31) provided online interactive services in terms of an online appointment function. In terms of providing online consultation services, rural LHCs outperformed suburban and urban LHCs (16.4% versus 14.5% and 6.0%, respectively). Most LHCs in Taiwan do not seem to take full advantage of the Internet, with their websites typically serving as static bulletin boards instead of new channels of communication. Further studies could focus on the effectiveness of these websites.
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Wang C, Kuo HC, Cheng SF, Hung JL, Xiong JH, Tang PL. Continuity of care and multiple chronic conditions impact frequent use of outpatient services. Health Informatics J 2019; 26:318-327. [PMID: 30702018 DOI: 10.1177/1460458218824720] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the association between care continuity and chronic conditions in relation to highly frequent use of outpatient service in order to find constructive suggestions to bring efficient, high-quality care for patients with multiple chronic conditions. The National Health Insurance database was used and 333,294 patients were identified from 2007 to 2009. The continuity of care index indicates the dispersion of a patient's ambulatory visits among providers. Multivariate logistic regression was used to estimate adjusted odds ratios with 95 percent confidence intervals. Continuity of care index was significantly associated with age, sex, urbanization level, socioeconomic status, emergency department visits, hospitalization, psychological disorders, chronic diseases, and catastrophic illness card; those with low continuity of care index were likely to use outpatient care highly frequently. Improving continuity of care is fundamental, and the best way is to advance the practice of family medicine for primary care.
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Affiliation(s)
| | | | | | | | | | - Pei-Ling Tang
- Meiho University; Kaohsiung Medical University; Kaohsiung Veterans General Hospital
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21
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Huang YY, Cheng SH. A community pharmacist home visit project for high utilizers under a universal health system: A preliminary assessment. Health Policy 2019; 123:373-378. [PMID: 30739818 DOI: 10.1016/j.healthpol.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 01/20/2023]
Abstract
Due to the increasing prevalence of multimorbidity, the percentage of heavy users of health care services increased rapidly. To contain inappropriate outpatient visits and improve better medication management of high utilizers, the National Health Insurance Administration in Taiwan launched a community pharmacist home visit (CPHV) project for high utilizers in 2010. We employed a natural experimental design to evaluate the preliminary effects of the CPHV project. The intervention group consisted of patients enrolled in the CPHV project during 2010 and 2013. Patients in the comparison group were non-enrollees selected via a propensity score matching technique. A difference-in-differences analysis was conducted by using multilevel models to examine the effects of the project. The average number of physician visits decreased from 130.0 to 98.9 visits (23.8%) among the CPHV project enrollees, while the average number decreased from 99.5 to 89.5 visits (10.1%) among the non-enrollees, with a net effect of a 21.0-visit reduction. The CPHV project also led to modest reductions in the number of medication items used per day, the probability of hospital admission and yearly healthcare expenses. The CPHV project seems promising for decreasing health care utilization and costs of the patients with high-needs.
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Affiliation(s)
- Yu-Ying Huang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Medical Affair Division, National Health Insurance Administration, Ministry of Health and Welfare, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Population Health Research Center, National Taiwan University, Taipei, Taiwan.
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Chen CH, Sheu JJ, Lin YC, Lin HC. Association of migraines with brain tumors: a nationwide population-based study. J Headache Pain 2018; 19:111. [PMID: 30442087 PMCID: PMC6755602 DOI: 10.1186/s10194-018-0944-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/06/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Several studies examined headaches as a symptom of brain neoplasms. Nevertheless, very few studies attempted to specifically evaluate the role of headaches as a risk factor. This study aimed to investigate the risk of migraine occurrence in the preceding years among patients diagnosed with brain tumors and unaffected controls. METHODS Data were obtained from the Taiwan National Health Insurance Research Database. In total, 11,325 adults with a first-time brain tumor diagnosis were included as cases, together with 11,325 unaffected matched controls. Each individual was traced in the healthcare claims dataset for a prior diagnosis of migraines. Conditional logistic regressions were performed to calculate the odds ratio (OR) and the corresponding 95% confidence interval (CI) to present the association between brain tumors and having previously been diagnosed with migraines. RESULTS We found that among patients with and those without brain tumors, 554 (4.89%) and 235 (2.08%) individuals, respectively, were identified as having a prior migraine diagnosis. Compared to unaffected controls, patients with brain tumors experienced an independent 2.45-fold increased risk of having a prior migraine diagnosis. The risks were even higher among men (odds ratio (OR) = 3.04, 95% confidence interval (CI) = 2.29~ 4.04) and after patients who had received a prior migraine diagnosis within 3 years were excluded (OR = 1.91, 95% CI = 1.59~ 2.29). CONCLUSIONS This is the first report demonstrating the occurrence of brain tumors to be associated with a prior migraine history, for both men and women, in a population-based study.
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Affiliation(s)
- Chao-Hung Chen
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Lin
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. .,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Cheng BR, Chang HT, Lin MH, Chen TJ, Chou LF, Hwang SJ. Rural-urban disparities in family physician practice patterns: A nationwide survey in Taiwan. Int J Health Plann Manage 2018; 34:e464-e473. [PMID: 30238506 DOI: 10.1002/hpm.2662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In a world with increasing urbanization, rural-urban disparities in health care utilization have been a long-term concern. However, the details regarding the practice patterns of family physicians in Taiwan have not received sufficient attention thus far. METHODS The National Health Insurance Research Database of Taiwan offered 0.2% of the total ambulatory visit records for Taiwan in 2013. Records from community clinics of family medicine were collected, with the clinics categorized as rural, suburban, or urban area clinics according to their locations. RESULTS Among 100 334 visits to family medicine clinics, the median patient age was 50 years for urban clinics, 51 for suburban clinics, and 58 for rural clinics. The distributions of patient ages differed in the three areas (P < 0.001). Four types of chronic diseases (cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers) accounted for 10.8%, 11.3%, and 13.6%, of the visits to urban, suburban, and rural clinics, respectively. The most common procedure was wound treatment, and the pattern of the top 10 procedures was similar in the three areas. CONCLUSION Although rural patients in Taiwan were older and had more chronic diseases than urban and suburban patients, the pattern of procedures undertaken by rural family physicians did not differ from those of urban and suburban family physicians.
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Affiliation(s)
- Bo-Ren Cheng
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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The impact of a medication record sharing program among diabetes patients under a single-payer system: The role of inquiry rate. Int J Med Inform 2018; 116:18-23. [PMID: 29887231 DOI: 10.1016/j.ijmedinf.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/14/2018] [Accepted: 05/18/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Taiwan's single health insurer introduced a medication record exchange platform, the PharmaCloud program, in 2013. This study aimed to evaluate the effects of the medication record inquiry rate on medication duplication among patients with diabetes. MATERIALS AND METHODS A retrospective pre-post design with a comparison group was conducted using nationwide health insurance claim data of diabetic patients from 2013 to 2014. Patients whose medication record inquiry rate fell within the upper 25th percentile were classified as the high-inquiry group, and the others as the low-inquiry group. The dependent variables were the likelihood of receiving duplicated medication and the overlapped medication days of the study subjects. Generalized estimation equations with difference-in-difference analysis were calculated to examine the net effect of the PharmaCloud inquiry rate for a matched sub-sample. RESULTS In total, 106,508 patients with diabetes were randomly selected. From 2013 to 2014, the medication duplication rate was reduced 7.76 percentile (54.12%-46.36%) for the high-inquiry group and 9.58 percentile (63.72%-54.14%) for the low-inquiry group; the average medication overlap periods were shortened 4.36 days (8.49-4.13) and 6.29 days (11.28-4.99), respectively. The regression models showed patients in the high-inquiry group were more likely to receive duplicated medication (OR = 1.11, 95% C.I. = 1.07-1.16) and with longer overlapped days (7.53%, P = 0.0081) after the program. CONCLUSION The medication record sharing program has reduced medication duplication among diabetes patients. However, higher inquiry rate did not lead to greater reduction in medication duplication; the overall effect might be due to enhanced internal control via prescription alert system in hospitals rather physician's review of the records.
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Yang TY, Chen M, Lin WR, Li CY, Tsai WK, Chiu AW, Ko MC. Preoperative treatment with 5α-reductase inhibitors and the risk of hemorrhagic events in patients undergoing transurethral resection of the prostate - A population-based cohort study. Clinics (Sao Paulo) 2018; 73:e264. [PMID: 29538495 PMCID: PMC5840823 DOI: 10.6061/clinics/2018/e264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery. METHODS We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders. RESULTS Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters. CONCLUSIONS This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.
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Affiliation(s)
- Ti-Yuan Yang
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Allen W. Chiu
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chung Ko
- Department of Urology, Taipei City Hospital, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Corresponding author. E-mail:
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Wang YJ, Chiang SC, Lee PC, Chen YC, Chou LF, Chou YC, Chen TJ. Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan. Front Pharmacol 2018. [PMID: 29515446 PMCID: PMC5826280 DOI: 10.3389/fphar.2018.00120] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy. Methods: Retrospective cohort analyses of excessive polypharmacy, defined as prescription of ≥ 10 medicines at an ambulatory visit, from 2001 to 2013 were conducted using a nationally representative claims database in Taiwan. Survival analyses with log-rank test of adult patients with first-time excessive polypharmacy were conducted to predict the probabilities, stratified by age and sex, of having repeatedly excessive polypharmacy. Results: During the study period, excessive polypharmacy occurred in 5.4% of patients for the first time. Among them, 63.9% had repeatedly excessive polypharmacy and the probabilities were higher in men and old people. Men versus women, and old versus middle-aged and young people had shorter median excessive polypharmacy-free times (9.4 vs. 5.5 months, 5.3 vs. 10.1 and 35.0 months, both p < 0.001). Overall, the probabilities of having no repeatedly excessive polypharmacy within 3 months, 6 months, and 1 year were 59.9, 53.6, and 48.1%, respectively. Conclusion: Although male and old patients were more likely to have persistently excessive polypharmacy, most cases of excessive polypharmacy were transient or did not re-appear in the short run. Systemic deprescribing measures should be tailored to at-risk groups.
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Affiliation(s)
- Yi-Jen Wang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.,Department of Financial Engineering and Actuarial Mathematics, Soochow University, Taipei, Taiwan
| | - Pei-Chen Lee
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Huang CY, Nguyen PAA, Clinciu DL, Hsu CK, Lu JCR, Yang HC, Wu CC, Tsai WC, Chou YC, Kuo TBJ, Chang PL, Jian WS, Li YCJ. A personalized medication management platform (PMMP) to improve medication adherence: A randomized control trial. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 140:275-281. [PMID: 28254084 DOI: 10.1016/j.cmpb.2016.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/02/2016] [Accepted: 12/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Medication non-adherence caused by forgetting and delays has serious health implications and causes substantial expenses to patients, healthcare providers, and insurance companies. We assessed the effectiveness of a personalized medication management platform (PMMP) for improving medication adherence, self-management medication, and reducing long-term medication costs. METHODS We developed a mobile PMMP to reduce delayed and missed medications. A randomized control trial was conducted of three medical centers in Taiwan. A total 1198 participants who aged over 20 years, received outpatient prescription drugs for a maximum period of 14 days. 763 patients were randomly assigned to intervention group as receiving daily SMS reminders for their medications and 434 patients in control group did not. The primary outcome was change in delaying and forgetting medication between before and after intervention (after 7 days). RESULTS Medication delays were reduced from 85% to 18% (67% improvement) after SMSs for the intervention group and from 80% to 43% (37% improvement) for the control group. Patients forgot medications were significantly reduced from 46% to 5% (41% improvement) for the experimental group after SMSs and from 44% to 17% (27% improvement) for the control group. The SMSs were considered helpful by 83% of patients and 74% of them thought SMSs help in controlling diseases. 92% of patients would recommend this system to their family and friends. CONCLUSIONS A timely and personalized medication reminder through SMS can improve medication adherence in a nationalized healthcare system with overall savings in medication costs and significant improvements in health and disease management. TRIAL REGISTRATION ClinicalTrials.gov: NCT02197689.
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Affiliation(s)
- Chu-Ya Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Taiwan College of Healthcare Executives, Taiwan
| | - Phung-Anh Alex Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Daniel L Clinciu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Feng Chia University, Taichung, Taiwan
| | - Chun-Kung Hsu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Jui-Chia Richard Lu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Chieh-Chen Wu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yueh-Ching Chou
- Pharmacy Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan
| | - Po-Lun Chang
- Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan
| | - Wen-Shan Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Taipei Medical University, Wan-Fang Hospital, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taiwan.
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Wang HY, Yeh MK, Ho CH, Hu MK, Huang YB. Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud. Pharmacoepidemiol Drug Saf 2016; 26:71-80. [PMID: 27730699 DOI: 10.1002/pds.4117] [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: 04/27/2016] [Revised: 09/13/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). METHODS A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. RESULTS DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. CONCLUSIONS With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hue-Yu Wang
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan.,College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan.,Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Kuan Hu
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan
| | - Yaw-Bin Huang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tseng GL, Chen CY. Evaluation of high myopia complications prevention program in university freshmen. Medicine (Baltimore) 2016; 95:e5093. [PMID: 27749586 PMCID: PMC5059089 DOI: 10.1097/md.0000000000005093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 11/29/2022] Open
Abstract
High myopia is a global eye health problem because of its high incidence of sight-threatening complications. Due to the role of awareness, self-examination, and preventive behavior in prevention of morbidity of high myopia complications, promoting knowledge, capabilities, and attitude of high myopic personnel are required in this regard.In this quasi-experiment study, 31 freshmen with high myopia in a national university were enrolled in 2014. The data were collected by validated and reliable questionnaire based on health belief model (HBM) and self-efficacy theory. The intervention program consisted of 1 educational session lasting 150 minutes by lecturing of high myopia complications, virtual reality experiencing, similarity modeling, and quibbling a film made on high myopia complications preventive concepts.Implementing the educational program showed immediate effect in knowledge, perceived susceptibility, perceived severity, self-efficacy, and preventive behavior intention. While 6 weeks after the educational program, significant increases were observed in cues to action, self-efficacy, and preventive behavior intention.This article provided that, after a single session, there was positive improvement in high myopia complication prevention behavior intention among participants. These positive effects confirmed the efficacy of the education program and will probably induce behavior change.
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Affiliation(s)
- Gow-Lieng Tseng
- Department of Ophthalmology, Taipei City Hospital, Renai Branch
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Cheng-Yu Chen
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC
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Validation of algorithms to identify stroke risk factors in patients with acute ischemic stroke, transient ischemic attack, or intracerebral hemorrhage in an administrative claims database. Int J Cardiol 2016; 215:277-82. [DOI: 10.1016/j.ijcard.2016.04.069] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
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Pan SC, Chen CC, Chiang YT, Chang HY, Fang CT, Lin HH. Health Care Visits as a Risk Factor for Tuberculosis in Taiwan: A Population-Based Case-Control Study. Am J Public Health 2016; 106:1323-8. [PMID: 27196655 PMCID: PMC4984759 DOI: 10.2105/ajph.2016.303152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess whether health care visits of nontuberculous patients are a risk factor for contracting tuberculosis. METHODS We conducted a case-control study nested within the cohort of 1 million individuals from the health insurance database in Taiwan between 2003 and 2010. We identified incident cases of tuberculosis through International Classification of Diseases, Ninth Revision (ICD-9) codes and prescription of antituberculosis drugs. We identified 4202 case participants and 16 808 control participants matched by age, gender, and date of diagnosis to estimate the association between frequency of health care visits and incidence of tuberculosis. RESULTS Frequency of health care visits was associated with increased risk of tuberculosis in a dose-dependent manner after adjustment for other medical comorbidities (P for trend < .001). Compared with individuals with fewer than 5 visits per year, those with more than 30 had a 77% increase in tuberculosis risk (adjusted odds ratio = 1.77; 95% confidence interval [CI] = 1.60, 1.97). CONCLUSIONS Frequent health care visits of nontuberculous patients appear to be a risk factor for contracting tuberculosis. PUBLIC HEALTH IMPLICATIONS Efforts should focus on educating the general population to avoid unnecessary hospital visits, strengthening active case finding, and intensifying infection control in all health care settings.
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Affiliation(s)
- Sung-Ching Pan
- Sung-Ching Pan and Chi-Tai Fan are with the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Chien-Chou Chen, Yi-Ting Chiang, and Hsien-Ho Lin are with Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. Hsing-Yi Chang is with the Center for Health Policy Research and Development, National Health Research Institutes, Taipan, Taiwan
| | - Chien-Chou Chen
- Sung-Ching Pan and Chi-Tai Fan are with the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Chien-Chou Chen, Yi-Ting Chiang, and Hsien-Ho Lin are with Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. Hsing-Yi Chang is with the Center for Health Policy Research and Development, National Health Research Institutes, Taipan, Taiwan
| | - Yi-Ting Chiang
- Sung-Ching Pan and Chi-Tai Fan are with the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Chien-Chou Chen, Yi-Ting Chiang, and Hsien-Ho Lin are with Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. Hsing-Yi Chang is with the Center for Health Policy Research and Development, National Health Research Institutes, Taipan, Taiwan
| | - Hsing-Yi Chang
- Sung-Ching Pan and Chi-Tai Fan are with the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Chien-Chou Chen, Yi-Ting Chiang, and Hsien-Ho Lin are with Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. Hsing-Yi Chang is with the Center for Health Policy Research and Development, National Health Research Institutes, Taipan, Taiwan
| | - Chi-Tai Fang
- Sung-Ching Pan and Chi-Tai Fan are with the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Chien-Chou Chen, Yi-Ting Chiang, and Hsien-Ho Lin are with Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. Hsing-Yi Chang is with the Center for Health Policy Research and Development, National Health Research Institutes, Taipan, Taiwan
| | - Hsien-Ho Lin
- Sung-Ching Pan and Chi-Tai Fan are with the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Chien-Chou Chen, Yi-Ting Chiang, and Hsien-Ho Lin are with Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. Hsing-Yi Chang is with the Center for Health Policy Research and Development, National Health Research Institutes, Taipan, Taiwan
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van Weel C, Kassai R, Tsoi GW, Hwang SJ, Cho K, Wong SY, Phui-Nah C, Jiang S, Ii M, Goodyear-Smith F. Evolving health policy for primary care in the Asia Pacific region. Br J Gen Pract 2016; 66:e451-3. [PMID: 27231305 PMCID: PMC4871311 DOI: 10.3399/bjgp16x685513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; Honorary Professor of Primary Health Care Research, Department of Health Systems Research and Policy, Australian National University, Canberra, Australia
| | - Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University, Fukushima, Japan
| | - Gene Ww Tsoi
- Hong Kong College of Family Physicians, Hong Kong
| | - Shinn-Jang Hwang
- Taipei Veterans General Hospital; Professor of Family Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Kyunghee Cho
- Department of Family Medicine, NHIMC Ilsan Hospital, Korea
| | - Samuel Ys Wong
- Professor of Family Medicine and Primary Health Care, Division of Family Medicine and Primary Healthcare, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
| | | | - Sunfang Jiang
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai Medical School Fudan University, China
| | - Masako Ii
- School of International and Public Policy, Hitotsubashi University, Tokyo, Japan
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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Patterns of outpatient care utilization by seniors under the National Health Insurance in Taiwan. J Formos Med Assoc 2016; 115:325-34. [PMID: 26809492 DOI: 10.1016/j.jfma.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/PURPOSE Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program. METHODS We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables. RESULTS In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas. CONCLUSION This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people.
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Chen CC, Cheng SH. Potentially Inappropriate Medication and Health Care Outcomes: An Instrumental Variable Approach. Health Serv Res 2015; 51:1670-91. [PMID: 26601656 DOI: 10.1111/1475-6773.12417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the effects of potentially inappropriate medication (PIM) use on health care outcomes in elderly individuals using an instrumental variable (IV) approach. DATA SOURCES/STUDY SETTING Representative claim data from the universal health insurance program in Taiwan from 2007 to 2010. STUDY DESIGN We employed a panel study design to examine the relationship between PIM and hospitalization. We applied both the naive generalized estimating equation (GEE) model, which controlled for the observed patient and hospital characteristics, and the two-stage residual inclusion (2SRI) GEE model, which further accounted for the unobserved confounding factors. The PIM prescription rate of the physician most frequently visited by each patient was used as the IV. PRINCIPAL FINDINGS The naive GEE models indicated that patient PIM use was associated with a higher likelihood of hospitalization (odds ratio [OR], 1.399; 95 percent confidence interval [CI], 1.363-1.435). Using the physician PIM prescribing rate as an IV, we identified a stronger significant association between PIM and hospitalization (OR, 1.990; 95 percent CI, 1.647-2.403). CONCLUSIONS PIM use is associated with increased hospitalization in elderly individuals. Adjusting for unobserved confounders is needed to obtain unbiased estimates of the relationship between PIM and health care outcomes.
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Affiliation(s)
- Chi-Chen Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shou-Hsia Cheng
- Department of Public Health, College of Medicine, Fu Jen Catholic University, Taiwan
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Cheng SH, Chang CM, Chen CC, Shih CY, Tsai SL. Half-Managed Care: A Preliminary Assessment of a Capitation Program in a Health Care System Without Gatekeepers. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 47:519-531. [PMID: 26588942 DOI: 10.1177/0020731415615310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 2011, a novel capitation program was launched in Taiwan under its universal health insurance plan. This study aimed to assess the short-term impact of the program. Two hospitals in the greater Taipei area, one participating in the "loyal patient" model (13,319 enrollees) and one in the "regional resident" model (13,768 enrollees), were analyzed. Two comparison groups were selected by propensity score matching. Generalized estimating equation models with differences-in-differences analysis were used to examine the net effects of the capitation program on health care utilization, expenses, and outcomes. Enrollees in the loyal patient model had fewer physician visits in the host hospital, but more physician visits outside that hospital during the program year than they had the year before. Compared with non-enrollees, the loyal patient model enrollees incurred fewer physician visits (β = -0.042, p < .001), fewer emergency department visits, (β = -0.140, p < .001), and similar total expenses and outcome. For the regional resident model, no differences were found in the number of physician visits, expenses, or outcomes between enrollees and non-enrollees. The novel capitation models in Taiwan had minimal impact on health care utilization after 1 year of implementation and the health care outcome was not compromised.
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Affiliation(s)
- Shou-Hsia Cheng
- 1 Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
| | - Chih-Ming Chang
- 2 National Health Insurance Administration, Taipei Division, Ministry of Health and Welfare, Taiwan
| | - Chi-Chen Chen
- 3 Department of Public Health, College of Medicine, Fen-Jen Catholic University, Taiwan
| | - Chih-Yuan Shih
- 4 Department of Family Medicine, National Taiwan University Hospital Jin-Shan Branch, Taipei, Taiwan
| | - Shu-Ling Tsai
- 5 National Health Insurance Administration, Ministry of Health and Welfare, Taiwan
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Ko M, Lee Y, Chen C, Chou P, Chu D. Incidence of and Predictors for Early Return Visits to the Emergency Department: A Population-Based Survey. Medicine (Baltimore) 2015; 94:e1770. [PMID: 26512573 PMCID: PMC4985387 DOI: 10.1097/md.0000000000001770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to estimate the proportion of and predictors for early return visits (ERVs) to the emergency department (ED) in Taiwan.This is a population-based study using data of 1 million people randomly selected from all beneficiaries of the Taiwan National Health Insurance. All ED visits in 2012 were analyzed. The ERVs to the ED were defined as those ED revisits within 3 days after the initial ED visit. We employed a generalized estimation equation model to investigate the independent effects of various characteristics associated with the initial ED visit on ERVs.The overall proportion of ERVs within 3 days with a same dichotomous diagnostic category according to injury or noninjury was 4.3% (6740/158,132), and the overall proportion of hospitalizations after ERVs was 24.1% (1627/6740). Male subjects (4.3%) were more likely to have ERVs with an adjusted odds ratio (AOR) of 1.10 (95% confidence interval [CI]: 1.04-1.16). Compared with patients aged 18 to 64 years (4.0%), those aged >64 years had a significantly increased risk of ERVs (6.2%, AOR: 1.49, 95% CI: 1.39-1.59). In comparison to patients with injury diagnoses (2.2%), those with noninjury diagnoses had a higher risk of ERVs (5.2%, AOR: 2.50, 95% CI: 2.33-2.70). Compared with patients initially treated at medical centers (3.7%), those initially treated at regional (4.5%, AOR: 1.28, 95% CI: 1.20-1.37) or district hospitals (4.5%, AOR: 1.38, 95% CI: 1.27-1.49) had significantly higher risks of ERVs. Among the 6740 patients with ERVs, 2622 (38.9%) returned to a different hospital, and these patients tended to be those aged 18 to 64 years and initially treated at district hospitals.The risk of ERVs was associated with demographic characteristics and accreditation level of hospital. We noted a large proportion of patients with ERVs to a different hospital. The reason underlying this phenomenon warrants further investigations.
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Affiliation(s)
- Mingchung Ko
- From the Department of Emergency Medicine and Surgery, Taipei City Hospital (MK, DC); Institute of Public Health and Community Medicine Research Center, National Yang-Ming University (MK, YL, PC, DC); Department of Health Care Management, National Taipei University of Nursing and Health Sciences (MK, CC, DC); Department of Dentistry, Taipei City Hospital (YL); and Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan (YL)
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Isaac V, McLachlan CS, Baune BT, Huang CT, Wu CY. Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan. Medicine (Baltimore) 2015; 94:e1477. [PMID: 26356706 PMCID: PMC4616650 DOI: 10.1097/md.0000000000001477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our aim was to investigate the association between self-rated health (SRH) and use of hospital services (ie, medical outpatient department, emergency department, and general ward. admissions). Cross-sectional study data were collected from 230 consecutive patients admitted to medical departments of a 2000-bed academic medical center in Taiwan using standardized operating procedures for data collection of SRH (ie, a single-item question inquiring overall perceived health status), medical disorders, depressive symptoms, and combined service utilization over a 1-year period (ie, number of visits to outpatient department, number of visits to emergency department, and number of hospitalizations). Electronic medical records were retrieved, with self-reported external medical visits added to in-hospital frequencies of service use to provide better estimation of health service utilization. Fifty-two percent of study patients rated their health as poor or very poor. Poor SRH was associated with more visits to medical outpatient department, emergency department, and hospital admission. Multivariate logistic regression demonstrated an independent association between poor SRH and services utilization after adjustment for age, gender, hypertension, diabetes, metastatic cancer, number of chronic illness, life-threatening event, life-time suicidal ideation, and depression. SRH may be a useful research tool to model medical service use for inpatients with chronic conditions.
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Affiliation(s)
- Vivian Isaac
- From the Rural Clinical School, University of New South Wales, Sydney, Australia (VI, CSM); Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia (BTB); Departments of Internal Medicine and Traumatology, National Taiwan University Hospital, Taipei, Taiwan (C-TH); and Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan (C-YW)
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Lin MH, Chang HT, Tu CY, Chen TJ, Hwang SJ. Doctor-Shopping Behaviors among Traditional Chinese Medicine Users in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9237-47. [PMID: 26262631 PMCID: PMC4555276 DOI: 10.3390/ijerph120809237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/30/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022]
Abstract
Doctor-shopping has caused an increase in medical expense, potential to receive duplicate medications, and suffer adverse drug reactions. We carried out a population-based retrospective study aimed at examining the user patterns of traditional Chinese medicine (TCM) ambulatory care in Taiwan. We retrieved complete TCM ambulatory visit datasets for the year 2007 from the National Health Insurance database in Taiwan. We defined the patients whose distribution of TCM physician numbers scored more than 97.5 percent (more than, or equal to, five TCM physicians) within one year as TCM doctor-shoppers. In total, 6,596,814 subjects (28.9%) paid TCM visits during that year. All 177,728 subjects (2.69%) who visited more than five (including) TCM physicians were classified as TCM shoppers. The most prevalent diagnostic grouping was upper respiratory infections (44.7%) and sprains and strains (44.0%). Men had a lower odds ratio (OR) among TCM shoppers than women (OR = 0.94, 95% confidence interval (CI) = 0.93-0.96). Younger people were less likely to be TCM shoppers than other people were. The ORs of TCM shoppers were higher among veterans and low-income patients (OR = 1.29 (1.23-1.35), and 1.33 (1.27-1.41)). In conclusion, health education on the potential of drug interactions and iatrogenic health risks incurred from doctor-shopping should be addressed to those high-risk patients.
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Affiliation(s)
- Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Chun-Yi Tu
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, Taoyuan branch, No. 100, Sec. 3, Cheng-Kung Road, Tao-Yuan 330, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
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Han DY, Lin YY, Liao SC, Lee MB, Thornicroft G, Wu CY. Analysis of the barriers of mental distress disclosure in medical inpatients in Taiwan. Int J Soc Psychiatry 2015; 61:446-55. [PMID: 25303956 DOI: 10.1177/0020764014552865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disclosure of mental distress to physicians is important for mental illness identification, early referrals and proper treatment to prevent suicide. Little is known about what affects mental health communication in the clinical settings in the Chinese societies. AIMS The study aimed to identify the demographic, psychosocial and medical factors related to people with non-disclosure of their mental distress. METHODS We interviewed a series of consecutive inpatients from two medical wards of a general hospital in northern Taiwan. We collected depressive symptoms (the Patient Health Questionnaire, PHQ-9), living arrangement, threatening life events, suicide risks (i.e. past self-harm history, lifetime suicide ideas and hopelessness) and recent experience of mental distress disclosure. Furthermore, we explored the reasons of non-disclosure. RESULTS A total of 230 medical inpatients agreed to participate (53.5% males). The results indicated that only 5.7% actually communicated their mental health concerns, and that 12.3% were willing to talk about their mental health problems. Among the 69 (30%) depressed participants (PHQ-9 score ≥ 10 points), the disclosure rate was low (8.7%) and the wish to talk about mental distress was also low (10.3%). After adjustment, living alone (OR = 7.58, 95% CI = 1.56-36.91) and having stressful life events (OR = 3.68, 95% CI = 1.09-12.46) remained significant in predicting disclosure of mental distress. The 109 participants attributed their refusal of communicating mental distress as medical-related attributes, subjective perceptions or sociocultural factors. CONCLUSION Communication of mental distress in medical settings was uncommon due to medical or psychosocial barriers in Taiwan. Skill training to facilitate disclosure in medical education and public campaigns to improve knowledge of depression and enhance help-seeking deserve more attention, particularly under the influence of stigma in the Chinese societies.
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Affiliation(s)
- Der-Yan Han
- Center for General Education, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yi-Yin Lin
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Been Lee
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Tseng GL, Chen CY. Doctor-Shopping Behavior among Patients with Eye Floaters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7949-58. [PMID: 26184266 PMCID: PMC4515702 DOI: 10.3390/ijerph120707949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 12/20/2022]
Abstract
Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers) who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters.
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Affiliation(s)
- Gow-Lieng Tseng
- Department of Ophthalmology, Taipei Municipal Hospital, Renai Branch, No.10, Sec. 4, Ren’Ai Rd., Taipei 10629, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-2-2709-3600 (ext. 3395)
| | - Cheng-Yu Chen
- Department of Health Promotion and Health Education, National Taiwan Normal University, No. 162, Sec.1, Heping East Road, Taipei 10610, Taiwan; E-Mail:
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Lu TH, Lee YY, Lee HC, Lin YM. Doctor Shopping Behavior for Zolpidem Among Insomnia Patients in Taiwan: A Nationwide Population-Based Study. Sleep 2015; 38:1039-44. [PMID: 25761979 DOI: 10.5665/sleep.4806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/24/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Although zolpidem is listed as a controlled drug in Taiwan, patients' behavior has not been restricted and has led to the problem of doctor shopping behavior (DSB), leading to overutilization of medical resources and excess spending. The National Health Insurance Administration in Taiwan has instituted a new policy to regulate physicians' prescribing behavior and decrease DSB. This retrospective study aimed to analyze the DSB for zolpidem by insomnia patients and assess related factors. DESIGN AND PARTICIPANTS Data were extracted from the Longitudinal Health Insurance Database in Taiwan. Individuals with a diagnosis of insomnia who received more than one prescription of zolpidem in 2008 were followed for 24 mo. Doctor shopping was defined as ≥ 2 prescriptions by different doctors within ≥ 1 day overlapping in the duration of therapy. The percentage of zolpidem obtained through doctor shopping was used as an indicator of the DSB of each patient. RESULTS Among the 6,947 insomnia patients who were prescribed zolpidem, 1,652 exhibited DSB (23.78%). The average dose of zolpidem dispensed for each patient during 24 mo was 244.21 daily defined doses. The doctor shopping indicator (DSI) was 0.20 (standard deviation, 0.23) among patients with DSB. Younger age, chronic diseases, high number of diseases, higher premium status, high socioeconomic status, and fewer people served per practicing physicians were all factors significantly related to doctor shopping behavior. CONCLUSION Doctor shopping for zolpidem appears to be an important issue in Taiwan. Implementing a proper referral system with efficient data exchange by physician or pharmacist-led medication reconciliation process might reduce DSB.
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Affiliation(s)
- Tzu-Hsuan Lu
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yen-Ying Lee
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medical Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - You-Meei Lin
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Chan CL, Lin W, Yang NP, Lai KR, Huang HT. Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis. PLoS One 2015; 10:e0127793. [PMID: 26030278 PMCID: PMC4452693 DOI: 10.1371/journal.pone.0127793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. Objectives We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS) and subsequent events. Methods This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events. Results The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13), and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively. Conclusions The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.
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Affiliation(s)
- Chien-Lung Chan
- Department of Information Management and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan
| | - Wender Lin
- Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan
| | - Nan-Ping Yang
- Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - K. Robert Lai
- Department of Computer Science and Engineering, and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan
| | - Hsin-Tsung Huang
- Department of Information Management and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan
- Medical Affairs Division, National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
- * E-mail:
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Lee YH, Chu D, Yang NP, Chan CL, Cheng SP, Pai JT, Chang NT. Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study. BMC Palliat Care 2015; 14:25. [PMID: 25956135 PMCID: PMC4436097 DOI: 10.1186/s12904-015-0016-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increased number of emergency visits at the end of life may indicate poor-quality cancer care. The study aimed to investigate the prevalence and utilization of emergency visits and to explore the reasons for emergency department (ED) visits among cancer patients at the end of life. METHODS A retrospective cohort study was performed by tracking one year of ambulatory medical service records before death. Data were collected from the cancer dataset of Taiwan's National Health Insurance Research Database (NHIRD). RESULTS A total of 32,772 (19.2%) patients with malignant cancer visited EDs, and 23,883 patients died during the study period. Of these, the prevalence of emergency visits in the mortality group was 81.5%, and their ED utilization was significantly increased monthly to the end of life. The most frequent types of cancer were digestive and peritoneum cancers (34.8%), followed by breast cancer (17.7%) and head and neck cancers (13.3%). Older patients, males, and those diagnosed with metastases, respiratory or digestive cancer were more likely to use ED services at the end of life. Use of an ED service in the nearest community hospital to replace medical centers for dying cancer patients would be more acceptable in emergency situations. CONCLUSIONS Our study provided population-based evidence related to ED utilization. An understanding of the reasons for such visits could be useful in preventing overuse of ED visits to improve the quality of end-of-life care.
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Affiliation(s)
- Yi-Hui Lee
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Nursing, School of Nursing, College of Medicine, Chang-Gang University, Taoyuan, Taiwan.
| | - Dachen Chu
- Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan.
| | - Nan-Ping Yang
- Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Medical Research, Keelung General Hospital, Ministry of Health & Welfare, Keelung, Taiwan.
| | - Chien-Lung Chan
- Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan.
| | - Shun-Ping Cheng
- Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Rehabilitation, Taoyuan General Hospital, Ministry of Health & Welfare, Taoyuan, Taiwan.
| | - Jih-Tung Pai
- Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Oncology & Internal Medicine, Taoyuan General Hospital, Ministry of Health & Welfare, Taoyuan, Taiwan.
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Chen CC, Cheng SH. Does pay-for-performance benefit patients with multiple chronic conditions? Evidence from a universal coverage health care system. Health Policy Plan 2015; 31:83-90. [PMID: 25944704 DOI: 10.1093/heapol/czv024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Numerous studies have examined the impact of pay-for-performance (P4P) programmes, yet little is known regarding their effects on continuity of care (COC) and the role of multiple chronic conditions (MCCs). This study aimed to examine the effects of a P4P programme for diabetes care on health care provision, COC and health care outcomes in diabetic patients with and without comorbid hypertension. METHODS This study utilized a large-scale natural experiment with a 4-year follow-up period under a compulsory universal health insurance programme in Taiwan. The intervention groups consisted of patients with diabetes who were enrolled in the P4P programme in 2005. The comparison groups were selected via propensity score matching with patients who were seen by the same group of physicians. A difference-in-differences analysis was conducted using generalized estimating equation models to examine the effects of the P4P programme. RESULTS Significant impacts were observed after the implementation of the P4P programme for diabetic patients with and without hypertension. The programme increased the number of necessary examinations/tests and improved the COC between patients and their physicians. The programme significantly reduced the likelihood of diabetes-related hospital admissions and emergency department visits [odds ratio (OR): 0.71; 95% confidence interval (CI): 0.63-0.80 for diabetic patients with hypertension; OR: 0.74; 95% CI: 0.64-0.86 for patients without hypertension]. However, the effects of the P4P programme diminished to some extent in the second year after its implementation. CONCLUSION This study suggests that a financial incentive programme may improve the provision of necessary health care, COC and health care outcomes for diabetic patients both with and without comorbid hypertension. Health authorities could develop policies to increase participation in P4P programmes and encourage continued improvement in health care outcomes.
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Affiliation(s)
- Chi-Chen Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan and
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Lai LJ, Chou CL, Su HI, Chen TJ, Chou LF, Chou YC, Hwang SJ, Yu HC. No gynecologist in town: the gynecological care of women in rural Taiwan. Patient Prefer Adherence 2015; 9:1077-83. [PMID: 26251581 PMCID: PMC4524465 DOI: 10.2147/ppa.s64731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan. METHODS Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman's residency was operationally inferred from the locations where she had most frequently visited physicians' clinics or local community hospitals within the year. RESULTS In Taiwan, 145 (39.4%) of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7%) lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7%) had sought medical help for gynecological diseases and 113,698 (29.8%) had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less likely to consult for gynecological diseases (23.8% versus 35.4%; P<0.001) and visit gynecologists (18.7% versus 30.4%; P<0.001) than women in towns with a gynecologist. The disparity existed in each age group. Among 5,189 adult women living in towns without a gynecologist and having gynecological diseases, 78.5% (number [n]=4,074) visited gynecologists out of town, especially for infertility, benign disorders of the uterus and ovaries, gynecological examinations, and contraceptive problems, and by contrast 23.3% (n=1,209) visited nongynecologists in town, most commonly for menopausal disorders, endometriosis and pelvic pain, menstrual disorders and hormonal dysfunction, and genital dysplasia. CONCLUSION Gynecological care of rural women was adversely affected by the shortage of gynecologists. The consequences of accessibility in underserved areas deserve further investigation.
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Affiliation(s)
- Li-Jung Lai
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Lin Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - H Irene Su
- Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hann-Chin Yu
- Taipei Veterans General Hospital Hsinchu Branch, Hsinchu County, Taiwan
- Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan
- Correspondence: Hann-Chin Yu, Taipei Veterans General Hospital Hsinchu Branch, No 81, Sec 1, Zhongfeng Road, Zhudong Township, Hsinchu County 310, Taiwan, Tel +886 359 611 86, Fax +886 359 695 91, Email
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Increased healthcare service utilizations for patients with dementia: a population-based study. PLoS One 2014; 9:e105789. [PMID: 25157405 PMCID: PMC4144915 DOI: 10.1371/journal.pone.0105789] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/23/2014] [Indexed: 11/19/2022] Open
Abstract
Background The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan’s National Health Insurance population-based database. Methods This study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services. Results As for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p<0.001) and significantly higher outpatient costs (US$124 vs. US$16, p<0.001) than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p<0.001) and significantly higher outpatient costs (US$1754 vs. US$1322, p<0.001) than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p<0.001) and significantly higher outpatient costs (US$1878 vs. US$1338, p<0.001) than comparison subjects. Furthermore, the total cost was about 2-fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p<0.001). Conclusions We concluded that subjects who had received a clinical dementia diagnosis had significantly higher utilization of all healthcare services than comparison subjects.
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The ecology of gynecological care for women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7669-77. [PMID: 25089773 PMCID: PMC4143825 DOI: 10.3390/ijerph110807669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 11/26/2022]
Abstract
Gynecological care is vital to women’s health but utilization of gynecological care has been seldom addressed. We applied the population-based “ecology model” to demonstrate the utilization of gynecological care of women, with examples from Taiwan. We analyzed the claims data from the cohort datasets within the National Health Insurance Research Database in Taiwan. Women’s utilization of gynecological care in 2009 was computed. Of 1000 women, 319 utilized gynecological care at least once, 277 visited Western medicine clinics, 193 visited physician clinics, 118 visited hospital-based outpatient clinics, 73 visited traditional Chinese medicine clinics, eight were hospitalized, four were hospitalized in an academic medical center, and four visited emergency departments. More than 90% of young and middle-aged women who sought gynecological care visited gynecologist clinics. Elderly women were less likely to utilize gynecological care in all settings of medical care, but were more likely to be attended by non-gynecologists. Young women tended to visit emergency departments. The ecology model highlighted age disparities in women’s utilization of gynecological care in various settings of medical care. Since gynecological conditions were common among women, more attention should be paid on the availability of gynecologists and continuing medical education in gynecological care for non-gynecologists to guarantee women’s health.
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Chiang KL, Cheng CY. Prevalence and neuro-psychiatric comorbidities of pediatric epilepsy in Taiwan: a national population-based study. Epilepsy Res 2014; 108:1451-60. [PMID: 25107685 DOI: 10.1016/j.eplepsyres.2014.07.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/27/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Children with epilepsy may have comorbidities that result in significant disability. Epidemiological information for pediatric patients with epilepsy in Taiwan is scant. This research estimates the prevalence and common neuro-psychiatric comorbidities of children with epilepsy in Taiwan. METHODS Patients aged less than 20 years old who had received a diagnosis of epilepsy and suffered from epileptic seizures in 2005 were identified in the NHIRD based on ICD-9-CM and prescription records for the use of at least one AED. We used cases of epileptic seizure to survey outpatient service data, and identify common neuro-psychiatric comorbidities. The crude prevalence rate and the age- and sex-specific prevalence were estimated. We also examined the effects of urbanization. RESULTS The estimated prevalence of epilepsy was 0.33% in the pediatric population, with 0.29% for girls and 0.36% for boys. The most common neuropsychiatric comorbidities were learning disability and developmental delay, cerebral palsy, and mental retardation. Epilepsy was more prevalent in boys than in girls, especially among infants, preschool children, and those living in rural areas. In addition, boys with epilepsy had a higher rate of neurological comorbidities. The prevalence of psychiatric comorbidities was lower than that reported in previous studies performed in other countries, especially among children with epilepsy living in rural areas. CONCLUSION This research provides the largest nationwide, population-based study of childhood epilepsy to estimate the prevalence and the associated neuropsychiatric comorbidities of pediatric epilepsy in Taiwan. Potential rural-urban disparity basing on prevalence and associated neuropsychiatric comorbidities cannot be ignored in Taiwan.
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Affiliation(s)
- Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, No. 117, Shatian Road Shalu District, Taichung City 433, Taiwan ROC.
| | - Chen-Yang Cheng
- Program of Health Administration, Tunghai University, No. 181, Section 3, Taichung Harbor Road, Taichung, 407-04, Taiwan ROC.
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Lai NS, Tsai TY, Koo M, Huang KY, Tung CH, Lu MC. Patterns of ambulatory medical care utilization and rheumatologist consultation predating the diagnosis of systemic lupus erythematosus: a national population-based study. PLoS One 2014; 9:e101485. [PMID: 24999630 PMCID: PMC4084818 DOI: 10.1371/journal.pone.0101485] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 06/09/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To investigate the records of ambulatory medical care from patients predating the diagnosis of systemic lupus erythematosus (SLE) using nationwide, population-based claims data. METHODS The frequencies and costs of ambulatory medical care utilization in 337 newly-diagnosed SLE cases between 2004 and 2010, identified from Taiwan's National Health Insurance Research Database, were compared with 1,348 controls who were frequency matched for sex, age, and the catastrophic illness certificate application year of the cases. RESULTS Patients with SLE had a median frequency of ambulatory medical care utilization compared with controls one year prior to the index date (22 vs. 2, P<0.001). The differences were significant throughout all eight annual periods. Similarly, the inflation-adjusted costs of ambulatory medical care utilization in patients with SLE increased annually over the study period, from a median of US$18 eight years prior to the index date to US$680 one year prior to the index date. Diseases of the respiratory system (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 460-519), digestive system (ICD-9-CM codes 520-579), musculoskeletal system and connective tissue (ICD-9-CM codes 710-739, excluding 710.0), and skin and subcutaneous tissue (ICD-9-CM codes 680-709) were the top four common causes of visits in the 0.5 to 2 year period preceding the index date and percentages of SLE patients suffered from these disorders increased progressively over the study period. Only 56.4% of the patients with SLE had consulted a rheumatologist and most of the serology tests were done within one year predating the index date. CONCLUSIONS Increased frequencies and costs of ambulatory care utilization among Taiwanese patients with SLE occurred several years predating their definitive SLE diagnosis. When multisystemic disorders are presented in young female patients, the possibility of SLE should be considered and screened with tools such as the antinuclear antibody test.
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Affiliation(s)
- Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tzung-Yi Tsai
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Malcolm Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kuang-Yung Huang
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Hsueh Tung
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Lu MC, Fa WH, Tsai TY, Koo M, Lai NS. Increased utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of Sjögren's syndrome in female patients: a longitudinal population-based study in Taiwan. BMJ Open 2014; 4:e003862. [PMID: 24844268 PMCID: PMC4039788 DOI: 10.1136/bmjopen-2013-003862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To investigate the utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of primary Sjögren's syndrome in female Taiwanese patients. DESIGN A nationwide, population-based case-control study. SETTING Taiwan's National Health Insurance Research Database. PARTICIPANTS A total of 347 patients with a diagnosis of primary Sjögren's syndrome from 2005 to 2010 and 1735 controls frequency matched on 10-year age interval and index year were identified from Taiwan's National Health Insurance Research Database. Diagnoses of eye disorder (International Classification of Diseases, Ninth Revision, clinical modification (ICD-9-CM) codes from 360 to 370) were retrospectively screened to 1997. MAIN OUTCOME MEASURE The utilisation of eye disorder-related medical service over different intervals prior to diagnosis of Sjögren's syndrome between cases and controls were compared using generalised estimating equations with negative binomial distribution and log link function. RESULTS A significantly higher proportion of patients with Sjögren's syndrome (7.5%) utilised eye disorder-related ambulatory medical services over an 8-year interval prior to the diagnosis of the disease compared with controls (4.8%). The annual frequency of utilisation of eye disorder-related ambulatory medical services increased significantly faster when closer to the index date in patients with Sjögren's syndrome compared with controls (interaction effect, p=0.010). Subgroup analyses indicated that the changes over time in the utilisation of services related to disorders of lacrimal system (interaction effect, p=0.019) and conjunctiva (interaction effect, p=0.066) were significantly greater in patients with Sjögren's syndrome compared with controls. CONCLUSIONS An increase in the utilisation of eye disorder-related ambulatory medical services was observed in patients with Sjögren's syndrome several years prior to the diagnosis of the disease. General practitioners and ophthalmologists can play an important role by including Sjögren's syndrome in the diagnostic evaluation of their patients afflicted with relevant symptoms.
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Affiliation(s)
- Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Hsiung Fa
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Ophthalmology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Tzung-Yi Tsai
- Department of Medical Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Malcolm Koo
- Department of Medical Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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