1
|
Jolidon V, Eicher M, Peytremann-Bridevaux I, Arditi C. Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants. BMC Health Serv Res 2024; 24:733. [PMID: 38877526 PMCID: PMC11179203 DOI: 10.1186/s12913-024-11174-x] [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: 10/25/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Patients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients' experiences with cancer care. OBJECTIVE To examine whether patients' experiences with cancer care differ according to their economic status and health literacy. METHODS Secondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients' economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors. RESULTS Adjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of 'respect for patients' preferences' and 'physical comfort' where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of 'respect for patients' preferences', 'physical comfort' and 'emotional support' were associated with health literacy. DISCUSSION This study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.
Collapse
Affiliation(s)
- Vladimir Jolidon
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Chantal Arditi
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland.
| |
Collapse
|
2
|
Jaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K. Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a cross-sectional, questionnaire-based study. BMC Health Serv Res 2024; 24:103. [PMID: 38238764 PMCID: PMC10797974 DOI: 10.1186/s12913-023-10348-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Low-acuity pediatric emergency department (PED) visits are frequent in high-income countries and have a negative impact on patient care at the individual and health system levels. Knowing what drives low-acuity PED visits is crucial to inform adaptations in health care delivery. We aimed to identify factors associated with low-acuity PED visits in Switzerland, including socioeconomic status, demographic features, and medical resources of families. METHODS We conducted a prospective, questionnaire-based study in the PEDs of two Swiss tertiary care hospitals, Bern and Lausanne. We invited all consecutive children and their caregiver attending the PED during data collection times representative of the overall PED consultation structure (e.g. day/night, weekdays/weekends) to complete a questionnaire on demographic features, socioeconomic status, and medical resources. We collected medical and administrative data about the visit and defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed, and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits. RESULTS We analysed 778 PED visits (September 2019 to July 2020). Most children visiting our PEDs had a designated primary care provider (92%), with only 6% not having seen them during the last year. Fifty-five per cent of caregivers had asked for medical advice before coming to the PED. The proportion of low-acuity visits was 58%. Low-acuity visits were associated with caregiver's difficulties paying bills (aOR 2.6, 95% CI 1.6 - 4.4), having already visited a PED in the last 6 months (aOR 1.7, 95% CI 1.1 - 2.5) but not with parental education status, nor parental country of birth, parental employment status or absence of family network. CONCLUSION Economic precariousness is an important driver for low-acuity PED visits in Switzerland, a high-income country with compulsory health coverage where most children have a designated primary care provider and a regular pediatric follow-up. Primary care providers and PEDs should screen families for economic precariousness and offer anticipatory guidance and connect those in financial need to social support.
Collapse
Affiliation(s)
- Manon Jaboyedoff
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Carl Starvaggi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joan-Carles Suris
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mario Gehri
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Marques-Vidal P, Chekanova V, de Mestral C, Guessous I, Stringhini S. Trends and determinants of prevalence, awareness, treatment and control of dyslipidaemia in canton of Geneva, 2005-2019: Potent statins are underused. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200187. [PMID: 37250185 PMCID: PMC10209490 DOI: 10.1016/j.ijcrp.2023.200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023]
Abstract
We assessed 1) trends in prevalence, awareness, treatment and control rates of dyslipidaemia and associated factors, 2) the effect of statin generation/potency on control levels and 3) the effect of ESC lipid guidelines, on lipid management. Data from multiple cross-sectional, population-based surveys conducted between 2005 and 2019 in the canton of Geneva, Switzerland, were used. Prevalence, awareness, treatment and control rates of dyslipidaemia were 46.0% and 34.9% (p < 0.001), 67.0% and 77.3% (p = 0.124), 40.0% and 19.9% (p < 0.001), and 68.0% and 84.0% (p = 0.255), in 2005 and 2019, respectively. After multivariable adjustment, only the decrease in treatment rates was significant. Increasing age, higher BMI, history of hypertension or diabetes were positively associated with prevalence, while female sex was negatively associated. Female sex, history of diabetes or CVD were positively associated with awareness, while increasing age was negatively associated. Increasing age, smoking, higher BMI, history of hypertension, diabetes or CVD were positively associated with treatment, while female sex was negatively associated. Female sex was positively associated with control, while increasing age was negatively associated. Highly potent statins increased from 50.0% to 87.5% and third generation statins from 0% to 47.5% in 2009 and 2015, respectively. Increased statin potency was borderline (p = 0.059) associated with dyslipidaemia control. ESC guidelines had no effect regarding the prescription of more potent or higher generation statins. We conclude that in the canton of Geneva, treatment of diagnosed dyslipidaemia is low, but control is adequate. Women are undertreated but better controlled than men. The most potent hypolipidemic drugs are underused.
Collapse
Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valeriya Chekanova
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- National Medical Research Center of Cardiology, Moscow, Russia
| | - Carlos de Mestral
- Population Epidemiology Unit, Primary Care Division, Geneva University Hospital, Geneva, Switzerland
| | - Idris Guessous
- Population Epidemiology Unit, Primary Care Division, Geneva University Hospital, Geneva, Switzerland
| | - Silvia Stringhini
- Population Epidemiology Unit, Primary Care Division, Geneva University Hospital, Geneva, Switzerland
| |
Collapse
|
4
|
Achstetter K, Blümel M, Köppen J, Hengel P, Busse R. Assessment of health system performance in Germany: Survey-based insights into the perspective of people with private health insurance. Int J Health Plann Manage 2022; 37:3103-3125. [PMID: 35960184 DOI: 10.1002/hpm.3541] [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: 12/10/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) defined intermediate and overall goals to assess the performance of health systems. As the population perspective becomes more important for improving health systems, the aim of this study was to gain insights into the perspective of people with private health insurance (PHI) in Germany along the predefined WHO goals. METHODS A cross-sectional survey was conducted in 2018 among people with PHI in Germany. The questionnaire included items on all intermediate (access, coverage, quality, and safety) and overall WHO goals (improved health, responsiveness, social and financial risk protection, and improved efficiency). Descriptive analyses were conducted for the total sample and subgroups (gender, age, income, and health status). RESULTS In total, 3601 respondents (age 58.5 ± 14.6; 64.7% male) assessed the German health system. For example, 3.3%-7.5% of the respondents with subjective needs reported forgone care in the past 12 months due to waiting time, distance, or financial reasons and 14.4% suspected medical errors in their care. During the last physician visit 94.2% experienced respectful treatment but only 60.6% perceived coordination of care as good. Unnecessary health services were perceived by 24.2%. For many items significant subgroup differences were found, particularly for age groups (18-64 vs. 65+). CONCLUSION Conducting a health system performance assessment from the population perspective gained new and unique insights into the perception of people with PHI in Germany. Areas to improve the health system were seen in, for example, coordination of care, financial risk protection, and quality of care, and inequalities between subgroups were identified.
Collapse
Affiliation(s)
- Katharina Achstetter
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Miriam Blümel
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Julia Köppen
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Philipp Hengel
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| |
Collapse
|
5
|
Hardman R, Begg S, Spelten E. Exploring the ability of self-report measures to identify risk of high treatment burden in chronic disease patients: a cross-sectional study. BMC Public Health 2022; 22:163. [PMID: 35073896 PMCID: PMC8785389 DOI: 10.1186/s12889-022-12579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/13/2022] [Indexed: 09/03/2023] Open
Abstract
Background Effective self-management of chronic health conditions is key to avoiding disease escalation and poor health outcomes, but self-management abilities vary. Adequate patient capacity, in terms of abilities and resources, is needed to effectively manage the treatment burden associated with chronic health conditions. The ability to measure different elements of capacity, as well as treatment burden, may assist to identify those at risk of poor self-management. Our aims were to: 1. Investigate correlations between established self-report tools measuring aspects of patient capacity, and treatment burden; and 2. Explore whether individual questions from the self-report tools will correlate to perceived treatment burden without loss of explanation. This may assist in the development of a clinical screening tool to identify people at risk of high treatment burden. Methods A cross-sectional survey in both a postal and online format. Patients reporting one or more chronic diseases completed validated self-report scales assessing social, financial, physical and emotional capacity; quality of life; and perceived treatment burden. Logistic regression analysis was used to explore relationships between different capacity variables, and perceived high treatment burden. Results Respondents (n = 183) were mostly female (78%) with a mean age of 60 years. Most participants were multimorbid (94%), with 45% reporting more than five conditions. 51% reported a high treatment burden. Following logistic regression analyses, high perceived treatment burden was correlated with younger age, material deprivation, low self-efficacy and usual activity limitation. These factors accounted for 50.7% of the variance in high perceived treatment burden. Neither disease burden nor specific diagnosis was correlated with treatment burden. Conclusions This study supports previous observations that psychosocial factors may be more influential than specific diagnoses for multimorbid patients in managing their treatment workload. A simple capacity measure may be useful to identify those who are likely to struggle with healthcare demands. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12579-1.
Collapse
|
6
|
Douillet D, Dupont C, Leloup N, Ménager G, Delori M, Soulie C, Morin F, Moumneh T, Savary D, Roy PM, Armand A. Prevalence and characterization of forgoing care: comparison of two prospective multicentre cohorts between pre-COVID-19 era and a lockdown period. Arch Public Health 2022; 80:32. [PMID: 35042548 PMCID: PMC8766360 DOI: 10.1186/s13690-022-00797-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about patients who forego healthcare, although it is an important provider of unfavorable health-related outcomes. Forgoing healthcare characterizes situations in which people do not initiate or interrupt a care process, even though they perceive the need for it, whether or not this need is medically proven. The aims of this study were to assess the prevalence and the determinants of patients who forego healthcare. The second aim was to compare the characteristics of patients who gave up healthcare during the French lockdown due to COVID-19. METHODS We conducted two multicenter cross-sectional studies in 2017 and 2020 carried out in French patients presenting to the emergency departments. Patients who gave their consent to participate were interviewed with a standardized questionnaire. It consisted of two parts: epidemiological characteristics and health care refusal. A third part concerning the renunciation of care during the COVID-19 period was added to the second study period. RESULTS A total of 1878 patients had completed the questionnaire during the interview with the physicians, 900 during the first period in 2017 (47.9%) and 978 (52.1%) during the second period. A total of 401/1878 patients reported not seeking care in the last 12 months (21.4% [95%CI: 19.5-23.3%]). In 2020, patients forewent care more during the confinement period than outside with different characteristics of the foregoing care populations. CONCLUSION Forgoing care is common in a universal health care system such as France's and increased during the pandemic. Key public health messages targeted at the reasons for not seeking care must now be disseminated in order to combat this.
Collapse
Affiliation(s)
- Delphine Douillet
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France. .,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France.
| | - Clémence Dupont
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | - Noémie Leloup
- Emergency Department, Le Mans Hospital, Le Mans, France
| | | | - Maud Delori
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | | | - François Morin
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | - Thomas Moumneh
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,EHESP, Irset, Inserm, UMR S1085, CAPTV CDC, University of Rennes, Rennes, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
| | - Aurore Armand
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,République des Savoirs- Lettres, Sciences, Philosophie - USR3608- ED540- ENS-PSL, Paris, France
| |
Collapse
|
7
|
Petrovic D, Marcus K, Sandoval J, Cullati S, Piumatti G, Bodenmann P, Jackson YL, Durosier Izart C, Wolff H, Guessous I, Stringhini S. Health-related biological and non-biological consequences of forgoing healthcare for economic reasons. Prev Med Rep 2021; 24:101602. [PMID: 34976659 PMCID: PMC8683898 DOI: 10.1016/j.pmedr.2021.101602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 12/14/2022] Open
Abstract
Forgoing healthcare for economic reasons has been previously associated with adverse health outcomes, including a higher risk of hospitalization, a lower quality of life, and worse self-reported health. However, the exact cause-to-effect relation between forgoing healthcare and health-related outcomes has been insufficiently described. Here, we investigate the prospective health consequences of forgoing healthcare for economic reasons using data from “ReBus” (N = 400), a prospective study examining the health consequences of forgoing healthcare (Baseline: 2008–2013, Follow-up: 2014–2016). Using regression models, we explored the baseline determinants of forgoing healthcare, including socioeconomic, demographic, and pre-existing health-risk factors, and examined the associations between forgoing healthcare at baseline and health deterioration at follow-up, using highly pertinent biomarkers (glucose, glycated hemoglobin, lipids, blood pressure) and SF-36 questionnaire data. Low income, low occupation, low education, and smoking were associated with higher odds of forgoing healthcare at baseline. Forgoing healthcare for economic reasons at baseline was subsequently related to detrimental changes in glucose, high-density lipoprotein cholesterol (HDL), and blood pressure (BP) at follow-up, independently of baseline socioeconomic factors (Glucose-β = 0.19, 95%CI[0.03;0.34], HDL-β = -0.07, 95%CI[-0.14;0.01], BP-β = 3.30, 95%CI[-0.01;6.60]). Moreover, we found strong associations between forgoing healthcare and adverse SF-36 health scores at follow-up, with individuals forgoing healthcare systematically displaying worse health scores (6%–11% lower scores). For the first time, we show that forgoing healthcare for economic reasons predicts adverse health-related consequences 2–8 years later. Our findings shall further encourage the implementation of public health measures aimed at identifying individuals who forgo healthcare and preventing the adverse health consequences of unmet medical needs.
Collapse
Affiliation(s)
- Dusan Petrovic
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland.,Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Kailing Marcus
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - José Sandoval
- Department of Oncology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, Switzerland.,Quality of Care Service, Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Switzerland
| | | | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland.,Faculty of Biology and Medicine, Deanship, University of Lausanne, Lausanne, Switzerland
| | - Yves-Laurent Jackson
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Claire Durosier Izart
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Hans Wolff
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Idris Guessous
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Silvia Stringhini
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland
| |
Collapse
|
8
|
Schneider R, Näpflin M, Syrogiannouli L, Bissig S, Tal K, Bulliard JL, Ducros C, Senn O, Selby K, Bähler C, Blozik E, Auer R. Change in Colorectal Cancer Tests Submitted for Reimbursement in Switzerland 2012-2018: Evidence from Claims Data of a Large Insurance. Int J Public Health 2021; 66:1604073. [PMID: 34744596 PMCID: PMC8565273 DOI: 10.3389/ijph.2021.1604073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Guidelines recommend colorectal cancer (CRC) screening by fecal occult blood test (FOBT) or colonoscopy. In 2013, Switzerland introduced reimbursement of CRC screening by mandatory health insurance for 50-69-years-olds, after they met their deductible. We hypothesized that the 2013 reimbursement policy increased testing rate. Methods: In claims data from a Swiss insurance, we determined yearly CRC testing rate among 50-75-year-olds (2012–2018) and the association with socio-demographic, insurance-, and health-related covariates with multivariate-adjusted logistic regression models. We tested for interaction of age (50–69/70–75) on testing rate over time. Results: Among insurees (2012:355′683; 2018:348′526), yearly CRC testing rate increased from 2012 to 2018 (overall: 8.1–9.9%; colonoscopy: 5.0–7.6%; FOBT: 3.1–2.3%). Odds ratio (OR) were higher for 70–75-year-olds (2012: 1.16, 95%CI 1.13–1.20; 2018: 1.05, 95%CI 1.02–1.08). Deductible interacted with changes in testing rate over time (p < 0.001). The increase in testing rate was proportionally higher among 50-69-years-olds than 70-75-year-olds over the years. Conclusions: CRC testing rate in Switzerland increased from 2012 to 2018, particularly among 50-69-years-olds, the target population of the 2013 law. Future studies should explore the effect of encouraging FOBT or waiving deductible.
Collapse
Affiliation(s)
- Rémi Schneider
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Markus Näpflin
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Lamprini Syrogiannouli
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Sarah Bissig
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Kali Tal
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Cyril Ducros
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Oliver Senn
- Institut für Hausarztmedizin, Universitätsklinikum Zürich, Zürich, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Reto Auer
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| |
Collapse
|
9
|
Routinely asking patients about income in primary care: a mixed-methods study. BJGP Open 2021; 6:BJGPO.2021.0090. [PMID: 34666982 PMCID: PMC8958735 DOI: 10.3399/bjgpo.2021.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Income is a key social determinant of health, yet it is rare for data on income to be routinely collected and integrated with electronic health records. Aim To examine response bias and evaluate patient perspectives of being asked about income in primary care. Design & setting Mixed-methods study in a large, multi-site primary care organisation in Toronto, Canada, where patients are asked about income in a routinely administered sociodemographic survey. Method Data were examined from the electronic health records of patients who answered at least one question on the survey between December 2013 and March 2016 (n = 14 247). The study compared those who responded to the income question with non-responders. Structured interviews with 27 patients were also conducted. Results A total of 10 441 (73%) patients responded to both parts of the income question: ‘What was your total family income before taxes last year?’ and ‘How many people does your income support?’. Female patients, ethnic minorities, caregivers of young children, and older people were less likely to respond. From interviews, many patients were comfortable answering the income question, particularly if they understood the connection between income and health, and believed the data would be used to improve care. Several patients found it difficult to estimate their income or felt the options did not reflect fluctuating financial circumstances. Conclusion Many patients will provide data on income in the context of a survey in primary care, but accurately estimating income can be challenging. Future research should compare self-reported income to perceived financial strain. Data on income linked to health records can help identify health inequities and help target anti-poverty interventions.
Collapse
|
10
|
Jalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health 2021; 21:1588. [PMID: 34429093 PMCID: PMC8386068 DOI: 10.1186/s12889-021-11639-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Diabetes mellitus is a complex chronic disease requiring appropriate continuous medical care and delayed, or forgone care may exacerbate the severity of the disease. This study aimed to investigate the factors affecting forgone care in patients with type2 diabetes. MATERIALS AND METHODS This was a cross-sectional study involving 1139 patients with type 2 diabetes aged> 18 years in 2019 in Tabriz, Iran. The researcher-made questionnaire was used for data collection. Data were analyzed using IBM SPSS software version 22 and IBM AMOS 22. Exploratory Factor Analysis (EFA) was performed for dimension reduction of the questionnaire, and Confirmatory Factor Analysis (CFA) used to verify the result of EFA. We applied the binary logistic regression model to assess the factors affecting forgone care. RESULTS Of the 1139 patients, 510 patients (45%) reported forgone care during the last year. The percentage of forgoing care was higher in patients without supplementary insurance coverage (P = 0.01), those with complications (P = 0.01) and those with a history of hospitalization (P = 0.006). The majority of patients (41.5%) reported that the most important reason for forgoing care is financial barriers resulting from disease treatment costs. Of the main four factors affecting, quality of care had the highest impact on forgone care at 61.28 (of 100), followed by accessibility (37.01 of 100), awareness and attitude towards disease (18.52 of 100) and social support (17.22 of 100). CONCLUSION The results showed that, despite the implementation of the Islamic Republic of Iran on a fast-track to beating non-communicable diseases (IraPEN), a considerable number of patients with type2 diabetes had a history of forgoing care, and the most important reasons for forgoing care were related to the financial pressure and dissatisfaction with the quality of care. Therefore, not only more financial support programs should be carried out, but the quality of care should be improved.
Collapse
Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Somayeh Heydari
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Mir
- Student Research Committee, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
11
|
Baggio S, Spechbach H, Vernaz N, Guessous I, Gétaz L, Kaiser L, Chappuis F, Salamun J, Jacquerioz F. SARS-CoV-2 testing strategy: A comparison of restricted and extended strategies in a Swiss outpatient cohort from the community and hospital employees. PLoS One 2021; 16:e0250021. [PMID: 33886627 PMCID: PMC8061911 DOI: 10.1371/journal.pone.0250021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Testing is a key measure to control the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we empirically compared two SARS-CoV-2 testing strategies. METHODS We used data from a Swiss single-centre, outpatient cohort study (n = 6,331 test results). A "restricted" strategy was applied to individuals with respiratory symptoms and/or fever and selected risk factors, or an epidemiological link and an "extended" strategy included any clinical symptoms without restriction, irrespective of risk factors and exposure. Data on infection, symptoms, viral load were collected during the first wave (March 11-April 21, 2020) and patients were followed up for clinical complications and hospitalisations until August 31, 2020. FINDINGS Infection, clinical complications, and hospitalisation rates were lower for those in the extended strategy compared with the restricted strategy (17.2% vs. 25.0%, 12.3% vs. 20.8%, and 0.7% vs. 2.3%). In the whole cohort, participants included in the extended strategy had a lower number of symptoms (3.51 vs. 4.57; p < .001) and visits occurred earlier after symptom onset (0-3 days: 59.2% vs. 44.2%; p < .001). Among positive cases, the viral load was higher for the extended strategy (p < .001). CONCLUSIONS These findings highlighted the crucial importance to implement a widespread testing strategy to achieve a better understanding of the infection, to mount an effective control response, by capturing people when their viral load is highest. A widespread test strategy should be available without barriers to help break the chains of transmission.
Collapse
Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Office of Corrections, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland
| | - Hervé Spechbach
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Nathalie Vernaz
- Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Salamun
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Jacquerioz
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
12
|
Bawab N, Zuercher E, Carron T, Chinet L, Bugnon O, Berger J, Peytremann-Bridevaux I. Interest in and use of person-centred pharmacy services - a Swiss study of people with diabetes. BMC Health Serv Res 2021; 21:216. [PMID: 33691691 PMCID: PMC7945663 DOI: 10.1186/s12913-021-06217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes is one of the most important chronic diseases and affects 9% of the world’s population. To support these people in the day-to-day management of their treatments, pharmacies can offer professional pharmacy services. These are defined as one or more actions organized or provided in a pharmacy to optimize the process of care, with the goal of improving health outcomes and the value of healthcare. Such services have to be tailored to the needs and interests of patients. This study aimed to evaluate interest in and use of pharmacy services among people with diabetes in the canton of Vaud, Switzerland. Methods This cross-sectional study analysed self-reported data from 790 people with diabetes included in the CoDiab-VD cohort. Questions focused on sociodemographic and economic characteristics, diabetes and its management, and interest in and use of pharmacy services related to (1) medication intake and adherence and (2) diabetes and general health. Descriptive analyses were first conducted. Logistic regression analyses were then performed for pharmacy services that were of interest to ≥50% of respondents. Results The mean age of participants was 66 years, and the sample included more males (59%) than females. The pharmacy services that interested the most respondents were individual interview, pill boxes or weekly pill boxes, treatment plans, checks of all medications, first medical opinions from pharmacists and counselling on devices. Factors significantly associated with interest in pharmacy services were being older, having a lower self-efficacy score, taking more than three medications and having a positive opinion about pharmacists. Conclusions This study provides key information on interest in and use of pharmacy services among patients with diabetes in Switzerland; it should help pharmacists individualize their services for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06217-6.
Collapse
Affiliation(s)
- Noura Bawab
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. .,Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, University of Lausanne, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
| | - Emilie Zuercher
- Department of Epidemiology and Health Systems (DESS), Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Tania Carron
- Department of Epidemiology and Health Systems (DESS), Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Léonie Chinet
- diabètevaud, Avenue de Provence 12, 1007, Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, University of Lausanne, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Jérôme Berger
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, University of Lausanne, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems (DESS), Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| |
Collapse
|
13
|
Khera R, Valero-Elizondo J, Nasir K. Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions. J Am Heart Assoc 2020; 9:e017793. [PMID: 32924728 PMCID: PMC7792407 DOI: 10.1161/jaha.120.017793] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has posed an increasing burden on Americans and the United States healthcare system for decades. In addition, ASCVD has had a substantial economic impact, with national expenditures for ASCVD projected to increase by over 2.5‐fold from 2015 to 2035. This rapid increase in costs associated with health care for ASCVD has consequences for payers, healthcare providers, and patients. The issues to patients are particularly relevant in recent years, with a growing trend of shifting costs of treatment expenses to patients in various forms, such as high deductibles, copays, and coinsurance. Therefore, the issue of “financial toxicity” of health care is gaining significant attention. The term encapsulates the deleterious impact of healthcare expenditures for patients. This includes the economic burden posed by healthcare costs, but also the unintended consequences it creates in form of barriers to necessary medical care, quality of life as well tradeoffs related to non‐health–related necessities. While the societal impact of rising costs related to ASCVD management have been actively studied and debated in policy circles, there is lack of a comprehensive assessment of the current literature on the financial impact of cost sharing for ASCVD patients and their families. In this review we systematically describe the scope and domains of financial toxicity, the instruments that measure various facets of healthcare‐related financial toxicity, and accentuating factors and consequences on patient health and well‐being. We further identify avenues and potential solutions for clinicians to apply in medical practice to mitigate the burden and consequences of out‐of‐pocket costs for ASCVD patients and their families.
Collapse
Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| |
Collapse
|
14
|
Feral-Pierssens AL, Rives-Lange C, Matta J, Rodwin VG, Goldberg M, Juvin P, Zins M, Carette C, Czernichow S. Forgoing health care under universal health insurance: the case of France. Int J Public Health 2020; 65:617-625. [PMID: 32474715 DOI: 10.1007/s00038-020-01395-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We investigate the reliability of a survey question on forgone healthcare services for financial reasons, based on analysis of actual healthcare use over the 3-year period preceding response to the question. We compare the actual use of different health services by patients who report having forgone health care to those who do not. METHODS Based on a prospective cohort study (CONSTANCES), we link survey data from enrolled participants to the Universal Health Insurance (UHI) claims database and compare use of health services of those who report having forgone health care to controls. We present multivariable logistic regression models and assess the odds of using different health services. RESULTS Compared to controls, forgoing care participants had lower odds of consulting GPs (OR = 0.83; 95% CI 0.73, 0.93), especially specialists outside hospitals (gynecologists: 0.74 (0.69, 0.78); dermatologists: 0.81 (0.78-0.85); pneumologists 0.82 (0.71-0.94); dentists 0.71 (0.68, 0.75)); higher odds of ED visits (OR = 1.25; 95% CI 1.19, 1.31); and no difference in hospital admissions (OR = 1.02; 95% CI 0.97, 1.09). Participants with lower occupational status and income had higher odds of forgoing health care. CONCLUSIONS The perception of those who report having forgone health care for financial reasons is consistent with their lower actual use of community-based ambulatory care (CBAC). While UHI may be necessary to improve healthcare access, it does not address the social factors associated with the population forgoing health care for financial reasons.
Collapse
Affiliation(s)
- Anne-Laure Feral-Pierssens
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France. .,Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France. .,Improving Emergency Care - IMPEC federation, Paris, France.
| | - Claire Rives-Lange
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France.,Paris University, Paris, France.,INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France
| | - Joane Matta
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Victor G Rodwin
- Département Epidémiologie et Systèmes de Santé, UniSanté, Lausanne, Switzerland.,Wagner School of Public Service, New York University, New York, USA
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France.,Paris University, Paris, France
| | - Philippe Juvin
- Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France.,Improving Emergency Care - IMPEC federation, Paris, France.,Paris University, Paris, France
| | - Marie Zins
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France.,Paris University, Paris, France
| | - Claire Carette
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France.,CIC1418, INSERM, Georges Pompidou European Hospital, Paris, France
| | - Sebastien Czernichow
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France.,Paris University, Paris, France.,INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France
| |
Collapse
|
15
|
Kino S, Bernabé E, Sabbah W. Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234642. [PMID: 31766584 PMCID: PMC6926506 DOI: 10.3390/ijerph16234642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/03/2023]
Abstract
This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe.
Collapse
Affiliation(s)
- Shiho Kino
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University of Boston, Boston, MA 02115, USA;
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE5 9RS, UK;
- Correspondence:
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE5 9RS, UK;
| |
Collapse
|
16
|
Costa D, Hatzidimitriadou E, Ioannidi-Kapolo E, Lindert J, Soares J, Sundin Ö, Toth O, Barros H. The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study. Eur J Public Health 2019; 29:359-364. [PMID: 30169658 DOI: 10.1093/eurpub/cky167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both. METHODS This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18-64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare ('Have you been in need of a certain care service in the past year, but did not seek any help?'). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain. RESULTS Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02-1.70). CONCLUSION IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake.
Collapse
Affiliation(s)
- Diogo Costa
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Eleni Hatzidimitriadou
- Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, Kent, UK
| | | | - Jutta Lindert
- Department of Public Health Science Ludwigsburg, Protestant University of Applied Sciences Ludwigsburg, Ludwigsburg, Germany.,University of Applied Sciences Emden, Emden, Germany.,WRSC, Brandeis University, Waltham, MA, USA
| | - Joaquim Soares
- Institution for Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Olga Toth
- Institute of Sociology, Hungarian Academy of Sciences, Budapest, Hungary
| | - Henrique Barros
- EPIUnit, Institute of Public Health, University of Porto and University of Porto Medical School, Porto, Portugal
| |
Collapse
|
17
|
Moscrop A, Ziebland S, Roberts N, Papanikitas A. A systematic review of reasons for and against asking patients about their socioeconomic contexts. Int J Equity Health 2019; 18:112. [PMID: 31337403 PMCID: PMC6652018 DOI: 10.1186/s12939-019-1014-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 12/20/2022] Open
Abstract
Background People’s social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients’ socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients’ socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not, be enquired about. Methods Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a ‘snowball’ search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients’ socioeconomic information; ‘screening’ patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients’ healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. ‘Reason data’ was extracted from eligible publications by two authors, then analysed and organised. Results We identified 138 eligible publications. Most offered reasons for why patients’ should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary. Conclusions This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.
Collapse
Affiliation(s)
- Andrew Moscrop
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Papanikitas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
18
|
Gnädinger M, Herzig L, Ceschi A, Conen D, Staehelin A, Zoller M, Puhan MA. Chronic conditions and multimorbidity in a primary care population: a study in the Swiss Sentinel Surveillance Network (Sentinella). Int J Public Health 2018; 63:1017-1026. [PMID: 29786762 PMCID: PMC6245242 DOI: 10.1007/s00038-018-1114-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To provide estimates of the prevalence of chronic conditions in Swiss primary care. METHODS In total, 175 general practitioners (GP) or pediatricians (PED) reporting to the Swiss Sentinel Surveillance Network collected morbidity data. RESULTS In 26,853 patient contacts, mean (± SD) age was 55.8 ± 21.6 or 6.1 ± 5.7 years (in GPs vs. PEDs, respectively) and 47% were males. In GP patients, median Thurgau Morbidity Index was 2 (IQR 1-3). The median numbers of chronic conditions and permanently used prescribed drugs were 2 (0-5) and 2 (1-4), respectively; in PEDs medians were 0. Out of all patients, 16.7 and 7.0% of the PED patients were hospitalized during the previous year; patients cared by family/proxies or community nurses were hospitalized significantly more often than patients living in homes (50.1 vs. 35.4%, OR 1.41, p < 0.001). Out of patients over 80 years of age, 51.5% were care dependent and 45.5% of the patients over 90 years were living in homes for the elderly. CONCLUSIONS In a representative sample of Swiss primary care patients, a substantial part shows multimorbidity with a high prevalence of chronic diseases, multiple drug treatment, and care dependency. These data may serve to be compared with other patient groups or other primary care systems. Trial registration www.clinicaltrials.gov NCT0229537, national study registry www.kofam.ch SNCTP000001207.
Collapse
Affiliation(s)
- Markus Gnädinger
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Lilli Herzig
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
- Swiss Sentinel Surveillance Network (Sentinella), Swiss Federal Office of Public Health, Bern, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Dieter Conen
- Patientensicherheit Schweiz, Zurich, Switzerland
| | - Alfred Staehelin
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Swiss Sentinel Surveillance Network (Sentinella), Swiss Federal Office of Public Health, Bern, Switzerland
| | - Marco Zoller
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Li X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open 2018; 8:e019901. [PMID: 29549207 PMCID: PMC5857704 DOI: 10.1136/bmjopen-2017-019901] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In general, published studies analyse healthcare utilisation, rather than foregone care, among different population groups. The assessment of forgone care as an aspect of healthcare system performance is important because it indicates the gap between perceived need and actual utilisation of healthcare services. This study focused on a specific vulnerable group, middle-aged and elderly people with chronic diseases, and evaluated the prevalence of foregone care and associated factors among this population in China. METHODS Data were obtained from a nationally representative household survey of middle-aged and elderly individuals (≥45 years), the China Health and Retirement Longitudinal Study, which was conducted by the National School of Development of Peking University in 2013. Descriptive statistics were used to analyse sample characteristics and the prevalence of foregone care. Andersen's healthcare utilisation and binary logistic models were used to evaluate the determinants of foregone care among middle-aged and elderly individuals with chronic diseases. RESULTS The prevalence of foregone outpatient and inpatient care among middle-aged and elderly people was 10.21% and 6.84%, respectively, whereas the prevalence of foregone care for physical examinations was relatively high (57.88%). Predisposing factors, including age, marital status, employment, education and family size, significantly affected foregone care in this population. Regarding enabling factors, individuals in the highest income group reported less foregone inpatient care or physical examinations compared with those in the lowest income group. Social healthcare insurance could significantly reduce foregone care in outpatient and inpatient situations; however, these schemes (except for urban employee medical insurance) did not appear to have a significant impact on foregone care involving physical examinations. CONCLUSION In China, policy-makers may need to further adjust healthcare policies, such as health insurance schemes, and improve the hierarchical medical system, to promote reduction in foregone care and effective utilisation of health services.
Collapse
Affiliation(s)
- Xiangjun Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
- Nanjing Medical University, Institute of Healthy Jiangsu Construction & Development, Nanjing, China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
- Nanjing Medical University, Institute of Healthy Jiangsu Construction & Development, Nanjing, China
| | - Lei Si
- Centre for the Health Economy, Macquarie University, New South Wales, Australia
| |
Collapse
|
20
|
Baggio S, Dupuis M, Richard JB, Beck F. Addictive behaviors and healthcare renunciation for economic reasons in a French population-based sample. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:1-7. [PMID: 28818639 DOI: 10.1016/j.drugpo.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/22/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare renunciation for economic reasons is a major health concern, but it has been scarcely investigated among drug users, even if drug users constitute a vulnerable population in need of medical care. This study investigated associations of healthcare renunciation for economic reasons and addictive behaviors (alcohol, tobacco, cannabis, illicit drug use, and gambling) in a population-based sample of adults living in France, a country with universal health coverage. METHODS Data were collected using the 2014 Health Barometer, a French cross-sectional survey conducted among a random representative sample of the general population aged 18-64 (n=12,852). Measures included healthcare renunciation, substance use (alcohol, tobacco, cannabis, and other illicit drugs) and gambling. Experimental/recreational and heavy/chronic use were assessed. Logistic regressions were used to test the relationship between healthcare renunciation and addictive behaviors, controlling for relevant covariates. RESULTS A total of 25% of the participants had renounced care at least once in the previous twelve months. Most variables of drug use were significantly associated with increased healthcare renunciation. This was the case for heavy/hazardous use and experimental/recreational use. Regular gambling was not associated with healthcare renunciation, but disordered gambling was. CONCLUSION This study showed that addictive behaviors, including substance use and gambling, were part of the burden of vulnerability of people who forgo care. Therefore, drug use and gambling patterns should be a focus in the development of policies to reduce health inequalities, not only for heavy and chronic drug users.
Collapse
Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Switzerland; Division of Correctional Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Marc Dupuis
- Institute of Psychology, University of Lausanne, Switzerland.
| | | | - François Beck
- Observatoire Français des Drogues et des Toxicomanies (OFDT), The French Monitoring Center for Drugs and Drug Addiction, France; ERES, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMRS, 1136 Paris, France.
| |
Collapse
|
21
|
Leiser S, Déruaz-Luyet A, N’Goran AA, Pasquier J, Streit S, Neuner-Jehle S, Zeller A, Haller DM, Herzig L, Bodenmann P. Determinants associated with deprivation in multimorbid patients in primary care-A cross-sectional study in Switzerland. PLoS One 2017; 12:e0181534. [PMID: 28738070 PMCID: PMC5524289 DOI: 10.1371/journal.pone.0181534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deprivation usually encompasses material, social, and health components. It has been shown to be associated with greater risks of developing chronic health conditions and of worse outcome in multimorbidity. The DipCare questionnaire, an instrument developed and validated in Switzerland for use in primary care, identifies patients subject to potentially higher levels of deprivation. OBJECTIVES To identifying determinants of the material, social, and health profiles associated with deprivation in a sample of multimorbid, primary care patients, and thus set priorities in screening for deprivation in this population. DESIGN Secondary analysis from a nationwide cross-sectional study in Switzerland. PARTICIPANTS A random sample of 886 adult patients suffering from at least three chronic health conditions. MAIN MEASURES The outcomes of interest were the patients' levels of deprivation as measured using the DipCare questionnaire. Classification And Regression Tree analysis identified the independent variables that separated the examined population into groups with increasing deprivation scores. Finally, a sensitivity analysis (multivariate regression) confirmed the robustness of our results. KEY RESULTS Being aged under 64 years old was associated with higher overall, material, and health deprivation; being aged over 77 years old was associated with higher social deprivation. Other variables associated with deprivation were the level of education, marital status, and the presence of depression or chronic pain. CONCLUSION Specific profiles, such as being younger, were associated with higher levels of overall, material, and health deprivation in multimorbid patients. In contrast, patients over 77 years old reported higher levels of social deprivation. Furthermore, chronic pain and depression added to the score for health deprivation. It is important that GPs consider the possibility of deprivation in these multimorbid patients and are able to identify it, both in order to encourage treatment adherence and limit any forgoing of care for financial reasons.
Collapse
Affiliation(s)
- Silja Leiser
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Anouk Déruaz-Luyet
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Jérôme Pasquier
- Institute of Preventive and Social Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Dagmar M. Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lilli Herzig
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
22
|
Rosselet PC, Zuercher E, Pasquier J, Burnand B, Peytremann-Bridevaux I. Impact of forgoing care because of costs on the quality of diabetes care: A three-year cohort study. Eur J Intern Med 2017; 41:e35-e37. [PMID: 28292557 DOI: 10.1016/j.ejim.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Patricia C Rosselet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Emilie Zuercher
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Isabelle Peytremann-Bridevaux
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| |
Collapse
|
23
|
Röttger J, Blümel M, Köppen J, Busse R. Forgone care among chronically ill patients in Germany-Results from a cross-sectional survey with 15,565 individuals. Health Policy 2016; 120:170-8. [PMID: 26806678 DOI: 10.1016/j.healthpol.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/27/2015] [Accepted: 01/03/2016] [Indexed: 01/09/2023]
Abstract
The decision not to seek health care although one feels that care is needed (forgone care), is influenced by various factors. Within the study "Responsiveness in ambulatory care" 15,565 chronically ill (coronary heart disease and/or type 2 diabetes) patients in Germany were surveyed in 2013. The survey included questions on forgone care, perceived discrimination when seeking care, net-income, subjective health status and subjective socioeconomic status (subSES). Survey data were linked on patient-level with administrative claims data by a German sickness fund. We applied multivariate binomial logistic regression analyses to assess the association between age, sex, comorbidities, living area, subjective health status, subSES, experienced discrimination, net-equivalent income and reported forgone care. The majority in the sample are men (71.4%), the average age is 69.4 (SD: 10.2) years and 14.1% reported forgone care. In the multivariate model, we find that younger age, female gender, perceived discrimination, depression, and a poor subjective health status increase the odds of reporting forgone care. Overall, our results suggest that a negative experience with the health care system, i.e. perceived discrimination/unfair treatment, are strong predictors of forgone care among the chronically ill.
Collapse
Affiliation(s)
- Julia Röttger
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany.
| | - Miriam Blümel
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Julia Köppen
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Reinhard Busse
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
| |
Collapse
|
24
|
Bodenmann P, Baggio S, Iglesias K, Althaus F, Velonaki VS, Stucki S, Ansermet C, Paroz S, Trueb L, Hugli O, Griffin JL, Daeppen JB. Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study. Int J Equity Health 2015; 14:146. [PMID: 26645272 PMCID: PMC4673736 DOI: 10.1186/s12939-015-0277-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.
Collapse
Affiliation(s)
- Patrick Bodenmann
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Stéphanie Baggio
- Life Course and Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland.
| | - Katia Iglesias
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Fabrice Althaus
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Venetia-Sofia Velonaki
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital, Lausanne, CH-1010, Switzerland.
| | - Stephanie Stucki
- Addiction Switzerland, Research Institute, Lausanne, CH-1001, Switzerland.
| | - Corine Ansermet
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Sophie Paroz
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Lionel Trueb
- Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Judith L Griffin
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Service, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| |
Collapse
|
25
|
Baggio S, Abarca M, Bodenmann P, Gehri M, Madrid C. Early childhood caries in Switzerland: a marker of social inequalities. BMC Oral Health 2015. [PMID: 26198542 PMCID: PMC4511018 DOI: 10.1186/s12903-015-0066-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood caries (ECC) is a marker of social inequalities worldwide because disadvantaged children are more likely to develop caries than their peers. This study aimed to define the ECC prevalence among children living in French-speaking Switzerland, where data on this topic were scarce, and to assess whether ECC was an early marker of social inequalities in this country. METHODS The study took place between 2010 and 2012 in the primary care facility of Lausanne Children's Hospital. We clinically screened 856 children from 36 to 71 months old for ECC, and their caregivers (parents or legal guardians) filled in a questionnaire including items on socioeconomic background (education, occupation, income, literacy and immigration status), dental care and dietary habits. Prevalence rates, prevalence ratios and logistic regressions were calculated. RESULTS The overall ECC prevalence was 24.8 %. ECC was less frequent among children from higher socioeconomic backgrounds than children from lower ones (prevalence ratios ≤ 0.58). CONCLUSIONS This study reported a worrying prevalence rate of ECC among children from 36 to 71 months old, living in French-speaking Switzerland. ECC appears to be a good marker of social inequalities as disadvantaged children, whether from Swiss or immigrant backgrounds, were more likely to have caries than their less disadvantaged peers. Specific preventive interventions regarding ECC are needed for all disadvantaged children, whether immigrants or Swiss.
Collapse
Affiliation(s)
- Stéphanie Baggio
- Life Course and Inequality Research Centre, University of Lausanne, Lausanne, Switzerland.
| | - Marcelo Abarca
- Private practice, University of Lausanne, Lausanne, Switzerland.
| | - Patrick Bodenmann
- Vulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, Switzerland.
| | - Mario Gehri
- Children's Hospital, Lausanne University Hospital, Lausanne, Switzerland.
| | - Carlos Madrid
- Stomatology and Dentistry Unit, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
26
|
Guessous I, Theler JM, Durosier Izart C, Stringhini S, Bodenmann P, Gaspoz JM, Wolff H. Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study. BMC Oral Health 2014; 14:121. [PMID: 25270828 PMCID: PMC4190381 DOI: 10.1186/1472-6831-14-121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years. Methods Repeated population-based surveys (2007–2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. Results A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥13,000CHF, 1CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy. Conclusions In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care. Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-14-121) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Idris Guessous
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | | | | | | | | | | | | |
Collapse
|