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Pfefferle A, Binder N, Sauer J, Sofroniou M, Metzner G, Farin E, Voigt-Radloff S, Maun A, Salm C. Association between continuity of care and inappropriate prescribing in outpatient care in Germany: a cross-sectional analysis conducted as part of the LoChro trial. BMJ Open 2024; 14:e082245. [PMID: 39038858 DOI: 10.1136/bmjopen-2023-082245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are common in multimorbid patients. This study aims to describe PIMs and PPOs in an open-access outpatient setting and to investigate any association between continuity of care (CoC) and PIMs and PPOs in multimorbid older patients. DESIGN Cross-sectional study using patient-confirmed outpatient medication plans to describe PIMs and PPOs using the 'Screening Tool of Older Person's Prescription/Screening Tool to Alert to Right Treatment' version 2. Four Poisson regressions modelled the number of PIMs and PPOs using context-adapted versions of the Usual Provider of Care (UPC) and the Modified Modified Continuity Index (MMCI) as measures for CoC. SETTING Southern Germany, outpatient setting. PARTICIPANTS 321 participants of the LoChro-trial at 12-month follow-up (both arms). The LoChro-trial compared healthcare involving an additional care manager with usual care. Inclusion criteria were age over 64, local residence and scoring over one in the Identification of Older patients at Risk Screening Tool. PRIMARY OUTCOMES Numbers of PIMs and PPOs. RESULTS The mean number of PIMs was 1.5 (SD 1.5), lower than the average number of PPOs at 2.9 (SD 1.7). CoC showed similar results for both indices with a mean of 0.548 (SD 0.279) for MMCI and 0.514 (SD 0.262) for UPC. Both models predicting PPOs indicated more PPOs with higher CoC; statistical significance was only demonstrated for MMCI (MMCI~PPO: Exp(B)=1.42, 95% CI (1.11; 1.81), p=0.004; UPC~PPO: Exp(B)=1.29, 95% CI (0.99; 1.67), p=0.056). No significant association between PIMs and CoC was found (MMCI~PIM: Exp(B)=0.72, 95% CI (0.50; 1.03), p=0.072; UPC~PIM: Exp(B)=0.83, 95% CI (0.57; 1.21), p=0.337). CONCLUSION The results did not show a significant association between higher CoC and lesser PIMs. Remarkably, an association between increased CoC, represented through MMCI, and more PPOs was found. Consultation of different care providers in open-access healthcare systems could possibly ameliorate under-prescribing in multimorbid older patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00013904.
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Affiliation(s)
- Aline Pfefferle
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Nadine Binder
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Julia Sauer
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Mario Sofroniou
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
- Wyvern Health Partnership, NHS Bath Gloucestershire Swindon and Wiltshire Local Area Team, Swindon, UK
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Andy Maun
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Claudia Salm
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
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Moreno A, Lostao L, Sperlich S, Beller J, Ronda E, Geyer S, Regidor E. Socioeconomic Patterns in the Frequency of Doctor Visits in Germany and Spain in Subjects With and Without Chronic Diseases. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:121-130. [PMID: 38166504 DOI: 10.1177/27551938231224708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income.
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Affiliation(s)
- Almudena Moreno
- Department of Sociology. Medical Sociology, Universidad Pública de Navarra, Pamplona, Spain
- I-COMMUNITAS - Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain
| | - Lourdes Lostao
- Department of Sociology. Medical Sociology, Universidad Pública de Navarra, Pamplona, Spain
- I-COMMUNITAS - Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain
| | | | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Elena Ronda
- Preventive Medicine and Public Health Unit, Universidad de Alicante, Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Wang Z, Mortani Barbosa EJ. Socio-Economic Factors and Clinical Context Can Predict Adherence to Incidental Pulmonary Nodule Follow-up via Machine Learning Models. J Am Coll Radiol 2024:S1546-1440(24)00274-6. [PMID: 38461910 DOI: 10.1016/j.jacr.2024.02.031] [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: 11/12/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To quantify the relative importance of demographic, contextual, socio-economic, and nodule-related factors that influence patient adherence to incidental pulmonary nodule (IPN) follow-up visits and evaluate the predictive performance of machine learning models utilizing these features. METHODS We curated a 1,610-subject patient data set from electronic medical records consisting of 13 clinical and socio-economic predictors and IPN follow-up adherence status (timely, delayed, or never) as the outcome. Univariate analysis and multivariate logistic regression were performed to quantify the predictors' contributions to follow-up adherence. Three additional machine learning models (random forests, neural network, and support vector machine) were fitted and cross-validated to examine prediction performance across different model architectures and evaluate intermodel concordance. RESULTS On univariate basis, all 13 predictors except comorbidity were found to have a significant association with follow-up. In multiple logistic regression, inpatient or emergency clinical context (odds ratio favoring never following up: 7.28 and 8.56 versus outpatient, respectively) and high nodule risk (odds ratio: 0.25 versus low risk) are the most significant predictors of follow-up, and sex, race, and marital status become additionally significant if clinical context is removed from the model. Clinical context itself is associated with sex, race, insurance, employment, marriage, income, nodule risk, and smoking status, suggesting its role in mediating socio-economic inequities. On cross-validation, all four machine learning models demonstrated comparable and good predictive performances, with mean area under the curve ranging from 0.759 to 0.802, with sensitivity 0.641 to 0.660 and specificity 0.768 to 0.840. CONCLUSION Socio-economic factors and clinical context are predictive of IPN follow-up adherence, with clinical context being the most significant contributor and likely representing uncaptured socio-economic determinants.
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Affiliation(s)
- Zhuoyang Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eduardo J Mortani Barbosa
- Director of CT Modality at the Thoracic Imaging Section, Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Killingmo RM, Tveter AT, Pripp AH, Tingulstad A, Maas E, Rysstad T, Grotle M. Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study. BMJ Open 2024; 14:e080567. [PMID: 38431296 PMCID: PMC10910429 DOI: 10.1136/bmjopen-2023-080567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss. DESIGN A prospective cohort study with a 1-year follow-up. PARTICIPANTS AND SETTING A total of 549 participants (aged 18-67 years) on sick leave (≥ 4 weeks) due to musculoskeletal disorders in Norway were included. OUTCOME MEASURES AND METHOD The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs. RESULTS Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss. CONCLUSION Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted. TRIAL REGISTRATION NUMBER NCT04196634, 12 December 2019.
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Affiliation(s)
- Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Anne Therese Tveter
- Center for treatment of rheumatic and musculoskeletal diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Alexander Tingulstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Esther Maas
- Department of Health Sciences, Vrije University Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Sahakyan S, Muradyan D, Giloyan A, Harutyunyan T. Factors associated with delay or avoidance of medical care during the COVID-19 pandemic in Armenia: results from a nationwide survey. BMC Health Serv Res 2024; 24:20. [PMID: 38178214 PMCID: PMC10768194 DOI: 10.1186/s12913-023-10483-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: 06/16/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems throughout the world. Many patients faced delays and cancellation of care due to scaled back services, mobility restrictions, and concerns related to the risk of infection. The present study aimed to assess the prevalence of and risk factors associated with the avoidance or delay of medical care due to COVID-19 in Armenia. METHODS We conducted a cross-sectional telephone survey of 3,483 adults across Armenia. We used stratified two-stage cluster sampling to select the participants from different age groups proportionate to their size in the population. Logistic regression analysis assessed the association of risk factors with avoidance/delay of routine, urgent/emergency, and any medical care. RESULTS The mean age of the sample was 49.5 (SD = 14.8), ranging from 18 to 90. About 9.9% of the respondents avoided/delayed any type of medical care; whereas 5.5% avoided/delayed urgent/emergency care and 6.6% routine care. In the adjusted analysis, female gender and higher monthly expenditures were associated with avoidance/delay of routine medical care. Factors associated with delay/avoidance of urgent/emergency care included female gender and higher perceived threat of COVID-19. Younger age, female gender, higher perceived threat and not being vaccinated against COVID-19 were associated with avoidance/delay of any medical care in the adjusted analysis. CONCLUSION Since avoiding or delaying care might increase morbidity and mortality associated with conditions not related to COVID-19, identifying population groups that are more likely to avoid care is important. Targeting such groups with educational interventions focusing on the risks of using versus not using medical care in times of pandemic might be crucial. Ensuring the provision of in-home healthcare services for high-risk groups might help to address important medical care needs during the pandemic.
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Affiliation(s)
- Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| | - Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia.
| | - Aida Giloyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| | - Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
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Naseralallah L, Stewart D, Price M, Paudyal V. Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review. Int J Clin Pharm 2023; 45:1359-1377. [PMID: 37682400 PMCID: PMC10682158 DOI: 10.1007/s11096-023-01626-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/12/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Medication errors are common events that compromise patient safety. Outpatient and ambulatory settings enhance access to healthcare which has been linked to favorable outcomes. While medication errors have been extensively researched in inpatient settings, there is dearth of literature from outpatient settings. AIM To synthesize the peer-reviewed literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings. METHOD A systematic review was conducted using Medline, Embase, CINAHL, and Google Scholar which were searched from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason's accident causation model. RESULTS Twenty-four articles were included in the review. Medication errors were common in outpatient and ambulatory settings (23-92% of prescribed drugs). Prescribing errors were the most common type of errors reported (up to 91% of the prescribed drugs, high variations in the data), with dosing errors being most prevalent (up to 41% of the prescribed drugs). Latent conditions, largely due to inadequate knowledge, were common contributory factors followed by active failures. The seven studies that discussed interventions were of poor quality and none used a randomized design. CONCLUSION Medication errors (particularly prescribing errors and dosing errors) in outpatient settings are prevalent, although reported prevalence range is wide. Future research should be informed by behavioral theories and should use high quality designs. These interventions should encompass system-level strategies, multidisciplinary collaborations, effective integration of pharmacists, health information technology, and educational programs.
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Affiliation(s)
- Lina Naseralallah
- School of Pharmacy, College of Medical and Dental Science, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Derek Stewart
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Malcom Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Science, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Hwang J, Lyu B, Ballew S, Coresh J, Grams ME, Couper D, Lutsey P, Shin JI. The association between socioeconomic status and use of potentially inappropriate medications in older adults. J Am Geriatr Soc 2023; 71:1156-1166. [PMID: 36511705 PMCID: PMC10089965 DOI: 10.1111/jgs.18165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is an important public health problem, particularly among older adults who may need multiple pharmacologic therapies for various chronic conditions. As socioeconomic status (SES) affects the quality of healthcare that individuals receive, SES may be associated with the use of PIM in older adults. This study aimed to determine whether low SES is associated with increased use of PIM. METHODS We studied 4927 participants (aged 66-90 years) who were on at least one medication at visit five (2011-2013) of the Atherosclerosis Risk in Communities Study. We created a cumulative SES score categorized as high (7-9), middle (3-6), and low (0-2) based on education, income, and area deprivation index. We use multivariable logistic regression to examine the associations between SES and use of two or more PIM for older adults, defined by the 2019 Beers Criteria. RESULTS A total of 31.0% and 6.9% of the participants used one or more PIM and two or more PIM, respectively. After adjusting for demographic characteristics and insurance type, low cumulative SES score was associated with significantly greater use of two or more PIM (odds ratio [OR] = 1.83 [95% confidence interval (CI) 1.18-2.86]), as was middle cumulative SES score (OR = 1.40 [95% CI 1.06-1.83]), compared to high cumulative SES score. The results remained significant after further adjusting for comorbidities and medication burden for low cumulative SES score (OR = 1.66 [95%CI 1.02-2.71]). CONCLUSIONS We found that lower SES was associated with greater use of PIM among older adults independent of their medication burden and comorbidities, suggesting socioeconomic disparities in quality of medication management. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse drug events.
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Affiliation(s)
- Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beini Lyu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pamela Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Ripoll C, Bleidorn J, Zipprich A. SEAL: Why was this approach not effective? J Hepatol 2023; 78:e26-e27. [PMID: 35985544 DOI: 10.1016/j.jhep.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Cristina Ripoll
- Jena University Hospital. Department of Internal Medicine IV Gastroenterology, Hepatology, Infectious Diseases and Interdisciplinary Endoscopy), Jena, Germany.
| | - Jutta Bleidorn
- Jena University Hospital. Institute for Family Medicine, Jena, Germany
| | - Alexander Zipprich
- Jena University Hospital. Department of Internal Medicine IV Gastroenterology, Hepatology, Infectious Diseases and Interdisciplinary Endoscopy), Jena, Germany
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Interprofessional collaboration to support patients with social problems in general practice—a qualitative focus group study. BMC PRIMARY CARE 2022; 23:169. [PMID: 35788186 PMCID: PMC9251943 DOI: 10.1186/s12875-022-01782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/23/2022] [Indexed: 11/10/2022]
Abstract
Background Social problems of patients such as family or work-related conflicts as well as financial difficulties affect the individual health situation and the treatment of diseases in general practice. General practitioners (GPs) would like to have direct access to professionals in social care services. In Germany, there are many different social care facilities for people with a wide range of social problems. As the social and health care systems hardly interact collaborations between social professionals (SPs) and GPs are rare exceptions. This study explored perspectives of GPs regarding their patients with social problems in combination with the perspectives of SPs. Aim of this study was to explore how a systematic interprofessional collaboration between GPs and SPs could be realised. Methods We carried out a participatory sequential qualitative study design consisting of two focus groups with GPs, two with SPs and two mixed-professional focus groups with GPs and SPs. The focus groups were conducted with semi-structured moderating guidelines and analysed with a qualitative content analysis approach using inductive and deductive categories. Results GPs view themselves as the first point of contact for their patients' social problems. For persistent social problems, they expressed a desire for support and SPs were willing to provide this. We developed a stepped care implementation model for a systematic cooperation consisting of nine collaboration strategies. These strategies included: index or website of social care services, referrals to the social care system, using flyers and posters of social care services, direct contact/hotline to local social care services, participation in meetings of social care facilities, involving physician assistants, external social care advice service in GP rooms, implementation in education and training and access to volunteers. Conclusions Our stepped care implementation model for a systematic cooperation of GPs and SPs could be a feasible need- and resource-oriented approach for the collaborative care of patients with social problems to improve their medical treatment in most western healthcare systems. GPs and SPs are ready to generate the necessary evidence for policy makers in high quality RCTs.
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Loer AKM, Koschollek C, Hövener C. Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states. BMC Health Serv Res 2022; 22:1050. [PMID: 35978356 PMCID: PMC9382615 DOI: 10.1186/s12913-022-08419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately every fourth person in Germany has a migration background. Health research on the use of primary and specialist health care in this group is still scarce. Few studies have suggested a difference in the use of primary and specialist health care among people with a migration background. Potential resources and barriers to health care access should be investigated as they are critical to health equity. This study investigates associated sociodemographic, migration-sensitive, and health-related factors of primary and specialist health care utilization among people with a migration background as defined by nationality. METHODS Analyses are based on data from a feasibility study of the project "Improving Health Monitoring in Migrant Populations" (IMIRA), conducted by the Robert Koch Institute. The sample (n = 1055) included persons with Croatian, Polish, Romanian, Syrian, and Turkish nationalities living in the federal states of Berlin and Brandenburg, Germany. Descriptive and bivariate analyses as well as multiple binary logistic regression analyses were carried out to assess sociodemographic (sex, age, socioeconomic position), health-related (self-rated health), and migration-sensitive factors (duration of residence in Germany, residence status, German language proficiency) associated with the use of primary and specialist health care services in the past 12 months. RESULTS Of the total study population, 79.62% visited a general practitioner and 59.53% a specialized physician in the past 12 months. Participants who were female sex, aged 65 and older, and with moderate/poor/very poor self-rated health had higher odds of visiting a general practitioner and a specialized physician, with the strongest impact from self-rated health. After controlling for sociodemographic and health-related factors, duration of residence in Germany and residence status were associated with primary but not with specialist health care utilization. CONCLUSIONS Our results suggest that migration-sensitive characteristics, such as duration of residence, should be considered in a differentiated manner in health services research to gain detailed insights into health care utilization and its potential barriers among the heterogenous group of people with a migration background. Further research needs to be done to evaluate how to get people into contact with a general practitioner.
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Affiliation(s)
- Anne-Kathrin M Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Carmen Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
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Killingmo RM, Storheim K, van der Windt D, Zolic-Karlsson Z, Vigdal ØN, Kretz L, Småstuen MC, Grotle M. Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study. BMJ Open 2022; 12:e057778. [PMID: 35725262 PMCID: PMC9214384 DOI: 10.1136/bmjopen-2021-057778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To describe healthcare utilization and estimate associated costs during 1 year of follow-up among older people seeking primary care due to a new episode back pain and to describe healthcare utilization across patients with different risk profiles stratified using the StarT Back Screening Tool (SBST). DESIGN Prospective cohort study. PARTICIPANTS AND SETTING A total of 452 people aged ≥55 years seeking Norwegian primary care with a new episode of back pain were included. OUTCOME MEASURES The primary outcome of this study was total cost of healthcare utilization aggregated for 1 year of follow-up. Secondary outcomes included components of healthcare utilization aggregated for 1 year of follow-up. Healthcare utilization was self-reported and included: primary care consultations, medications, examinations, hospitalisation, rehabilitation stay, and operations. Costs were estimated based on unit costs collected from national pricelists. Healthcare utilization across patients with different SBST risk profiles was compared using Kruskal-Wallis test, post hoc Mann-Whitney U tests and Bonferroni adjustment. RESULTS In total, 438 patients were included in the analysis. Mean (BCa 95% CI) total cost per patient over 1 year was €825 (682-976). Median (BCa 95% CI) total cost was €364 (307-440). The largest cost category was primary care consultations, accounting for 56% of total costs. Imaging rate was 34%. The most commonly used medication was paracetamol (27%-35% of patients). Medium- and high-risk patients had a significantly higher degree of healthcare utilization compared with low-risk patients (p<0.030). CONCLUSION This study estimated a 1 year mean and median cost of healthcare utilization of €825 and €364, respectively. Patients within the top 25th percentile accounted for 77% of all costs. Patients classified as medium risk and high risk had a significantly higher degree of healthcare utilization compared with patients classified as low risk. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04261309, results.
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Affiliation(s)
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Lise Kretz
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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12
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Killingmo RM, Chiarotto A, van der Windt DA, Storheim K, Bierma-Zeinstra SMA, Småstuen MC, Zolic-Karlsson Z, Vigdal ØN, Koes BW, Grotle M. Modifiable prognostic factors of high costs related to healthcare utilization among older people seeking primary care due to back pain: an identification and replication study. BMC Health Serv Res 2022; 22:793. [PMID: 35717179 PMCID: PMC9206382 DOI: 10.1186/s12913-022-08180-2] [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: 12/17/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Back pain is an extensive burden to our healthcare system, yet few studies have explored modifiable prognostic factors associated with high costs related to healthcare utilization, especially among older back pain patients. The aims of this study were to identify modifiable prognostic factors for high costs related to healthcare utilization among older people seeking primary care with a new episode of back pain; and to replicate the identified associations in a similar cohort, in a different country. METHODS Data from two cohort studies within the BACE consortium were used, including 452 and 675 people aged ≥55 years seeking primary care with a new episode of back pain. High costs were defined as costs in the top 25th percentile. Healthcare utilization was self-reported, aggregated for one-year of follow-up and included: primary care consultations, medications, examinations, hospitalization, rehabilitation stay and operations. Costs were estimated based on unit costs collected from national pricelists. Nine potential modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression models were used to identify and replicate associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and high costs related to healthcare utilization. RESULTS Four modifiable prognostic factors associated with high costs related to healthcare utilization were identified and replicated: a higher degree of pain severity, disability, depression, and a lower degree of physical health-related quality of life. Kinesiophobia and recovery expectations showed no prognostic value. There were inconsistent results across the two cohorts with regards to comorbidity, radiating pain below the knee and mental health-related quality of life. CONCLUSION The factors identified in this study may be future targets for intervention with the potential to reduce high costs related to healthcare utilization among older back pain patients. TRIAL REGISTRATION ClinicalTrials.gov NCT04261309, 07 February 2020. Retrospectively registered.
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Affiliation(s)
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | | | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Department of Orthopedics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Milada C Småstuen
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | | - Ørjan N Vigdal
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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13
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Brinks R, Tönnies T, Hoyer A. Importance of Diagnostic Accuracy in Big Data: False-Positive Diagnoses of Type 2 Diabetes in Health Insurance Claims Data of 70 Million Germans. FRONTIERS IN EPIDEMIOLOGY 2022; 2:887335. [PMID: 38455330 PMCID: PMC10911003 DOI: 10.3389/fepid.2022.887335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 03/09/2024]
Abstract
Large data sets comprising diagnoses of chronic conditions are becoming increasingly available for research purposes. In Germany, it is planned that aggregated claims data - including medical diagnoses from the statutory health insurance - with roughly 70 million insurants will be published regularly. The validity of the diagnoses in such big datasets can hardly be assessed. In case the dataset comprises prevalence, incidence, and mortality, it is possible to estimate the proportion of false-positive diagnoses using mathematical relations from the illness-death model. We apply the method to age-specific aggregated claims data from 70 million Germans about type 2 diabetes in Germany stratified by sex and report the findings in terms of the age-specific ratio of false-positive diagnoses of type 2 diabetes (FPR) in the dataset. The FPR for men and women changes with age. In men, the FPR increases linearly from 1 to 3 per 1,000 in the age group of 30-50 years. For age between 50 and 80 years, FPR remains below 4 per 1,000. After 80 years of age, we have an increase to approximately 5 per 1,000. In women, we find a steep increase from age 30 to 60 years, the peak FPR is reached at approximately 12 per 1,000 between 60 and 70 years of age. After age 70 years, the FPR of women drops tremendously. In all age groups, the FPR is higher in women than in men. In terms of absolute numbers, we find that there are 217,000 people with a false-positive diagnosis in the dataset (95% confidence interval, CI: 204-229), the vast majority being women (172,000, 95% CI: 162-180). Our work indicates that possible false-positive (and negative) diagnoses should appropriately be dealt with in claims data, for example, by the inclusion of age- and sex-specific error terms in statistical models, to avoid potentially biased or wrong conclusions.
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Affiliation(s)
- Ralph Brinks
- Chair for Medical Biometry and Epidemiology, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Institute for Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Thaddäus Tönnies
- Institute for Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
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Sasko B, Jaehn P, Müller R, Andresen H, Müters S, Holmberg C, Ritter O, Pagonas N. Understanding the importance of social determinants and rurality for the long-term outcome after acute myocardial infarction: study protocol for a single-centre cohort study. BMJ Open 2022; 12:e056888. [PMID: 35428636 PMCID: PMC9013987 DOI: 10.1136/bmjopen-2021-056888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a major public health issue in Germany with considerable regional differences in morbidity and mortality. Possible reasons for regional differences include a higher prevalence of cardiovascular risk factors, infrastructural deficits, different levels of healthcare quality or social determinants. We aim to study associations of social determinants and of rural infrastructure with the quality of medical care (eg, time to reperfusion or medication adherence) and on the long-term outcome after myocardial infarction. METHODS AND ANALYSIS We will employ a prospective cohort study design. Patients who are admitted with AMI will be invited to participate. We aim to recruit a total of 1000 participants over the course of 5 years. Information on outpatient care prior to AMI, acute healthcare of AMI, healthcare-related environmental factors and social determinants will be collected. Baseline data will be assessed in interviews and from the electronic data system of the hospital. Follow-up will be conducted after an observation period of 1 year via patient interviews. The outcomes of interest are cardiac and all-cause mortality, changes in quality of life, changes in health status of heart failure, major adverse cardiovascular events and participation in rehabilitation programmes. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of Brandenburg Medical School (reference: E-01-20200923). Research findings will be disseminated and shared in different ways and include presenting at international and national conferences, publishing in peer-reviewed journals and facilitating dissemination workshops within local communities with patients and healthcare professionals. TRIALS REGISTRATION NUMBER DRKS00024463.
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Affiliation(s)
- Benjamin Sasko
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Rhea Müller
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Henrike Andresen
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stephan Müters
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Oliver Ritter
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Nikolaos Pagonas
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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15
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Matranga D, Maniscalco L. Inequality in Healthcare Utilization in Italy: How Important Are Barriers to Access? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031697. [PMID: 35162720 PMCID: PMC8835011 DOI: 10.3390/ijerph19031697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023]
Abstract
With the ageing population, equitable access to medical care has proven to be paramount for the effective and efficient management of all diseases. Healthcare access can be hindered by cost barriers for drugs or exams, long waiting lists or difficult access to the place where the needed healthcare service is provided. The aim of this paper is to investigate whether the probability of facing one of these barriers varies among individuals with different socio-economic status and care needs, controlling for geographical variability. METHODS The sample for this study included 9629 interviews with Italian individuals, aged 15 and over, from the second wave (2015) of the European Health Interview Survey, which was conducted in all EU Member States. To model barriers to healthcare, two-level variance components of logistic regression models with a nested structure given by the four Italian macro-areas were considered. RESULTS Of the barriers considered in this study, only two were found to be significantly associated with healthcare utilization. Specifically, they are long waiting lists for specialist service accessibility (adjOR = 1.20, 95% CI (1.07; 1.35)) and very expensive exams for dental visit accessibility (adjOR = 0.84, 95% CI (0.73; 0.96)). Another important result was the evidence of an increasing north-south gradient for all of the considered barriers. CONCLUSION In Italy, healthcare access is generally guaranteed for all of the services, except for specialist and dental visits that face a waiting time and financial barriers. However, barriers to healthcare were differentiated by income and sex. The north-south gradient for healthcare utilization could be explained through the existing differences in organizational characteristics of the several regional healthcare services throughout Italy.
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Affiliation(s)
- Domenica Matranga
- Department of Health Promotion, Mother and Child Care, Internal and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Laura Maniscalco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
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16
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Prütz F, Rommel A, Thom J, Du Y, Sarganas G, Starker A. Utilisation of outpatient medical services in Germany - Results from GEDA 2019/2020-EHIS. JOURNAL OF HEALTH MONITORING 2021; 6:45-65. [PMID: 35146316 PMCID: PMC8734077 DOI: 10.25646/8555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/25/2021] [Indexed: 04/13/2023]
Abstract
Outpatient health care provision plays an important role in the identification and treatment of health problems. Data are needed on the utilisation of health care services and their determinants to enable health policy decision-making and needs-based care provision. The analyses set out in this article are based on current data on the utilisation of outpatient health care services. The data stem from the German Health Update (GEDA 2019/2020-EHIS), a nationwide cross-sectional survey of the resident population in Germany that is undertaken as part of the health monitoring conducted at the Robert Koch Institute. Around 80% of the population aged 18 or over were treated at least once within twelve months by a general practitioner, 60% by a specialist, and 10% received psychiatric or psychotherapeutic treatment. Less than half of those eligible had had a stool test during the past two years, and just over half had had a colonoscopy in the past ten years. Around 80% of women and 70% of men had had their blood pressure checked within the last year, and 60% had had their blood cholesterol or blood sugar levels monitored. Over 50% reported that they had taken medically prescribed drugs in the past two weeks. In general, most of the indicators under study suggest that utilisation increases with age and that utilisation is higher among women than men, with the exception of psychiatric and psychotherapeutic services, among others.
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Affiliation(s)
- Franziska Prütz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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17
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König H, Rommel A, Thom J, Schmidt C, König HH, Brettschneider C, Konnopka A. The Excess Costs of Depression and the Influence of Sociodemographic and Socioeconomic Factors: Results from the German Health Interview and Examination Survey for Adults (DEGS). PHARMACOECONOMICS 2021; 39:667-680. [PMID: 33521892 PMCID: PMC8166710 DOI: 10.1007/s40273-021-01000-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 05/07/2023]
Abstract
INTRODUCTION The aim of this study was to estimate excess costs of depression in Germany and to examine the influence of sociodemographic and socioeconomic determinants. METHODS Annual excess costs of depression per patient were estimated for the year 2019 by comparing survey data of individuals with and without self-reported medically diagnosed depression, representative for the German population aged 18-79 years. Differences between individuals with depression (n = 223) and without depression (n = 4540) were adjusted using entropy balancing. Excess costs were estimated using generalized linear model regression with a gamma distribution and log-link function. We estimated direct (inpatient, outpatient, medication) and indirect (sick leave, early retirement) excess costs. Subgroup analyses by social determinants were conducted for sex, age, socioeconomic status, first-generation or second-generation migrants, partnership, and social support. RESULTS Total annual excess costs of depression amounted to €5047 (95% confidence interval [CI] 3214-6880) per patient. Indirect excess costs amounted to €2835 (1566-4103) and were higher than direct excess costs (€2212 [1083-3341]). Outpatient (€498), inpatient (€1345), early retirement (€1686), and sick leave (€1149) excess costs were statistically significant, while medication (€370) excess costs were not. Regarding social determinants, total excess costs were highest in the younger age groups (€7955 for 18-29-year-olds, €9560 for 30-44-year-olds), whereas total excess costs were lowest for the oldest age group (€2168 for 65+) and first-generation or second-generation migrants (€1820). CONCLUSIONS Depression was associated with high excess costs that varied by social determinants. Considerable differences between the socioeconomic and sociodemographic subgroups need further clarification as they point to specific treatment barriers as well as varying treatment needs.
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Affiliation(s)
- Hannah König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Alexander Rommel
- Department 2: Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Thom
- Department 2: Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christian Schmidt
- Department 2: Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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18
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König H, Rommel A, Baumert J, Schmidt C, König HH, Brettschneider C, Konnopka A. Excess costs of type 2 diabetes and their sociodemographic and clinical determinants: a cross-sectional study using data from the German Health Interview and Examination Survey for Adults (DEGS1). BMJ Open 2021; 11:e043944. [PMID: 33883150 PMCID: PMC8061816 DOI: 10.1136/bmjopen-2020-043944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The objectives of this study were to estimate the direct and indirect excess costs of type 2 diabetes mellitus (T2D) using data representative for the German adult population and to investigate the association of sociodemographic and clinical determinants with these excess costs. SETTING We calculated mean annual costs for individuals with T2D and a control group without diabetes, using data on healthcare utilisation and productivity losses from the cross-sectional German Health Interview and Examination Survey for Adults. We adjusted for group differences using entropy balancing and estimated excess costs for total, direct, indirect costs and additional cost categories using generalised linear models. We performed subgroup analyses to investigate the association of sociodemographic (age, sex and education) and clinical determinants (diabetes duration, glycaemic index and complications) with excess costs. PARTICIPANTS The final study sample included n=325 individuals with T2D and n=4490 individuals without diabetes in the age between 18 and 79 years. RESULTS Total excess costs amounted to €927, of which €719 were attributable to direct and €209 to indirect excess costs. Total costs were significantly increased by 28% for T2D compared with controls. Group differences in direct, outpatient and medication costs were statistically significant. Medication costs were 88% higher for T2D and had the highest share in direct excess costs. With respect to specific determinants, direct excess costs ranged from €203 for 4-10 years diabetes duration to €1405 for diabetes complications. Indirect excess costs ranged from €-544 for >10 years diabetes duration to €995 for high education. CONCLUSIONS T2D was associated with high costs, mainly due to direct costs. As pointed out by our results, diabetes complications and comorbidities have a large impact on the costs, leaving medication costs as main contributor of T2D excess costs.
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Affiliation(s)
- Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christian Schmidt
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mbuya-Bienge C, Simard M, Gaulin M, Candas B, Sirois C. Does socio-economic status influence the effect of multimorbidity on the frequent use of ambulatory care services in a universal healthcare system? A population-based cohort study. BMC Health Serv Res 2021; 21:202. [PMID: 33676497 PMCID: PMC7937264 DOI: 10.1186/s12913-021-06194-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire population covered by a universal health system. METHODS Using a linkage of administrative databases, we conducted a population-based cohort study of all adults in Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in the total population during the 2014-15 fiscal year. We used ajusted logistic regressions to model the association between frequent use of health services and multimorbidity, depending on socioeconomic status. RESULTS Frequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency departments and general practitioners. Socioeconomic status modified the association between multimorbidity and frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general practitioner. CONCLUSION Even in a universal healthcare system, the gap between socioeconomic groups widens as a function of multimorbidity with regard to visits to the specialist physicians. Further studies are needed to better understand the differential use of specialized care by the most deprived individuals.
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Affiliation(s)
- Cynthia Mbuya-Bienge
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.
- Quebec National Institute of Public Health, Quebec, QC, Canada.
- Centre de Recherche Sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada.
| | - Marc Simard
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Myles Gaulin
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Bernard Candas
- National Institute of Excellence in Health and Social Services, Quebec, QC, Canada
| | - Caroline Sirois
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Quebec National Institute of Public Health, Quebec, QC, Canada
- Centre de Recherche Sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Quebec, QC, Canada
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Lueckmann SL, Hoebel J, Roick J, Markert J, Spallek J, von dem Knesebeck O, Richter M. Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review. Int J Equity Health 2021; 20:58. [PMID: 33568126 PMCID: PMC7874661 DOI: 10.1186/s12939-020-01375-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/28/2020] [Indexed: 12/05/2022] Open
Abstract
Background Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries. Methods We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria. Results Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES. Conclusion This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare. PROSPERO registration number CRD42019123222. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01375-1.
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Affiliation(s)
- Sara Lena Lueckmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany. .,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Roick
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Jenny Markert
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Lueckmann SL, Mlinarić M, Richter M. [Social inequalities in healthcare provision for patients with coronary heart disease: Results from the GEDA (German Health Update) study 2014/2015]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 160:48-54. [PMID: 33451924 DOI: 10.1016/j.zefq.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Little is known about social inequalities in outpatient long-term care of coronary heart disease (CHD) in Germany. METHODS Regression analyses are based on the responses of women and men who participated in the national cross-sectional study "German Health update" (GEDA) 2014/2015 and had self-reported CHD (N=920). Outpatient healthcare of CHD was analysed on the basis of the self-reported administration of antihypertensive and cholesterol-lowering drugs, and the frequency of general practitioner (GP) contacts. RESULTS On average, respondents visited their GP 7.5 times a year (mean). 46 % did not receive guideline-consistent treatment, i. e. both antihypertensive and cholesterol-lowering drugs. Respondents of lower social status consulted their GP more frequently (approx. two visits per year) than those of higher social status (AME: 1.94; 95% CI 0.56 to 3.31). Regarding treatment with antihypertensive and cholesterol-lowering drugs, there were no significant differences for either gender or social status. Nevertheless, the probability that respondents with increased levels of blood lipids or cholesterol took only one or none of the two medications recommended for long-term treatment of CHD was reduced by 54 percentage points (AME: -0,54; 95% CI -0,61 to -0,48). DISCUSSION There are no social inequalities in the treatment of CHD patients with antihypertensive and cholesterol-lowering drugs, but inequalities exist in the frequency of visits to the GP who is more often consulted by the more socially disadvantaged patients. CONCLUSION With about 7.5 consultations per year, CHD patients visit their general practitioner more often than average, but in about half of these patients the medication supply is less than optimal. This may indicate a deficit in the medical treatment of CHD that cannot be explained by social inequalities. A possible starting point for improving healthcare, especially for patients without other risk factors, is to focus more strongly on a guideline-based approach to prescribing medication for CHD patients.
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Affiliation(s)
- Sara L Lueckmann
- Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Martin Mlinarić
- Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Abheiden H, Teut M, Berghöfer A. Predictors of the use and approval of CAM: results from the German General Social Survey (ALLBUS). BMC Complement Med Ther 2020; 20:183. [PMID: 32527256 PMCID: PMC7291752 DOI: 10.1186/s12906-020-02966-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies have shown that sociodemographic variables significantly predict the use of complementary and alternative medicine (CAM), although these predictions were not particularly strong. A multitude of predictors of the use or approval of CAM have been investigated in the field of personal values and worldviews, but the effects were small or doubtful due to non-representative samples. More recent psychological research has linked positive attitudes towards CAM with intuitive thinking, paranormal beliefs, ontological confusions and magical health beliefs, suggesting a common thinking style behind all these variables. The aim of this study is to identify the most important predictors of the use and approval of CAM. METHODS We performed a canonical correlation analysis on all 3480 records from the 2012 German General Social Survey (ALLBUS) with the lifetime use and opinion of CAM as the dependent variables. RESULTS Approval of paranormal practices such as fortune-telling, dowsing or spiritualism explained 32% of the variance in the dependent canonical variate "approval of CAM", while sociodemographic variables explained only 2%. Experience with paranormal practices explained 17% of the variance in the dependent canonical variate "experience with CAM", and sociodemographic variables explained 10% of the variance. Traditional religiosity, attitudes towards science and post-materialist values showed no relevant correlations with the dependent canonical variates. CONCLUSIONS Paranormal beliefs and related measures are the most important known predictors of the use and approval of CAM. Experience with paranormal practices not only indicates paranormal beliefs but also explains experience with CAM that cannot be explained by approval of CAM. Female gender and higher socioeconomic status predict experience with CAM without predicting approval of CAM, but their influence should not be overstated.
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Affiliation(s)
- Henrik Abheiden
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany
| | - Michael Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany
| | - Anne Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany.
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Krause L, Dini L, Prütz F. Gynaecology and general practitioner services utilisation by women in the age group 50 years and older. JOURNAL OF HEALTH MONITORING 2020; 5:15-25. [PMID: 35146266 PMCID: PMC8734149 DOI: 10.25646/6808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 06/14/2023]
Abstract
There are relatively few representative data on the utilisation of physician services in Germany and its influencing. Based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), we analyse the utilisation of gynaecology and general practitioner (GP) services, with a focus on women aged 50 years and older. We compare these findings with data from the German National Health Interview and Examination Survey 1998 (GNHIES98) and, based on this and further data, discuss possible developments. Figures for seeking GP services (over 80%) are constantly high across the entire lifespan, whereas figures for gynaecology services drop with age. Around 60% of women aged 50 years and older go to a gynaecological practice at least once a year. Socioeconomic status and place of residence are important determinants for the utilisation of services. Around half of all women aged 50 years and older sought both gynaecology and GP services at least once over a one-year period. Under 10% had only been to a gynaecologist, and around one third sought GP services only. Compared to GNHIES98, figures for GP and gynaecology services were considerably higher in DEGS1, health insurance data, however, shows no increase in the use of gynaecology services between 2008 and 2018. The results highlight the need to increase awareness among GPs of the needs of middle-aged and older women for gynaecological consultation and treatment.
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Affiliation(s)
- Laura Krause
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Lorena Dini
- Charité – UniversitätsmedizinBerlinInstitute of General Practice
| | - Franziska Prütz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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24
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Agyemang-Duah W, Peprah C, Arthur-Holmes F. Predictors of healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana. BMC Geriatr 2020; 20:79. [PMID: 32106834 PMCID: PMC7045420 DOI: 10.1186/s12877-020-1473-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Like many other low- and middle-income countries (LMICs), the Ghanaian healthcare system remains poor which is likely to affect the utilisation of healthcare services, especially among poor older people who are faced with multiple health problems. Yet, factors that explain healthcare use among poor older people in LMICs, particularly Ghana remain largely unexplored. Understanding the predictors of healthcare use among poor older people could have a huge impact on health policies in LMICs including Ghana. This study, therefore, examined factors associated with healthcare use among poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme in the Atwima Nwabiagya District of Ghana. METHODS Cross-sectional data were obtained from an Ageing, Health, Lifestyle and Health Services (AHLHS) study conducted between 1 and 20 June 2018 (N = 200) in Atwima Nwabiagya District, Ghana. Sequential logistic regression models were performed to estimate the variables that predict healthcare use among poor older people. All test results were considered significant at 0.05 or less. RESULTS The fully adjusted model showed that respondents aged 85-89 years (AOR = 0.094, CI: 0.007-1.170), acquired basic education (AOR =0.251, CI: 0.085-0.987), received no family support (AOR = 0.771, CI: 0.120-0.620), with no past illness records (AOR = 0.236, CI: 0.057-0.197) and who were not diagnosed of chronic non-communicable diseases (AOR = 0.418, CI: 0.101-0.723) were significantly less likely to utilise health facility compared with their respective counterparts. Moreover, those with no disability (AOR = 19.245, CI: 2.415-29.921) and who consumed low fruits (AOR = 1.435 = CI: 0.552-8.740) and vegetables (AOR = 1.202 = CI: 0.362-10.20) had a higher likelihood to use healthcare. CONCLUSION The study has outlined multiple factors influencing utilisation of healthcare among poor older people under the LEAP programme in Ghana. The results, therefore, validate the importance of social and behavioural determinants of healthcare use in the Ghanaian poor older population. We highlight the need for health planners and stakeholders to consider demographic, socio-economic, health-related and lifestyle factors when formulating health policy for poor older people in Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Peprah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Johnston KJ, Mittler J, Hockenberry JM. Patient social risk factors and continuity of care for Medicare beneficiaries. Health Serv Res 2020; 55:445-456. [PMID: 32037553 DOI: 10.1111/1475-6773.13272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To identify patient social risk factors associated with Continuity of Care (COC) index. DATA SOURCES/STUDY SETTING Medicare Current Beneficiary Survey (MCBS), the Dartmouth Institute, and Area Resource File for 2006-2013. STUDY DESIGN We use regression methods to assess the effect of patient social risk factors on COC after adjusting for medical complexity. In secondary analyses, we assess the effect of social risk factors on annual utilization of physicians and specialists for evaluation and management (E&M). DATA COLLECTION/EXTRACTION METHODS We retrospectively identified 59 499 patient years for Medicare beneficiaries with one year of enrollment and three or more E&M visits. PRINCIPAL FINDINGS After adjustment for medical complexity, individual-level social risk factors such as lack of education, low income, and living alone are all associated with better patient COC (P < .05). Similarly, area-level social risk factors such as living in areas that are nonurban or high poverty, as well as in areas with low specialist or high primary care physician supply, are all associated with better patient COC (P < .05). We found the opposite pattern of associations between these same risk factors and annual patient utilization of physicians and specialists (P < .05). CONCLUSIONS Medicare patients with multiple social risk factors have consistently better COC; these same social risk factors are associated with reduced patient-realized access to specialist physician care.
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Affiliation(s)
- Kenton J Johnston
- Department of Health Management and Policy and Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Jessica Mittler
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Jason M Hockenberry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Schulz M, Czwikla J, Tsiasioti C, Schwinger A, Gand D, Schmiemann G, Schmidt A, Wolf-Ostermann K, Kloep S, Heinze F, Rothgang H. Differences in medical specialist utilization among older people in need of long-term care - results from German health claims data. Int J Equity Health 2020; 19:22. [PMID: 32033606 PMCID: PMC7006141 DOI: 10.1186/s12939-020-1130-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. METHODS We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. RESULTS We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. CONCLUSION The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
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Affiliation(s)
- Maike Schulz
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Jonas Czwikla
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Chrysanthi Tsiasioti
- Research Institute of the Local Health Care Funds (WIdO), P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Antje Schwinger
- Research Institute of the Local Health Care Funds (WIdO), P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Daniel Gand
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Guido Schmiemann
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Annika Schmidt
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Stephan Kloep
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, High-Profile Area Health Sciences, Bremen, Germany
| | - Franziska Heinze
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
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Luppa M, Giersdorf J, Riedel-Heller S, Prütz F, Rommel A. Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS). BMC FAMILY PRACTICE 2020; 21:10. [PMID: 31931727 PMCID: PMC6958724 DOI: 10.1186/s12875-020-1082-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system. METHODS The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany's national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of general practitioner contacts in the preceding 12 months as frequent attenders of primary care services. Binary logistic regression models with average marginal effects were used to identify potential determinants for frequent use of primary care services. RESULTS The sample comprised 7956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, factors related to medical need for care such as medically diagnosed chronic conditions and for subjective health. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect suggesting that the association between subjective health status and frequent attendance vanishes with a higher number of non-communicable diseases. CONCLUSIONS We observed strong associations between frequent primary care attendance and medical need for care as well as subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization and to avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.
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Affiliation(s)
- Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Jan Giersdorf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Franziska Prütz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexander Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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Lampert T, Prütz F, Rommel A, Kuntz B. Social differences in the utilization of medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study. JOURNAL OF HEALTH MONITORING 2018; 3:35-51. [PMID: 35586145 PMCID: PMC8852810 DOI: 10.17886/rki-gbe-2018-098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022]
Abstract
Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family's socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.
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Affiliation(s)
- Thomas Lampert
- Corresponding author PD Dr Thomas Lampert, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail:
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Lampert T, Prütz F, Rommel A, Kuntz B. Social differences in the utilization of medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study. JOURNAL OF HEALTH MONITORING 2018. [PMID: 35586145 DOI: 10.17886/rki-gbe-2018-016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family's socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.
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Affiliation(s)
- Thomas Lampert
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Franziska Prütz
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Alexander Rommel
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Benjamin Kuntz
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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Leadership position and physician visits - results of a nationally representative longitudinal study in Germany. J Occup Med Toxicol 2018; 13:33. [PMID: 30386409 PMCID: PMC6203290 DOI: 10.1186/s12995-018-0216-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background So far, studies within the occupational field have largely concentrated on working conditions and job stressors and staff members’ or subordinate health. Only a few have focused on managers in this context, but studies are missing that explicitly look at the relation between leadership position and health care use (HCU). Thus, the purpose of this study was to examine the potential effects of a change in leadership position on HCU in women and men longitudinally. Methods Data were drawn from a nationally representative longitudinal study in Germany (German Socio-Economic Panel, GSOEP). Data from 2009 and 2013 were used. Leadership position was divided into (i) top management, (ii) middle management, (iii) lower management, and (iv) a highly qualified specialist position. The number of physician visits in the preceding 3 months were used to quantify HCU (n = 2140 observations in regression analysis; 69% male). Results Adjusting for various potential confounders (e.g., age, self-rated health, chronic conditions, and personality factors), Poisson FE regression analysis revealed that changes from a highly qualified specialist position to the top management were associated with a decrease in the number of physician visits in men (β = .47, p < .05), but not in women. Gender differences (gender x leadership position) were significant. Conclusions Findings of this study emphasize the impact of leadership positions on the number of physician visits in men. Further study is required to elucidate the underlying mechanisms.
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Friis Abrahamsen C, Ahrensberg JM, Vedsted P. Utilisation of primary care before a childhood cancer diagnosis: do socioeconomic factors matter?: A Danish nationwide population-based matched cohort study. BMJ Open 2018; 8:e023569. [PMID: 30121615 PMCID: PMC6104784 DOI: 10.1136/bmjopen-2018-023569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Early diagnosis of childhood cancer is critical. Nevertheless, little is known about the potential role of inequality. This study aims to describe the use of primary care 2 years before a childhood cancer diagnosis and to investigate whether socioeconomic factors influence the use of consultations and diagnostic tests in primary care. DESIGN A national population-based matched cohort study. SETTING AND PARTICIPANTS This study uses observational data from four Danish nationwide registers. All children aged 0-15 diagnosed with cancer during 2008-2015 were included (n=1386). Each case was matched based on gender and age with 10 references (n=13 860). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was additional rates for consultations and for invoiced diagnostic tests for children with cancer according to parental socioeconomic factors. Furthermore, we estimated the association between socioeconomic factors and frequent use of consultations, defined as at least four consultations, and the odds of receiving a diagnostic test within 3 months of diagnosis. RESULTS Children with cancer from families with high income had 1.46 (95% CI 1.23 to 1.69) additional consultations 3 months before diagnosis, whereas children from families with low income had 1.85 (95% CI 1.60 to 2.11) additional consultations. The highest odds of frequent use of consultations was observed among children from low-income families (OR: 1.94, 95% CI 1.24 to 3.03). A higher odds of receiving an invoiced diagnostic test was seen for children from families with mid-educational level (OR: 1.46, 95% CI 1.09 to 1.95). CONCLUSION We found a socioeconomic gradient in the use of general practice before a childhood cancer diagnosis. This suggests that social inequalities exist in the pattern of healthcare utilisation in general practice.
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Affiliation(s)
| | - Jette Møller Ahrensberg
- Department of Clinical Medicine, Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Luque Ramos A, Hoffmann F, Spreckelsen O. Waiting times in primary care depending on insurance scheme in Germany. BMC Health Serv Res 2018; 18:191. [PMID: 29558925 PMCID: PMC5859448 DOI: 10.1186/s12913-018-3000-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Waiting times for an outpatient appointment in Germany differ between insurants of the statutory and private health insurance schemes, especially for specialised care. The aim of this study was to uncover possible differences in waiting times depending on health insurance scheme and to identify predictors for excessive waiting times in primary care. METHODS We used data of the Bertelsmann Foundation Healthcare Monitor, which is a repeated cross sectional study dealing with experiences in health care and attitudes towards current health policy themes. We analysed the surveys conducted from 2011 to 2013, with respondents assigned to their health insurance fund, namely AOK, BARMER GEK, BKK, DAK, TK, IKK, other statutory funds and private funds. The mean waiting times for an appointment and spent in a physician's waiting room, and the satisfaction with waiting times were evaluated with respect to different health insurance funds. A logistic regression model was used to calculate the chance of excessive waiting times with respect to health insurance fund, age, sex, health and socioeconomic status. The ninetieth percentile of the waiting time distribution (10 days) was chosen as the cut-off point between average and excessive. RESULTS A total of 5618 respondents were analysed. Mean waiting times in primary care were low (4.0 days) and homogeneous (SHIs: 3.6-4.9 days), even though privately insured respondents reported shorter waiting times for appointments (3.3 days). They also reported a greater satisfaction with waiting times (77.5%) than SHI insurants (64.5%). However, we identified a group (10.1%), who experienced excessive waiting times in primary care. Compared to privately insured respondents, the chance of excessive waiting times was increased for SHI insurants (highest odds ratio for BKK: 2.17; 95%-CI: 1.38-3.42). Additionally, higher age and residence in East Germany were associated with higher chances of waiting times of 10 days or more. CONCLUSIONS Primary care in Germany is readily accessible with generally short waiting times. However, barriers in access to the health care system affect a certain part of patients depending on insurance status, age and region of residence. Ways to improve the access need to be studied.
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Affiliation(s)
- Andres Luque Ramos
- Department of Health Services Research, Carl von Ossietzky University, Ammerländer Heerstrasse 140, 26111 Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Ammerländer Heerstrasse 140, 26111 Oldenburg, Germany
| | - Ove Spreckelsen
- Department of Health Services Research, Carl von Ossietzky University, Ammerländer Heerstrasse 140, 26111 Oldenburg, Germany
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Dudko Y, Robey DE, Kruger E, Tennant M. Selecting a location for a primary healthcare facility: combining a mathematical approach with a Geographic Information System to rank areas of relative need. Aust J Prim Health 2018; 24:130-134. [DOI: 10.1071/py17093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 11/23/2022]
Abstract
Geographic Information Systems have become an invaluable tool in many industries as it can help to conceptualise available data and answer questions visually. The software allows for integration of key statistics and geographic data for a more detailed analysis. The objective of this study was to show how mathematically weighted, publicly available, relevant demographics data can be integrated with Geographic Information Systems to identify and rank potential locations for new primary healthcare facilities. Index of Relative Socio-economic Advantage and Disadvantage was mathematically weighted with respect to the usual resident population and the number of people not in the labour force data, at Statistical Area level 1 (SA1). Smoothing was applied by repeating the process at Statistical Area level 2, 3 and 4 to produce a quasi-index of priority. A total of 229 SA1 areas were identified and preselected as potential primary healthcare facility infrastructure sites across Australia. The quasi-index was incorporated into a Geographic Information System to produce a map identifying and ranking areas of relative need. Combining a mathematical approach with Geographic Information Systems can yield significant qualitative and quantitative advantages over conventional methods of site selection.
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Schröder SL, Fink A, Hoffmann L, Schumann N, Martin O, Frantz S, Richter M. Socioeconomic differences in the pathways to diagnosis of coronary heart disease: a qualitative study. Eur J Public Health 2017; 27:1055-1060. [DOI: 10.1093/eurpub/ckx147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mehring M, Donnachie E, Schneider A, Tauscher M, Gerlach R, Storr C, Linde K, Mielck A, Maier W. Impact of regional socioeconomic variation on coordination and cost of ambulatory care: investigation of claims data from Bavaria, Germany. BMJ Open 2017; 7:e016218. [PMID: 29061608 PMCID: PMC5665322 DOI: 10.1136/bmjopen-2017-016218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES A considerable proportion of regional variation in healthcare use and health expenditures is to date still unexplained. The aim was to investigate regional differences in the gatekeeping role of general practitioners and to identify relevant explanatory variables at patient and district level in Bavaria, Germany. DESIGN Retrospective routine data analysis using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. PARTICIPANTS All patients who consulted a specialist in ambulatory practice within the first quarter of 2011 (n=3 616 510). OUTCOMES MEASURES Of primary interest is the effect of district-level measures of rurality, physician density and multiple deprivation on (1) the proportion of patients with general practitioner (GP) coordination of specialist care and (2) the mean amount in Euros claimed by specialist physicians. RESULTS The proportion of patients whose use of specialist services was coordinated by a GP was significantly higher in rural areas and in highly deprived regions, as compared with urban and less deprived regions. The hierarchical models revealed that increasing age and the presence of chronic diseases are the strongest predictive factors for coordination by a GP. In contrast, the presence of mental illness, an increasing number of medical condition categories and living in a city are predictors for specialist use without GP coordination. The amount claimed per patient was €10 to €20 higher in urban districts and in regions with lower deprivation. Hierarchical models indicate that this amount is on average higher for patients living in towns and lower for patients in regions with high deprivation. CONCLUSION The present study shows that regional deprivation is closely associated with the way in which patients access primary and specialist care. This has clear consequences, both with respect to the role of the general practitioner and the financial costs of care.
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Affiliation(s)
- Michael Mehring
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ewan Donnachie
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Martin Tauscher
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | - Roman Gerlach
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | - Constanze Storr
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Klaus Linde
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andreas Mielck
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Socioeconomic position and health services use in Germany and Spain during the Great Recession. PLoS One 2017; 12:e0183325. [PMID: 28854226 PMCID: PMC5576673 DOI: 10.1371/journal.pone.0183325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022] Open
Abstract
Objective The relationship of socioeconomic position with the use of health services may have changed with the emergence of the economic crisis. This study shows that relationship before and during the economic crisis, in Germany and in Spain. Methods Data from the 2006 and 2011 Socio-Economic Panel carried out in Germany, and from the 2006 and 2011 National Health Surveys carried out in Spain were used. The health services investigated were physician consultations and hospitalization. The measures of socioeconomic position used were education and household income. The magnitude of the relationship between socioeconomic position and the use of each health services was estimated by calculating the percentage ratio by binary regression. Results In Germany, in both periods, after adjusting for age, sex, type of health insurance and need for care, subjects belonging to the lower educational categories had a lower frequency of physician consultations, while those belonging to the lower income categories had a higher frequency of hospitalization. In the model comparing the two lower socioeconomic categories to the two higher categories, the percentage ratio for physician consultation by education was 0.97 (95%CI 0.96–0.98) in 2006 and 0.96 (95%CI 0.95–0.97) in 2011, and the percentage ratio for hospitalization by income was 1.14 (95%CI 1.05–1.25) in 2006 and 1.12 (95%CI 1.03–1.21) in 2011. In Spain, no significant socioeconomic differences were observed in either period in the frequency of use of these health services in the fully adjusted model. Conclusion The results suggest that the economic crisis did not alter accessibility to the health system in either country, given that the socioeconomic pattern in the use of these health services was similar before and during the crisis in both countries.
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