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Laporte C, Fortin F, Dupouy J, Darmon D, Pereira B, Authier N, Delorme J, Chenaf C, Maisonneuve H, Schuers M. The French ecology of medical care. A nationwide population-based cross sectional study. Fam Pract 2024; 41:92-98. [PMID: 37934751 DOI: 10.1093/fampra/cmad098] [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: 11/09/2023] Open
Abstract
PURPOSE Studies in the United States, Canada, Belgium, and Switzerland showed that the majority of health problems are managed within primary health care; however, the ecology of French medical care has not yet been described. METHODS Nationwide, population-based, cross sectional study. In 2018, we included data from 576,125 beneficiaries from the General Sample of Beneficiaries database. We analysed the reimbursement of consultations with (i) a general practitioner (GP), (ii) an outpatient doctor other than a GP, (iii) a doctor from a university or non-university hospital; and the reimbursement of (iv) hospitalization in a private establishment, (v) general hospital, and (vi) university hospital. For each criterion, we calculated the average monthly number of reimbursements reported on 1,000 beneficiaries. For categorical variables, we used the χ2 test, and to compare means we used the z test. All tests were 2-tailed with a P-value < 5% considered significant. RESULTS Each month, on average, 454 (out of 1,000) beneficiaries received at least 1 reimbursement, 235 consulted a GP, 74 consulted other outpatient doctors in ambulatory care and 24 in a hospital, 13 were hospitalized in a public non-university hospital and 10 in the private sector, and 5 were admitted to a university hospital. Independently of age, people consulted GPs twice as much as other specialists. The 13-25-year-old group consulted the least. Women consulted more than men. Individuals covered by complementary universal health insurance had more care. CONCLUSIONS Our study on reimbursement data confirmed that, like in other countries, in France the majority of health problems are managed within primary health care.
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Affiliation(s)
- Catherine Laporte
- Département de Médecine Générale, Université Clermont Auvergne, UFR de Médecine et Profession paramédicales de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Frédéric Fortin
- Département de Médecine Générale, Université Clermont Auvergne, UFR de Médecine et Profession paramédicales de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Julie Dupouy
- Maison de Santé Pluriprofessionnelle Universitaire de Pins Justaret, Pins Justaret, France
- Département universitaire de médecine générale, UFR Santé, Université Toulouse III Paul Sabatier, Toulouse, France
- UMR 1295 Inserm CERPOP, Université Toulouse III, F-31000 Toulouse, France
| | - David Darmon
- Département d'Enseignement et de Recherche de Médecine Générale, Université Côte d'Azur, RETINES, UFR médecine 28, Avenue de Valombrose, Nice, 06107, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm 1107, Neuro-Dol, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jessica Delorme
- CHU Clermont-Ferrand, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm 1107, Neuro-Dol, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Chouki Chenaf
- CHU Clermont-Ferrand, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm 1107, Neuro-Dol, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Hubert Maisonneuve
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
| | - Matthieu Schuers
- Département de Médecine Générale, Normandie Université, UFR Santé Rouen, F-7600 Rouen, France
- Department of Biomedical Informatics, CHU Rouen, F-76000 Rouen, France
- INSERM, U1142, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé, LIMICS, Sorbonne Université, F-75006 Paris, France
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Kristoffersen ES, Bjorvatn B, Halvorsen PA, Nilsen S, Fossum GH, Fors EA, Jørgensen P, Øxnevad-Gundersen B, Gjelstad S, Bellika JG, Straand J, Rørtveit G. The Norwegian PraksisNett: a nationwide practice-based research network with a novel IT infrastructure. Scand J Prim Health Care 2022; 40:217-226. [PMID: 35549798 PMCID: PMC9397441 DOI: 10.1080/02813432.2022.2073966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
PURPOSE Clinical research in primary care is relatively scarce. Practice-based research networks (PBRNs) are research infrastructures to overcome hurdles associated with conducting studies in primary care. In Norway, almost all 5.4 million inhabitants have access to a general practitioner (GP) through a patient-list system. This gives opportunity for a PBRN with reliable information about the general population. The aim of the current paper is to describe the establishment, organization and function of PraksisNett (the Norwegian Primary Care Research Network). MATERIALS AND METHODS We describe the development, funding and logistics of PraksisNett as a nationwide PBRN. RESULTS PraksisNett received funding from the Research Council of Norway for an establishment period of five years (2018-2022). It is comprised of two parts; a human infrastructure (employees, including academic GPs) organized as four regional nodes and a coordinating node and an IT infrastructure comprised by the Snow system in conjunction with the Medrave M4 system. The core of the infrastructure is the 92 general practices that are contractually linked to PraksisNett. These include 492 GPs, serving almost 520,000 patients. Practices were recruited during 2019-2020 and comprise a representative mix of rural and urban settings spread throughout all regions of Norway. CONCLUSION Norway has established a nationwide PBRN to reduce hurdles for conducting clinical studies in primary care. Improved infrastructure for clinical studies in primary care is expected to increase the attractiveness for studies on the management of disorders and diseases in primary care and facilitate international research collaboration. This will benefit both patients, GPs and society in terms of improved quality of care.Key pointsPractice-based research networks (PBRNs) are research infrastructures to overcome hurdles associated with conducting studies in primary careImproved infrastructure for clinical studies in primary care is expected to increase the attractiveness for studies on the management of disorders and diseases in primary care and facilitate international research collaborationWe describe PraksisNett, a Norwegian PBRN consisting of 92 general practices including 492 GPs, serving almost 520,000 patientsAn advanced and secure IT infrastructure connects the general practices to PraksisNett and makes it possible to identify and recruit patients in a novel way, as well as reuse clinical dataPraksisNett will benefit both patients, GPs and society in terms of improved quality of careThis paper may inform and inspire initiatives to establish PBRNs elsewhere.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
- Research Unit for General Practice, Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
- CONTACT Espen Saxhaug Kristoffersen Department of General Practice, HELSAM, University of Oslo, PO Box 1130, Blindern, Oslo0318, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Stein Nilsen
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guro Haugen Fossum
- Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
- Research Unit for General Practice, Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
| | - Egil A. Fors
- Research Unit for General Practice, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Jørgensen
- Research Unit for General Practice, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Johan Gustav Bellika
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Jørund Straand
- Research Unit for General Practice, Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
| | - Guri Rørtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Giezendanner S, Fischer R, Diaz Hernandez L, Zeller A. The use of health care during the SARS-CoV-2 pandemic: repeated cross-sectional survey of the adult Swiss general population. BMC Public Health 2021; 21:853. [PMID: 33941109 PMCID: PMC8091147 DOI: 10.1186/s12889-021-10854-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The distribution of health care resources during a pandemic is challenging. The aim of the study was to describe the use of health care in a representative sample of the Swiss population during the SARS-CoV-2 pandemic in 2020, and to compare it to data from a survey conducted in 2018. METHODS We conducted an observational, population-based, nationwide, repeated cross-sectional survey of the adult Swiss general population in 2018 and in March and April 2020 during the first wave of the SARS-CoV-2 pandemic. Recruitment and data acquisition was conducted by the Link Institute in Lucerne in representative samples of Swiss citizens in 2020 and in 2018. Variables of interest were estimates of health problems, health seeking behaviour, medication and health care use in the population. RESULTS In total, we included data of 1980 individuals (in 2018 N = 958 and in 2020 N = 1022). Across both rounds of data collection the median age was 46 years (range = 18-79 years) and 50% were women. Per 1000 adults, half had at least one symptom and a quarter sought medical advice across both surveys. The most frequently consulted health providers in 2020 were general practitioners (GP) (180/1000), specialist physicians (41/1000), pharmacies (38/1000), the internet (26/1000) and accident and emergency units (25/1000). Compared to 2018, we noted a significant increase in the use of health providers during the pandemic, which was independent of demographic variables for the following health care providers: use of internet (OR = 9.8), pharmacy (OR = 2.64), accident and emergency units (OR = 2.54), and a significant decrease in the number of people who consulted specialist physicians (OR = 0.46). Overall, 76/1000 contacted their GP in relation to COVID-19. CONCLUSIONS Compared to 2018, GPs remained the most important source of medical advice for the population during the first wave of the COVID-19 pandemic in Switzerland. While the self-appraisal of health problems and of the need for medical advice remained constant, individuals seemed to change their provider choice during the pandemic, with an increased utilisation of accident and emergency units and pharmacies, which represent easily accessible and low-threshold medical services.
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Affiliation(s)
- Stéphanie Giezendanner
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Laura Diaz Hernandez
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
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Hoffmann K, Ristl R, George A, Maier M, Pichlhöfer O. The ecology of medical care: access points to the health care system in Austria and other developed countries. Scand J Prim Health Care 2019; 37:409-417. [PMID: 31512566 PMCID: PMC6883430 DOI: 10.1080/02813432.2019.1663593] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective: This study aimed to analyze the Austrian health care system using the ecology of care model. Our secondary aim was to compare data from Austria with those available from other countries.Design: 3508 interviews employing a 30-item questionnaire related to the utilization of the health care system including demographic factors were conducted. Participants were chosen by a Random Digital Dialing procedure. Further, a literature review of studies of other countries use of the ecology of care model was conducted.Main outcome measures: Austria has one of the highest utilization of health care services in any of the assessed categories. The comparison with the literature review shows that Austria has the highest utilization of specialists working in the outpatient sector as well as the highest hospitalization rates. Taiwan and Korea have comparable utilization patterns. Canada, Sweden, and Norway are countries with lower utilization patterns, and the U.S. and Japan are intermediate.Conclusion: In Austria and similarly organized countries, high utilization of all health care services can be observed, in particular, the utilization of specialists and hospitalizations. The over-utilization of all levels of health care in Austria may be due to the lack of a clear demarcation line between the primary and secondary levels of care, and the presence of universal health coverage, which also allows for unrestricted and undirected access to all levels of care. Previous studies have shown that comparable countries lack the health benefits of a strong primary care system with its coordination function.Key pointsIn Austria and similarly organized countries, there appears to be high utilization of health care in general, as well as with particular utilization of specialists and hospitalizations.The high utilization of all levels of care in Austria may be the result of competition, lack of a clear demarcation line between the primary and secondary level of care, and the presence of universal health coverage.Pathways between primary and secondary care should be strengthened as previous studies have shown that comparable countries lack the health benefits of strong primary care and its function for health care coordination.
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Affiliation(s)
- Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria;
- CONTACT Kathryn Hoffmann Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - Robin Ristl
- Center for Medical Statistics, Medical University of Vienna, Vienna, Austria;
| | - Aaron George
- Meritus Family Medicine Residency Program, Hagerstown, MD, USA
| | - Manfred Maier
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria;
| | - Otto Pichlhöfer
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria;
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Hoffmann K, George A, Jirovsky E, Dorner TE. Re-examining access points to the different levels of health care: a cross-sectional series in Austria. Eur J Public Health 2019; 29:1005-1010. [PMID: 30938408 PMCID: PMC6896971 DOI: 10.1093/eurpub/ckz050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is high variation in service utilization behaviour, health equity and outcomes among countries based upon the organization of access to primary and secondary care levels. Austria is a country with universal health coverage and access without clear delineation between access to primary and secondary care. The aim of this study was to investigate development of access points to the Austrian system over time and subsequent utilization. METHODS The databases used were the Austrian Health Interview Surveys 2006/2007 and 2014, including 15 747 and 15 771 persons, respectively. Descriptive analysis of health services utilization behaviour and demographic factors were conducted. Logistic regression models were applied. Furthermore, differences between the two periods are shown. RESULT Utilization of all services assessed was high in 2014 when compared to 2006/2007. Between these periods, a 6-7% increase in use of secondary care services was found. There was a 10.8% increase in access to specialist care services and 4.1% increase in hospital outpatient visits, each without prior General Practitioner (GP) visits. The largest increases were found in those groups that had previously demonstrated the lowest utilization behaviour of accessing specialist consultations and consultations without a prior GP visit. CONCLUSION Despite the lack of change to the health care system or access to care, there was an increase in utilization of secondary care services, with a lower percentage of patients seeking direct GP consultation. This is concerning for systems development, cost containment and quality of care, as it demonstrates a possible trend shifting away from primary care as initial access point.
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Affiliation(s)
- Kathryn Hoffmann
- Kathryn Hoffmann, MD, MPH, Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - Aaron George
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA USA
| | - Elena Jirovsky
- Elena Jirovsky, PhD, Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - Thomas E Dorner
- Thomas E. Dorner, MD, MPH, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
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Abstract
OBJECTIVE To obtain first-hand in-depth accounts of overtesting amongst GPs in Norway, as well as the GPs' perspectives on drivers of overtesting and strategies that can prevent overtesting. DESIGN AND SETTING Four focus groups with GPs were conducted. All participants were asked to share examples of unnecessary testing from their everyday general practice, to identify the driving forces involved in these examples and discuss any measures that might prevent excessive testing. All authors collaborated on the analysis, conducted as systematic text condensation, using critical incident technique. RESULTS This study reveals two main positions regarding overtesting in general practice. In the categorical position there is no such thing as overtesting and GPs are obliged to perform extensive investigations on the suspicion that any person can carry a fatal disease, no matter how minor or absent their symptoms are. In contrast, in the dilemmatic position, the GPs acknowledge that investigations can cause significant harm, but still feel pressured to discover disease at the earliest opportunity and to meet patients' demands. The GPs' strategies for resolving this dilemma are often demanding and not always successful, but sharing uncertainty and fallibility with patients and colleagues appears to be the most promising strategy. CONCLUSIONS Our study indicates that GPs in Norway experience a strong pressure to discover any instance of disease and to meet patients' demands for investigations. One way of preventing the harm that accrues from overtesting is openly sharing uncertainty and fallibility with patients and colleagues.
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Affiliation(s)
- Per Øystein Opdal
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
- CONTACT Per Øystein Opdal Department of Global Health and Primary Care, University of Bergen, Kalfarveien 31, 5018Bergen, Norway
| | - Eivind Meland
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stefan Hjörleifsson
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Center, Norway
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Hansen AH, Broz J, Claudi T, Årsand E. Relations Between the Use of Electronic Health and the Use of General Practitioner and Somatic Specialist Visits in Patients With Type 1 Diabetes: Cross-Sectional Study. J Med Internet Res 2018; 20:e11322. [PMID: 30404766 PMCID: PMC6249507 DOI: 10.2196/11322] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/11/2018] [Accepted: 09/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be of great value. However, little is known about the association between the use of eHealth and provider-based health care services among people with diabetes. OBJECTIVE The objective of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and associations with the use of provider-based health care visits among people diagnosed with type 1 diabetes mellitus (T1DM). METHODS We used email survey data collected from 1250 members of the Norwegian Diabetes Association (aged 18 to 89 years) in 2018. Eligible for analyses were the 523 respondents with T1DM. Using descriptive statistics, we estimated the use of eHealth and the use of general practitioners (GPs) and somatic specialist outpatient services. By logistic regressions, we studied the associations between the use of these provider-based health services and the use of eHealth, adjusted for gender, age, education, and self-rated health. RESULTS Of the sample of 523 people with T1DM, 90.7% (441/486) had visited a GP once or more, and 61.0% (289/474) had visited specialist services during the previous year. Internet search engines (such as Google) were used for health purposes sometimes or often by 84.0% (431/513), apps by 55.4% (285/514), social media (such as Facebook) by 45.2% (232/513), and video services (such as YouTube) by 23.3% (118/506). Participants aged from 18 to 39 years used all forms of eHealth more than people aged 40 years and older, with the exception of social media. The use of search engines was positively associated with the use of somatic specialist services (odds ratio 2.43, 95% CI 1.33-4.45). GP visits were not associated with any kind of eHealth use. CONCLUSIONS eHealth services are now widely used for health support and health information by people with T1DM, primarily in the form of search engines but often in the form of apps and social media as well. We found a positive association between the use of search engines and specialist visits and that people with T1DM are frequent users of eHealth, GPs, and specialist services. We found no evidence that eHealth reduces the use of provider-based health care; these services seem to be additional rather than alternative. Future research should focus on how health care services can meet and adapt to the high prevalence of eHealth use. Our results also indicate that many patients with T1DM do not visit specialist clinics once a year as recommended. This raises questions about collaboration in health care services and needs to be followed up in future research.
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Affiliation(s)
- Anne Helen Hansen
- Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Jan Broz
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tor Claudi
- Medical Department, Nordland Hospital, Bodø, Norway
| | - Eirik Årsand
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
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Fukui T, Rahman M, Ohde S, Hoshino E, Kimura T, Urayama KY, Omata F, Deshpande GA, Takahashi O. Reassessing the Ecology of Medical Care in Japan. J Community Health 2018; 42:935-941. [PMID: 28364318 DOI: 10.1007/s10900-017-0337-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Studies on ecology of medical care can provide valuable information on how people seek healthcare in a specific geographic area. The objective of this study was to update a 2003 report on the ecology of medical care in Japan, identifying relevant changes in healthcare patterns. We collected information based on a prospective health diary recorded for a month in 2013 (n = 4548; 3787 adults and 797 children) using a population-weighted random sample from a nationally representative panel. We compared our overall and stratified findings with a similar study conducted in 2003. During a one-month period, per 1000 adults and children living in Japan, we estimated that 794 report at least one symptom, 447 use an over-the-counter (OTC) drug, 265 visit a physician's office, 117 seek help from a professional provider of complementary or alternative medicine (CAM), 70 visit a hospital outpatient clinic (60 community-based and 10 university-based), 6 are hospitalized, and 4 visit a hospital emergency department. After adjusting for demographic variables, we found that healthcare seeking behaviors were influenced by age, gender and area of living. Compared with the 2003 study, participants in this study had fewer symptoms, fewer physician and emergency room visits, and less OTC use, but reported higher frequency of CAM use (p < .01 for all). Compared with 2003, reported symptoms, physician visits and OTC use has decreased, while CAM use has increased. Our findings may be useful to policymakers in Japan in a context where healthcare expenditure and a rapidly aging population are two challenging issues.
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Affiliation(s)
- Tsuguya Fukui
- St. Luke's International Hospital, Akashi-cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan.,St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mahbubur Rahman
- St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sachiko Ohde
- St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Eri Hoshino
- St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeshi Kimura
- St. Luke's International Hospital, Akashi-cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan.,St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kevin Y Urayama
- St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Fumio Omata
- St. Luke's International Hospital, Akashi-cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Gautam A Deshpande
- St. Luke's International Hospital, Akashi-cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan.,St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Osamu Takahashi
- St. Luke's International Hospital, Akashi-cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan. .,St. Luke's Center for Clinical Academia, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Hansen AH, Kristoffersen AE. The use of CAM providers and psychiatric outpatient services in people with anxiety/depression: a cross-sectional survey. Altern Ther Health Med 2016; 16:461. [PMID: 27835971 PMCID: PMC5106802 DOI: 10.1186/s12906-016-1446-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/03/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Depression has been identified as one of the most frequent predictors of CAM use. However, limited data exist about the use of CAM providers among people with anxiety/depression in Norway. The aim of this study was to investigate the use of CAM providers, and the use of CAM providers and psychiatric outpatient services in combination, among people with self-reported anxiety and/or depression. METHODS We used questionnaire data from 12,982 participants (30-87 years) in the cross-sectional sixth Tromsø Study (conducted in 2007-8). Eligible for analyses in our study were 1685 participants who reported suffering from anxiety and/or depression. By descriptive statistical methods, we estimated the use of CAM providers, psychiatric outpatient services, and the combination of these. By logistic regressions we studied the association between the use of these services and gender, age, income, education, and self-reported degree of anxiety/depression. RESULTS During the previous year, 17.8 % of people with anxiety/depression visited a CAM provider once or more, 11.8 % visited psychiatric outpatient services, and 2.5 % visited both. Men with anxiety/depression were less likely to visit CAM providers compared to women (odds ratio [OR] 0.40, confidence interval [CI] 0.30-0.55), whereas higher educated people were more likely to visit compared to the lowest educated (OR 1.47, CI 1.02-2.13). The use of CAM providers was not associated with the degree of anxiety/depression. For those who used both CAM providers and psychiatric specialist services during the previous year, severe anxiety/depression was strongly associated with use compared to moderate disease (OR 7.53, CI 2.75-20.65). CONCLUSIONS People with severe anxiety/depression seem to use CAM providers and psychiatric services additionally, whereas those with moderate disease seem to use these services more as alternative pathways. CAM provider treatment might be a substitute for conventional care, particularly in patients with moderate disease.
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Abstract
This study aimed to describe the ecology of medical care in Korea. Using the yearly data of 2012 derived from the Korea Health Panel, we estimated the numbers of people per 1,000 residents aged 18 and over who had any health problem and/or any medical care at a variety of care settings, such as clinics, hospitals, and tertiary hospitals, in an average month. There was a total of 11,518 persons in the study population. While the number of those who had any health problem in an average month was estimated to be 939 per 1,000 persons, the estimated numbers of ambulatory care users were 333 at clinics, 101 at hospital outpatient departments, 35 at tertiary hospital outpatient departments, and 38 for Korean Oriental medical providers. The number of people who used emergency care at least once was 7 per 1,000 persons in an average month. The numbers of people hospitalized in clinics and hospitals were 3 and 8, respectively, while 3 persons were admitted to tertiary hospitals. There was a gap between the number of people experiencing any health problem and that of those having any medical care, and primary care comprised a large share of people's medical care experiences. It was noteworthy that more patients received ambulatory care at tertiary hospitals in Korea than in other countries. We hope that discussion about care delivery system reform and further studies will be encouraged.
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Affiliation(s)
- Yong Soo Kim
- Public Health Policy Institute, Seoul Metropolitan Government, Seoul, Korea
| | - Yong Jun Choi
- Department of Social and Preventive Medicine, College of Medicine, Hallym University, Chuncheon, Korea
- Health Services Research Center, Hallym University, Chuncheon, Korea.
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Hansen AH, Kristoffersen AE, Lian OS, Halvorsen PA. Continuity of GP care is associated with lower use of complementary and alternative medical providers: a population-based cross-sectional survey. BMC Health Serv Res 2014; 14:629. [PMID: 25491638 PMCID: PMC4267429 DOI: 10.1186/s12913-014-0629-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuity of general practitioner (GP) care is associated with reduced use of emergency departments, hospitalisation, and outpatient specialist services. Evidence about the relationship between continuity and use of complementary and alternative medical (CAM) providers has so far been lacking. The aim of this study was to test the association between continuity of GP care and the use of CAM providers. METHODS We used questionnaire data from the sixth Tromsø Study, conducted in 2007-8. Using descriptive statistical methods, we estimated the proportion using a CAM provider among adults (30-87 years) who had visited a GP during the last 12 months. By means of logistic regressions, we studied the association between the duration of the GP-patient relationship and the use of CAM providers. Analyses were adjusted for the frequency of GP visits, gender, age, marital status, income, education, and self-rated health and other proxies for health care needs. RESULTS Of 9,743 eligible GP users, 85.1% had seen the same GP for more than two years, 83.7% among women and 86.9% among men. The probability of visiting a CAM provider was lower among those with a GP relationship of more than 2 years compared to those with a shorter GP relationship (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.68-0.96). Other factors associated with CAM use were female gender, poor health, low age and high income. There was no association with education. CONCLUSIONS Continuity of GP care as measured by the duration of the GP-patient relationship was associated with lower use of CAM providers. Together with previous studies this suggests that continuity of GP care may contribute to health care delivery from fewer providers.
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12
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Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey. Br J Gen Pract 2014; 63:482-9. [PMID: 23834885 DOI: 10.3399/bjgp13x669202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Continuity of GP care is associated with reduced hospitalisations, but solid documentation of its relationship to use of outpatient specialist services is lacking. AIM To test the association between continuity of GP care and use of inpatient and outpatient specialist services. DESIGN AND SETTING A cross-sectional population-based study with questionnaire data from the sixth Tromsø Study (2007-2008). METHOD Descriptive statistics and two sample t-test were used to estimate specialist healthcare use according to duration of the GP-patient relationship. Logistic regression analysis was used to assess associations between duration and intensity of the GP-patient relationship and use of specialist care. Analyses were adjusted for sex, age, marital status, income, education, and self-rated health, and also stratified by self-rated health and age. RESULTS Of 10,624 eligible GP users, 85% had seen the same GP for >2 years. The probability of visiting outpatient specialist services was significantly lower among these participants compared to those with a shorter GP relationship (odds ratio [OR] = 0.81, 95% confidence interval [95% CI] = 0.71 to 0.92). Similar findings were found for hospitalisations (OR = 0.76, 95% CI = 0.64 to 0.90). Stratified analyses revealed that these associations were not dependent on self-rated health or age. The probability of specialist use increased for the frequent GP users. CONCLUSION Continuity of GP care is associated with reduced use of outpatient specialist services and hospitalisations. Healthcare providers and policymakers who wish to limit use of specialist health care may do well to perform and organise health services in ways that support continuity in general practice.
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