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PubMed2001

Health behavior in a kibbutz population: correlations among different modalities of healthcare utilization.

BACKGROUND: Alternative medicine use is increasing worldwide and the associated expenditures are significant. In Israel 19% of patients who consulted their family physician had also sought treatment by an alternative medicine practitioner. OBJECTIVES: To explore the correlation between different modalities of healthcare utilization, health behavior, and health belief among adult members of a kibbutz (rural communal settlement). This unique study population enabled the use of a simplified quantitative model due to the minimal individual differences in cost and access. METHODS: Healthcare utilization data were obtained for 220 kibbutz members aged 15-70 years from patient medical files and self-administered questionnaires over a 45 month period. Patient visits to the family practitioner and other specialist physicians were tallied, and individuals reported alternative medicine consultations during the previous year. Multiple regression analysis was used to control for age, chronic disease, and other background characteristics. RESULTS: The mean number of patient FP visits was 3.6 per patient per year. Women and chronic disease sufferers visited the doctor more frequently. A patient's number of FP visits and other specialist physician visits were closely correlated, with each specialist physician consult resulting in an additional 0.64 FP visit for a given individual (P = 0.007). Our analysis indicated that self-reported alternative therapy utilization was positively associated with the number of FP visits; patients reporting alternative therapy use visited their primary care physician once additionally per year (P = 0.03). Low self-rated health status was correlated with increased likelihood of alternative therapy use (borderline significance). CONCLUSION: These results suggest that a patient who seeks treatment from one type of healthcare practitioner will seek out other practitioners as well. This study supports the notion that unconventional therapies are used in conjunction with, rather than instead of, mainstream medical care.

Adolescent↗
PubMed2001

Prescription drug use, diagnoses, and healthcare utilization among the elderly.

BACKGROUND: More elderly patients affected by severe and chronic diseases are treated in primary care. Reports on the use of prescription drugs by the general elderly population are scarce, and more investigations are needed to optimize pharmaceutical care for these patients. OBJECTIVE: To analyze prescription drug use, diagnoses, and healthcare utilization among noninstitutionalized elderly patients. DESIGN: Retrospective cohort study. SETTING AND PATIENTS: All people > or =65 years old (n = 4642) living in the community of Tierp, Sweden, in 1994 were included. Prescription drug use and healthcare utilization have been registered for all inhabitants of the community since 1972. Information about filled prescriptions and diagnoses were obtained from a computerized research register. RESULTS: Prescription drug use was high among the elderly (78%); the most used pharmacologic groups were cardiovascular, nervous system, and gastrointestinal medications. Women used more prescription drugs than men (average 4.8 vs. 3.8) and had more nonfatal diagnoses. Use of five or more different prescription drugs during 1994 was common (39.0%), and multivariate analysis showed that the greatest number of primary care visits occurred with multiple drug use (> or =5 drugs over 1 y). CONCLUSIONS: This study shows an extensive multiple drug use among elderly people living at home. Whether this multiple drug use per se is harmful to the patients or not could not be evaluated in this study. Further focused investigations are needed to assess the effect of multiple drug use in an elderly population.

Age Distribution↗
PubMed2003

Analysis of healthcare utilization patterns and adherence in patients receiving typical and atypical antipsychotic medications.

OBJECTIVE: To examine the effects of typical and atypical antipsychotics on medication adherence and healthcare resource utilization. RESEARCH DESIGN AND METHODS: This was a retrospective observational cohort analysis of pharmacy and medical health insurance reimbursement data of patients from a southeastern United States health plan. Pharmacy data of subjects between 6 and 65 years of age were identified. Inclusion criteria included initiation of a single antipsychotic agent between July 1, 1999 and September 30, 2000; no antipsychotic medication usage 6 months prior to the index prescription date; and continuous health plan enrollment for the 18-month study period. Multivariable methods were utilized to analyze healthcare resource utilizations between groups. OUTCOME MEASURES: Primary outcome measures included: (1) adherence and persistence with antipsychotic therapy; (2) healthcare utilization for outpatient office and hospital visits, inpatient hospital visits, and emergency room visits; and (3) therapy modifications and concomitant medications. RESULTS: A total of 469 patients met initial study criteria. Atypical and typical antipsychotics were prescribed to 384 and 85 patients, respectively. Length of therapy (days) for the atypical cohort was significantly longer (136 vs 80; p < 0.001). As defined using medication possession ratio (MPR), the atypical cohort was significantly more adherent to therapy than the typical cohort (mean MPR, 0.53 vs 0.24; p < 0.001). After adjusting for differences in demographics, baseline utilization, MPR, and length of therapy (n = 377), the atypical cohort experienced significantly fewer office visits (2,635 vs 4,249 per 1000 patients per month [P1000PPM]; p = 0.005), fewer inpatient admissions (197 vs 511 P1000PPM; p = 0.032), and fewer emergency room visits (125 vs 354 P1000PPM; p = 0.002). CONCLUSIONS: Atypical antipsychotic users were significantly more adherent to therapy, and had lower rates of office, hospital and emergency room utilization. Within the context of inherent limitations associated with health insurance claims databases, this study suggests that a relationship exists across cohorts between medication adherence and use of healthcare resources.

Adolescent↗
PubMed2026

Effectiveness of peer recovery support services for substance use disorders: A systematic review of healthcare utilization, behavioral health, and engagement outcomes.

BACKGROUND: Peer recovery support services (PRS) delivered by individuals with lived experience of substance use, are increasingly incorporated into substance use disorder (SUD) care systems to improve care engagement, reduce acute care use, and support recovery. However, existing systematic reviews have focused on substance use outcomes, with limited attention to healthcare utilization, psychosocial functioning, and outcomes across settings, and populations. METHODS: This systematic review, registered in PROSPERO (CRD42023469279), synthesized peer-reviewed studies from 2003 to 2026 evaluating PRS for individuals with alcohol or drug-related SUD. Using MEDLINE, Embase, PsycINFO, and CINAHL, the review included 53 studies primarily conducted in high-income countries that reported quantitative outcomes across substance use, healthcare utilization, behavioral health, and treatment engagement. Risk of bias was assessed using Cochrane RoB 2, ROBINS-I, and ROBINS-E tools. RESULTS: Overall, evidence was most favorable for selected treatment-linkage and engagement outcomes, whereas findings for substance use, emergency department use, hospitalization, overdose, and mortality were inconsistent. Uncontrolled longitudinal studies frequently reported improvements in depression and anxiety, but no randomized trials evaluated these outcomes, limiting causal inference. Exploratory cross-study patterns suggested that sustained navigation, practical assistance, and repeated peer contact were more often present in programs reporting favorable outcomes; however, these components were not independently evaluated. Substantial heterogeneity, frequent multicomponent interventions, high risk of bias in many nonrandomized studies, and limited long-term and economic data constrain conclusions. CONCLUSIONS: Findings support the promise of PRS while underscoring the need for more rigorous comparative studies, cost-effectiveness data, and further research in low- and middle-income countries.

Humans↗
PubMedDate not supplied

A novel stress and coping workplace program reduces illness and healthcare utilization.

OBJECTIVE: The purpose of this study was to determine if a novel workplace stress management program, delivered either face-to-face or by self-help, would reduce illness and health services utilization among participants. METHODS: Five hundred one volunteers were randomly allocated to one of three groups: full intervention, which received assessment and personalized self-study feedback and was offered six face-to-face, small-group sessions; partial intervention, a self-help group that received assessment and personalized feedback by mail; and a wait-list control group. All participants completed questionnaires for stress, anxiety, and coping at the start of the study and 6 and 12 months later. Health reports were completed at 0, 3, 6, 9, and 12 months. A subsample of subjects who subscribed to a single health maintenance organization provided objectively recorded doctor visit data across the study year. RESULTS: All three groups reported significant improvement in their stress, anxiety, and coping across the year. Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups. Full-intervention subjects also reported fewer days of illness than subjects in the other groups. Objectively measured physician visits showed a large (34%) reduction in healthcare utilization for full intervention subjects in the HMO subsample. CONCLUSIONS: These results indicated that a work-site program that focuses on stress, anxiety, and coping measurement along with small-group educational intervention can significantly reduce illness and healthcare utilization.

Absenteeism↗
PubMed2005

Healthcare utilization following cognitive-behavioral treatment for panic disorder with agoraphobia.

The aim of this study was to examine the overall changes in healthcare services utilization after providing an empirically supported cognitive-behavioral treatment for panic disorder with agoraphobia. Data on healthcare utilization were collected for a total of 84 adults meeting DSM-IV criteria. Participants were completers of a cognitive-behavioral treatment for panic disorder with agoraphobia. Data on utilization of healthcare services and medication were obtained from semi-structured interviews from baseline to 1-year after treatment. Results of the Friedman non-parametric analysis reveal a significant decrease in overall and mental health-related costs following treatment. This study shows a significant reduction in healthcare costs following cognitive behavior therapy for panic disorder with agoraphobia. More studies are needed to examine the potential long-term cost-offset effect of empirically supported treatments for panic disorder.

Adult↗
PubMedDate not supplied

Comparison of healthcare utilization and direct costs in three degenerative dementias.

The authors conducted a survey of healthcare utilization in three dementia syndromes to determine whether type of dementia influenced utilization or resulting direct costs. Patients with Alzheimer disease (n=131), dementia with parkinsonism (n=85), and Huntington disease (n=51) were identified from a registry and enrolled. Caregivers completed the mailed survey, and direct costs were estimated. The presence of dementia with parkinsonism resulted in significantly greater utilization of long-term care services and higher total direct costs. In all three groups, long-term care costs accounted for the majority of direct costs. Unique patterns of utilization and costs are seen in specific neurodegenerative dementias.

Aged↗
PubMed2004

Diabetes, depression, and healthcare utilization among African Americans in primary care.

PURPOSE: This study tested for an association between diabetes and depressive symptoms and assessed the effect of co-occurring diabetes and depressive symptoms on healthcare utilization outcomes among African-American patients. PROCEDURE: The sample consisted of 303 adult African-American patients age 40 and over from a primary care clinic serving the low-income population in Nashville, TN. Measures were based on self-reports during a structured interview. Multivariate analyses adjusted for age, gender, socioeconomic status, and comorbid chronic conditions. FINDINGS: African-American patients with and without diabetes did not differ on the presence or severity of depressive symptoms. However, the co-occurrence of major depressive symptoms with diabetes among African Americans was associated with nearly three times more reported emergency room visits and three times more inpatient days, but was only marginally associated with a lower number of physician visits. CONCLUSIONS: In contrast to previous studies with predominantly white samples that found a positive association between diabetes and depression, no association was found in this African-American sample. Nevertheless, the results did concur with research findings based on other samples, in that the co-occurrence of depression with diabetes was associated with more acute care utilization, such as emergency room visits and inpatient hospitalizations. This pattern of utilization may lead to higher healthcare costs among patients with diabetes who are depressed, regardless of race.

Adult↗
PubMed2001

The effect of alendronate on fracture-related healthcare utilization and costs: the fracture intervention trial.

The Vertebral Fracture Arm (VFA) of the Fracture Intervention Trial (FIT) study demonstrated that alendronate reduced the incidence of spine, forearm and hip fractures in women with low bone mass and existing vertebral fractures by about 50%. The objective of the present study was to determine the effects of alendronate therapy versus placebo on fracture-related healthcare utilization and costs. Participants were randomly assigned to double-masked treatment with alendronate (5 mg/day for 2 years and then 10 mg/day for 1 year) or placebo for 3 years. For each patient experiencing a clinical fracture, we determined whether treatment in an emergency room, hospital, nursing home and/or rehabilitation hospital was a consequence of the fracture. The VFA of the FIT Study enrolled 2027 women aged 55-81 years with low bone mass and pre-existing vertebral fractures from population-based listings in 11 metropolitan areas of the United States. We measured (1) the proportion of patients who had any fracture-related healthcare event and (2) the estimated cost of fracture-related healthcare services. Alendronate significantly reduced the proportion of patients utilizing fracture-related healthcare (emergency room, hospital, rehabilitation hospital or nursing home) by 25% (p = 0.038). Alendronate significantly reduced the costs associated with hip-fracture-related care by 58%, or $181 per patient randomized (p = 0.036). The reduction in fracture-related total costs was 35% ($190 per patient randomized) in the alendronate group relative to the placebo group (p = 0.114). Alendronate thus not only reduces the incidence of clinical fractures and associated morbidity, but reduces the proportion of patients utilizing the associated healthcare resources.

Aged↗
PubMed2002

Healthcare utilization by women in a comprehensive managed care population subsequent to diagnosis of a sexually transmitted disease.

BACKGROUND: Healthcare utilization (HCU) following a sexually transmitted disease (STD) diagnosis is poorly characterized. GOAL: The goal was to quantify HCU for new/recurrent STDs and other relevant Ob-Gyn and mental health problems in the 18 months subsequent to an STD diagnosis. STUDY DESIGN: We compared HCU between a group of females aged 18 to 45 years who were Kaiser Permanente Medical Program members with a diagnosed STD (n = 1,205) and a medical center- and age group-matched sample of women seen for a non-STD diagnosis in the same time period (n = 4820), with controlling where appropriate for age, medical center, and chronic disease status. RESULTS: An STD diagnosis was associated with significantly greater likelihood of subsequent visits for STDs (relative risk [RR] = 3.8), pelvic inflammatory disease/endometritis (RR = 2.9), candidiasis (RR = 2.0), vaginitis (RR = 2.4), cervical dysplasia (RR = 1.7), menstrual disorders/abnormal bleeding (RR = 1.3), high risk/complicated/ectopic pregnancy (RR = 1.5), and behavioral/mental health problems (RR = 1.3) than for women seen for a non-STD diagnosis. CONCLUSION: Detrimental sequelae of STDs are reflected in substantially elevated near-term HCU following an STD diagnosis.

Adult↗
PubMed2001

Respiratory illness and healthcare utilization in children: the primary and secondary care interface.

The aim of the present study was to quantify the healthcare utilization of a child population according to level of respiratory illness. A stratified random sample of 713 children was selected from respondents to a postal respiratory questionnaire, carried out in two general practice populations in 1993. Children were stratified into four groups according to the number of positive responses to five key questions. These groups were used as indicators of likelihood of asthma diagnosis. A search was made of these childrens' practice records covering a 2-yr period, to include both primary and secondary healthcare. There was a significant increase across positive response groups in the proportion of children having primary and secondary care based consultations, particularly for respiratory conditions (p = 0.001). There was also a significant increase in prescribing. Of those children considered to be "likely asthmatics" from their questionnaire responses, 8.1% (n = 31) did not receive any primary or secondary care for a respiratory problem over the 2-yr period. As the likelihood of respiratory illness increased in this population, more demand was made upon resources for the treatment of respiratory illness. Quantification of this demand enables evidence based resource allocation decisions to be made. This method of quantification could be applied in other populations.

Asthma↗
PubMed2002

Geriatric depression, antidepressant treatment, and healthcare utilization in a health maintenance organization.

OBJECTIVES: To assess the separate effects of depressive symptoms and antidepressant treatment on healthcare utilization and cost. SETTING: Social Health Maintenance Organization (HMO) at HealthPartners in Minnesota. PARTICIPANTS: Geriatric Social HMO enrollees were screened for depressive symptoms using the 30-item Geriatric Depression Scale. A stratified sample was created, composed of geriatric enrollees with depressive symptoms, with antidepressant prescriptions, or with neither (n = 516). DESIGN: Regression analyses were conducted with separate equations for utilization and charge outcome variables, both outpatient and inpatient (log-transformed). The Charlson Comorbidity Index, age, and gender served as covariates. MEASUREMENT: Depressive symptoms were identified through the Diagnostic Interview Schedule. Antidepressant treatment was determined from the HMO pharmacy database. RESULTS: Having depressive symptoms was associated with a 19 increase in the number of outpatient encounters and a 30 increase in total outpatient charges. Antidepressant treatment was associated with a 32 increase in total outpatient charges but was not significantly associated with number of outpatient encounters. Depressive symptoms and antidepressant therapy were not significantly associated with inpatient utilization or charges. CONCLUSION: This study found that patients with depressive symptoms generated more outpatient health care and higher charges but not necessarily more inpatient care. Our findings suggest that programs targeted to geriatric patients whose depression is comorbid with other chronic medical conditions might be cost-effective and particularly appropriate for geriatric care.

Aged↗
PubMed2002

Healthcare utilization patterns and risk adjustment under Taiwan's National Health Insurance system.

BACKGROUND AND PURPOSE: Some recent proposals for reform of Taiwan's National Health Insurance (NHI) system include risk adjustment mechanisms. However, there is a paucity of research on risk adjustment and its utilization in health insurance systems in Taiwan. The purposes of this study were to determine the healthcare utilization pattern and to develop a risk assessment model for capitation payments under NHI. METHODS: The individual enrollment and medical expenditure data for 1996 and 1997 were obtained from the Bureau of NHI. A random sample of 360,037 beneficiaries was divided into two sub-samples: one for model building and one for validation. Linear regression was employed to estimate the relationship between each individual's 1997 total expenditure and risk adjusters, i.e., age, gender, prior years' medical spending, and catastrophic status. RESULTS: The 10- to 14-years age group had the lowest total expenditure of $NT 3,055 ($US 1 = $NT 27.5 in 1996) in 1996, while the 65 years and over age group had the highest at almost 10 times more than the lowest. The distributions of total expenditure for both genders followed the familiar J-shaped curve. The average of the total expenditure of individuals with a catastrophic diagnosis was more than 17 times that of individuals without. Age and gender resulted in a predictive R2 of only 3.8% in the risk assessment model. By including prior total expenditure, the predictive R2 increased to 24.2%. Further addition of catastrophic status increased the predictability slightly to 25%. Prior outpatient expenditure predicted 72% of subsequent outpatient expenditure, but prior inpatient expenditure predicted only 3% of subsequent inpatient expenditure. CONCLUSIONS: As in other countries, age and gender provided only limited predictability in risk assessment. On the other hand, prior outpatient expenditure in this study provided relatively superior predictability in risk assessment. Prudence is required when including prior utilization as a part of the risk assessment model in calculating capitation payments, as this may indirectly encourage unnecessary use of healthcare services.

Adolescent↗
PubMedDate not supplied

Do poor health behaviors affect health-related quality of life and healthcare utilization among veterans? The Veterans Health Study.

The impact of health behaviors on Health-Related Quality of Life (HRQoL) and HealthCare Utilization (HCU) was examined in a sample of male veterans. We examined the relationship between health behaviors (cigarette smoking, alcohol use, exercise, seat belt use, cholesterol level, and body mass index [BMI]), and HRQoL and HCU, among Veterans Health Study participants providing complete baseline (t0) and 12-month follow-up (t12) data. (Respective sample sizes were 1242 and 1397.) HRQoL measures were derived from the SF-36, expressed as physical component summary (PCS) and mental component summary (MCS) scores. Prospective 12-month outpatient and inpatient utilization data were obtained from a VA administrative database. Exercise and BMI were significant PCS predictors at t0 and t12, adjusting for age, social supports, education, employment status, and comorbidities. Smoker status was negatively associated with PCS only at t0. Nonproblem (no abuse) alcohol users had significantly higher t0 PCS scores than nonusers. Only current problem alcohol use was associated with lower MCS at t0 and t12 in multivariate analyses. Regarding HCU, current smokers had fewer medical visits than never smokers; alcohol nonusers had more medical visits than current alcohol users, current problem users, and former problem users. No behaviors were associated with mental health visits or inpatient stays. HRQoL is negatively affected by poor health behaviors. HRQoL and physical health may be improved by practitioners targeting these behaviors for preventive interventions. This study did not support an association between poor health behaviors and higher HCU. Future research should consider the effect of moderating variables on this relationship.

Aged↗
PubMed1999

Healthcare utilization associated with dyspepsia in patients with arthritis.

OBJECTIVE: To compare gastrointestinal-related healthcare resource utilization in arthritis patients with and without dyspepsia. STUDY DESIGN: A historical cohort study based on a claims database. PATIENTS AND METHODS: Data were obtained from the MarketScan database. Adult patients with a diagnosis of arthritis (International Classification of Diseases, 9th Revision [ICD-9] codes 714.0-715.9) during 1992 and 1993 were included; individuals with a diagnosis of dyspepsia within the first 3 months of their arthritis diagnosis were considered study case patients. Each case patient was matched with 4 nondyspeptic arthritis patients based on age, gender, employment status, and type of insurance plan. Healthcare resource utilization in terms of outpatient services and inpatient admissions during the first year after the initial arthritis diagnosis was compared between the case and control groups. RESULTS: A total of 503 case and 2146 control patients were identified. There were no significant differences in demographic characteristics between the 2 groups. Dyspeptic patients (cases) had a significantly higher rate of claims for endoscopic procedures (odds ratio [OR] = 10.0, P < .01) than nondyspeptic patients (controls). Patients with dyspepsia also had a significantly higher claim rate of gastrointestinal ulcer or bleeding (OR = 4.2, P < .01) and were more likely to be hospitalized at least once (OR = 1.4, P < .01). Dyspeptic patients had overall higher frequencies of use of outpatient services (53.9 vs 32.5 claims per patient, P < .001) and higher costs for both inpatient admission and outpatient services than nondyspeptic patients. CONCLUSION: Dyspeptic arthritis patients have higher healthcare resource utilization and associated costs than nondyspeptic arthritis patients.

Adult↗
PubMed2003

The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension.

OBJECTIVES: Assess impact of community health workers (CHWs) on healthcare utilization of African-American Medicaid patients with diabetes mellitus (DM) with/without hypertension (HTN). DESIGN: Maryland Medicaid claim files were analyzed to compare utilization of emergency rooms, hospitalization, and costs in a population managed by CHWs (N=117). SETTING/PATIENTS: Patients were recruited from the discharge rolls of the University of Maryland Medical System (UMMS) and/or the Maryland Diabetes Care Program from March 1992 to June 1994. INTERVENTION: CHWs alternated weekly home visits and phone contacts to teach patients to understand the need to control their illnesses, to follow both their therapy and behavioral regimens, and to maintain appropriate visits to a primary care practitioner. RESULTS: Total emergency room (ER) visits declined by 40%; ER admissions to hospitals declined by 33%, as did total hospital admissions; and Medicaid reimbursements declined by 27%. CONCLUSIONS: The CHW program resulted in an average savings of 2,245 dollars per patient per year, and a total savings of 262,080 dollars for 117 patients, with improved quality of life (QOL) indicating cost effectiveness.

Adolescent↗
PubMed2003

Using respiratory-related calls to a nurse advice line to predict pediatric upper respiratory infection-related healthcare utilization.

Using Poisson regression analysis, respiratory-related calls to a nurse advice line in Denver, Colorado were used to predict pediatric upper respiratory infection (URI) outpatient and urgent care visits. Use of electronic hospital information systems and triage software allowed for the rapid identification of respiratory-related calls and URI-related utilization. Monitoring nurse advice line call volume may help increase awareness and planning for increases in healthcare utilization.

Colorado↗
PubMed2004

Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States.

BACKGROUND: Little non-clinic-based data are available on incident genital warts rates and related healthcare use. GOAL: : The goal of this study was to describe the incidence and predictors of genital warts and associated healthcare utilization patterns among a group of privately insured patients in the United States. STUDY: Health claims were evaluated prospectively from 5,914,107 privately insured individuals. RESULTS: The rate of new genital warts claims per 100,000 person-years at risk, age-standardized to the 2001 U.S. privately insured population, increased from 117.8 in 1998 to 205.0 in 2001. The highest rates were among 20- to 29-year-olds. The majority of claims came from dermatology and obstetrics/gynecology. CONCLUSIONS: The incidence of genital warts, as measured by the rate of new claims, appears to be rising. Age associations with the rate of new genital warts claims differed by gender; these associations may be influenced by changes in health-seeking behavior, potentially driven by health awareness.

Adolescent↗