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PubMed2006

Utilization of HIV/AIDS treatment services: comparing injecting drug users and other clients.

This study compared healthcare utilization by injection drug users (IDUs) and non-IDUs. Data were abstracted from patients' medical records, admitted on HIV/AIDS treatment centers, between 1986 and 2002, forming a non-concurrent cohort study. Variables included: sociodemographics, HIV/AIDS exposure group, healthcare utilization (consultations, procedures, and prescriptions). Descriptive analyses included age-period and cohort effects. Out of 170 patients, with an average age of 30 years, 39.4% were IDUs, 71.8% were males and had low levels of education. At the first consultation, 86.5% neither received an ARV prescription nor had a request for CD4 or viral load. Injection drug users, as compared to non-IDUs, were less likely to receive ARV prescriptions and requests for CD4 lymphocyte and viral load counts, even though the number of consultations did not differ between the two groups. Healthcare utilization increased in calendar-year in the non-IDUs group, parallel to the implementation of the Brazilian health policy of universal care. However, this favorable trend was not observed among IDUs. Differential outcomes for HIV/AIDS among IDUs, towards worse prognosis, suggest difficulties in terms of adherence and follow-up of ARV therapy in this population.

Antiretroviral Therapy, Highly Active↗

PubMed2004

Parent-reported asthma in Puerto Rican children.

We conducted a survey to determine parent-reported asthma prevalence, morbidity, and healthcare utilization among 3527 children attending public schools (n = 2849) and private schools (n = 678) in San Juan, Puerto Rico. Schools were randomly selected from each of 12 geographic regions of the San Juan metropolitan area. Parents of children age 4-7 years old completed a 12-item questionnaire on asthma diagnosis, respiratory symptoms and morbidity, and healthcare utilization. Parents of children in public schools and private schools reported similar rates of a physician having previously diagnosed asthma in their children (43.2% vs. 39.4%); however, significantly more children in public schools were reported to still have asthma at the time of the survey (32.6% vs. 23.7%). Children attending public schools vs. private schools were reported to have missed significantly more school and to have had more hospitalizations and emergency department visits. Among children reported to still have asthma, significantly more children visited an emergency department, were hospitalized, and missed more school days due to respiratory symptoms in the past year. The high prevalence of parent-reported asthma, respiratory symptoms, and healthcare utilization among Puerto Rican children in San Juan calls for further studies using objective methods for ascertaining asthma and asthma-related morbidity. Differences in healthcare utilization between children attending public vs. private schools suggest that socioeconomic factors play a role in asthma management in Puerto Rico.

Absenteeism↗

PubMed2003

Healthcare access and utilization among women 40 and older at the U.S.-Mexico border: predictors of a routine check-up.

Mexican Americans are more likely to experience barriers to access and utilization of healthcare services than any other U.S. Hispanic group. In Mexico, where the majority of the population has access to care, the pressing issue is the underutilization of preventive services among adults. This study was conducted to assess access and utilization barriers among a U.S.-Mexico border population. A cross-sectional, population-based survey was conducted during 1999-2000 in a pair of contiguous U.S.-Mexico border communities. Household surveys were administered to U.S. and Mexican women, 40 years of age and older, to assess healthcare access and utilization, participation in chronic disease screenings, orientation toward prevention and personal history of chronic disease. Analysis indicates few statistically significant differences (p < 0.05) among access and utilization variables by country. Mexican participants were more likely to have a regular source of care and to have had a blood sugar test within the past 12 months. U.S. participants more often reported having had a Pap smear and mammogram during the previous year. Factors independently positively associated with having had a routine check-up during the past 12 months included age and having a regular provider or place to go when sick. Only going to the doctor when ill was independently inversely associated with routine check-ups in the past 12 months. Findings suggest that U.S. and Mexican border populations are similar with regard to healthcare access and utilization characteristics. Efforts to increase utilization of preventive health screenings among women are needed at the U.S.-Mexico border.

Adult↗

PubMed2002

The relationship between chronically disrupted sleep and healthcare use.

STUDY OBJECTIVES: To determine whether chronic sleep deprivation, sleep disruption, sleepiness, insomnia, and OSA are associated with increased healthcare use in a community-based population. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: 6440 Sleep Heart Health Study (SHHS) participants recruited from ongoing cohort studies. INTERVENTIONS: N/A. MEASUREMENTS: Polysomnography results (Apnea Hypopnea Index (AHI), percent of sleep time with oxyhemoglobin saturation below 90% (CT90), arousal index) as well as data on sleep related symptoms, medication use, and chronic illness. The indirect measure of predicted healthcare utilization was the modified Chronic Disease Score (CDS) calculated from medication data. RESULTS: After adjustment for age, gender, BMI and study site, subjects in the highest quartiles of AHI, CT90 and Epworth score had CDS that were 6%-9% higher than the lowest quartiles. The adjusted mean CDS for subjects with sleep apnea was similar to that for subjects with hypertension, chronic bronchitis or asthma and 18% greater than the mean CDS for subjects without sleep apnea. Among subjects who did not have significant sleep-disordered breathing, complaints of insomnia, sleepiness, fatigue, and not getting enough sleep were associated with increased CDS. CONCLUSIONS: This study demonstrated an association between subjective complaints of daytime sleepiness, inadequate sleep time, insomnia as well as objective measures of severity of SDB, and an indirect measure of healthcare utilization in a community-based sample. Though the percent increases in healthcare utilization observed were modest, the prevalence of these factors in the general population is high, and may therefore be associated with a substantial cost burden to the healthcare system.

Adult↗

PubMed2026

Psychologically informed reminder messages for promoting BRCA1/2 carrier screening: evidence from a large-scale population-based study.

Psychologically Informed Reminder Messages (PIRMs) may promote health-behavior change, but their impact on preventive genetic screening is unclear. Due to low adherence to a screening program, Clalit Health Services initiated an intervention to encourage BRCA1/2 carrier screening in July 2022. This observational study assesses the effectiveness of the intervention in encouraging screening and its spillover effect on related healthcare utilization, focusing on Ashkenazi Jewish females aged 25-50 with no relevant cancer history. Patients were randomly assigned to receive one of five PIRMs. Four PIRMs utilized different psychological strategies, while the fifth served as a control. The effectiveness of the intervention on screening adherence was assessed using a regression discontinuity analysis. A Cox regression assessed the effectiveness of the four PIRMs compared to the control. Spillover effects on healthcare utilization were evaluated using logistic regressions. The intervention showed a positive correlation with increased adherence to screening (β = 0.37, 95% CI: 0.01-0.72). The "Barrier Remover" PIRM emphasized ease (hazards ratio = 1.09, 95% CI: 1.02-1.16), while the "Health Control" PIRM focused on autonomy (hazards ratio = 1.07, 95% CI: 1.01-1.14), both indicating greater effectiveness than the control. The findings suggest a positive short-term spillover effect of the "Health Control" PIRM on healthcare utilization compared to the control (odds ratio = 1.16, 95% CI: 1.04-1.29). PIRMs effectively increased BRCA1/2 carrier screening adherence, demonstrating a scalable, low-cost intervention to improve preventive healthcare uptake. The effect varied by the psychological strategies, highlighting the potential of tailored behavioral interventions to enhance public health.

Humans↗

PubMedDate not supplied

Evaluation of general practitioners' training: how to manage patients with unexplained physical symptoms.

Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.

Adult↗

PubMed2005

Reduction in use of healthcare services with combination sulfonylurea and rosiglitazone: findings from the Rosiglitazone Early vs SULfonylurea Titration (RESULT) study.

OBJECTIVE: To assess and compare healthcare utilization and costs over a 2-year period in older patients (> or = 60 years) with type 2 diabetes receiving combination therapy with rosiglitazone plus a sulfonylurea (glipizide) or progressive up-titration of glipizide monotherapy. STUDY DESIGN: Two-year, randomized, double-blind, parallel-group clinical trial. PATIENTS AND METHODS: Older type 2 diabetic patients initially receiving submaximal doses of a sulfonylurea were randomized to receive rosiglitazone plus glipizide (n = 115) or up-titrated glipizide monotherapy (n = 110). Information on patient self-reported healthcare utilization (hospitalizations, emergency department [ED] visits, physician office visits) was collected prospectively for the duration of the trial. National average healthcare costs per unit were applied to calculate direct medical costs. RESULTS: Demographic characteristics of the 2 groups were similar. At the study's end, glycemic values were better in the rosiglitazone-plus-glipizide group. Compared with the glipizide group, patients receiving rosiglitazone plus glipizide had significantly fewer ED visits (P = .0006) and hospitalizations (P = .0263). Although the glipizide group had more unscheduled physician office visits, the difference was not statistically significant. Estimated treatment costs per patient per month were significantly lower for the rosiglitazone-plus-glipizide group than for the glipizide group (480 dollars vs 645 dollars; P < .05). CONCLUSION: Addition of rosiglitazone to sulfonylurea therapy was associated with decreased use of medical resources, in particular hospitalizations and ED visits, compared with progressive sulfonylurea up-titration. Although causality could not be established, this therapeutic approach could improve clinical outcomes in patients with type 2 diabetes and reduce healthcare utilization and costs.

Adult↗

PubMed2003

Healthcare access and utilization by patients infected with human immunodeficiency virus: does gender matter?

OBJECTIVE: To examine access to and utilization of primary healthcare services with respect to gender. Greater family and child-rearing responsibilities are possible barriers to healthcare access and utilization for women with HIV infection. METHODS: This study was part of a prospective, randomized, controlled trial evaluating primary care for HIV-infected patients at Duke University Medical Center (DUMC), a tertiary care medical center. Subjects were 214 HIV-infected, uninsured or publicly insured participants. Ambulatory care visits, emergency room utilization, hospitalization rates, length of stay, preventive and screening measures, and antiretroviral use were the outcome measures. RESULTS: Women (n = 83) and men (n = 131) enrolled in the study were similar with respect to race, educational level, marital status, and employment status. Women with HIV were more likely than men to have children (80% vs. 25%, p = 0.001) and spend their time as primary caregivers for their children (22% vs. 0.8%, p = 0.001). Women had higher CD4(+) cell counts (378 +/- 287 vs. 243 +/- 252 cells/microl, p = 0.0002), and a smaller proportion of women than men had AIDS at baseline (41% vs. 62%, p = 0.002). Women and men had similar numbers of primary care visits, emergency room visits, annual admission rates, and lengths of stay for hospitalizations. Pneumocystis carinii pneumonia prophylaxis, pneumococcal vaccination, and tuberculosis screening were also similar between women and men. Women were more likely than men to have ever been prescribed an antiretroviral agent (88.0% vs. 71.8%, p = 0.005). CONCLUSIONS: Women had greater familial responsibilities than men, but this was not a barrier to access or utilization of healthcare services. Despite less advanced HIV disease, women received similar care and had similar utilization of health services.

Adult↗

PubMedDate not supplied

Features of hypochondriasis and illness worry in the general population in Germany.

OBJECTIVE: Although hypochondriasis is considered to be of high relevance in the healthcare sector, its prevalence in the general population has been investigated in few studies. The aims of this study were to estimate prevalence rates of hypochondriasis and of subthreshold conditions and to describe their associated features such as quality of life and healthcare utilization in a representative community sample. METHODS: Analyses of the present study are based on the German Health Interview and Examination Survey-Mental Health Supplement (N = 4181, representative for the German population from 18-65 years). The assessment included interviews for somatic conditions and mental disorders and self-report ratings on health-related quality of life, healthcare utilization, disability days, and physical activity. RESULTS: Only three cases (0.05%) were identified as meeting full criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. The prevalence rate of the less restrictively defined form of hypochondriasis, ("subthreshold hypochondriasis") was 0.58% and an additional 2.12% reported having had illness worries for at least 6 months but did not meet further hypochondriasis criteria. The two subthreshold diagnostic groups provided strong evidence of difference from the nonhypochondriac controls: comorbidity with psychiatric and medical disorders and healthcare utilization were higher, and quality of life was markedly reduced. CONCLUSIONS: The results provide additional support to not only consider "full" DSM-IV hypochondriasis, which is a very rare disorder in the general population, but also to include less restrictive hypochondriac conditions--associated with a clinically relevant degree of psychological and physical impairment--into clinical and scientific considerations.

Absenteeism↗

PubMed1996

Sibling adaptation to childhood cancer collaborative study: health outcomes of siblings of children with cancer.

OBJECTIVE: This seven-site study examined the overall health status, healthcare utilization, somatization, and health-risk behaviors of siblings of children with cancer compared to these factors in matched controls or normative data. The study also examined whether informants (i.e., siblings, parents, physicians) differed in their assessments of the above health domains. DESIGN: Subjects were 254 siblings of children with cancer from seven different pediatric oncology treatment centers that participated in the Sibling Adaptation to Childhood Cancer Collaborative study group. Predictors of the siblings' health status, healthcare utilization, somatization, and health-risk behaviors were identified, and the relationship between these health domains and the siblings' resiliency vs. dysfunctionality were explored via interviews. RESULTS: Overall, siblings were found to be moderately healthy, although siblings report significant problems with sleeping and eating. Healthcare utilization appears to be reduced for siblings. Most importantly, the parents of these siblings are less likely to seek medical help for a variety of conditions for which parents of control children would bring their children to a doctor. A pattern emerged of parental underreporting of sibling health variables when compared to what the siblings themselves reported. When the relationship between health outcomes and the siblings' adaptation to their sick sibling's illness was examined, the resilient and dysfunctional groups significantly differed from each other. It appears that health outcomes are related to sibling adaptation to the changes brought about by their sick sibling's cancer diagnosis and treatment. CONCLUSIONS: The focus of care for families of children with cancer is often limited to the child with cancer. As indicated in this study, the "healthy" siblings may be overlooked in the process. While parents appear to recognize that their "healthy" children are complaining more about aches and pains, they may have little energy or time to attend to the needs of these other family members. It is the intent of this study to document what clinicians may expect and to highlight the need for evaluation of this otherwise neglected group.

Adaptation, Psychological↗

PubMed2000

Comparing the medical expenses of children with Medicaid and commercial insurance in an HMO.

BACKGROUND: In recent years, growing numbers of children with Medicaid have been enrolled in managed care plans nationwide. Yet, large, commercial managed care plans are increasingly discontinuing their participation in Medicaid because of low Medicaid payment rates. OBJECTIVE: To compare the healthcare utilization and costs of children with Medicaid and children with commercial insurance within the same health maintenance organization (HMO). STUDY DESIGN: Retrospective study using electronically captured cost and utilization data. PATIENTS AND METHODS: We compared the healthcare utilization and costs of children with Medicaid (n = 42,636) and children with commercial insurance (n = 159,651) who were members of the same large, nonprofit HMO at any time between January 1, 1995, and December 31, 1997. Medicaid children were grouped as income eligible, medically needy, and blind or disabled. RESULTS: The unadjusted costs of income-eligible, Medicaid-insured children were not significantly different from those of commercially insured children. The medically needy were $25 per month more expensive than commercially insured children (P = 0.02), and the blind or disabled were $213 per month more expensive (P < .01). After adjusting for age and sex, income-eligible children were $5 per month more expensive than children with commercial insurance (P = .07), the medically needy were $20 per month more expensive (P = .02), and the blind or disabled were $216 per month more expensive (P < .01). CONCLUSIONS: The costs of income-eligible, Medicaid-insured children in this HMO were similar to those of commercially insured children, but the costs for the medically needy and the blind and disabled were substantially higher.

Adolescent↗

PubMed2026

Effectiveness of an AI-based home exercise app for rehabilitation of rotator cuff-related shoulder pain: A randomized controlled trial.

BACKGROUND: Rotator cuff-related shoulder pain contributes to disability and healthcare use. Although therapeutic exercise is first-line treatment, limited supervision and adherence may reduce its effectiveness; digital rehabilitation with real-time feedback may address these limitations. OBJECTIVES: To evaluate the effectiveness of adding a digital rehabilitation program to standard physiotherapy on pain, function, fear-avoidance beliefs, and healthcare utilization. DESIGN: Single-center, assessor-blinded, randomized controlled trial with two parallel groups. METHOD: Forty-six adults (mean age 59 years) with rotator cuff-related shoulder pain were randomized to 12 weeks of conventional physiotherapy or physiotherapy plus an AI-based digital rehabilitation program using computer vision for real-time feedback and performance monitoring. Outcomes were assessed at baseline and at 2, 4, and 12 weeks. Pain intensity (NPRS) was primary outcome; secondary outcomes included upper limb function (QuickDASH), fear-avoidance beliefs (FABQ), and post-intervention healthcare utilization. Analyses followed an intention-to-treat approach. RESULTS: Pain reduction exceeded the MCID (1.3) at 4 and 12 weeks. Between-group differences favoured the intervention at Weeks 2 and 4 (MD -0.7; 95% CI -1.13 to -0.14 and MD -1.01; 95% CI -1.8 to -0.2, respectively). Upper limb function improved more at Week 4 (MD -7.3; 95% CI -12.3 to -2.2). FABQ scores decreased more at Week 12 (MD -7.6; 95% CI -14 to -0.5). Fewer participants in the experimental group required post-intervention healthcare (3 vs 10; p = 0.02). CONCLUSION: Adding AI-based home exercise app to conventional treatment improve pain and may improve function and reduce healthcare utilization in rotator cuff-related shoulder pain.

Humans↗

PubMed2006

Assessment of Canadian provincial expenditures in depressed patients treated with venlafaxine XR versus SSRIs: the APEX Study.

OBJECTIVE: Empirical studies of antidepressant cost-effectiveness suggest that the use of venlafaxine may be no more costly than selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression. The objectives of this study were to identify patients' characteristics and factors associated with the choice of antidepressant and to assess differences in persistence, healthcare utilization and direct medical costs associated with venlafaxine and SSRIs pharmacotherapy. RESEARCH DESIGN AND METHODS: We examined demographic and clinical characteristics of patients (n = 17 144) who received both a diagnosis of depression and a prescription for venlafaxine or an SSRI between 1996 and 2004 using the Quebec health administrative databases. Logistic regression models were used to identify factors independently associated with the choice of antidepressant. Persistence to treatment and overall direct medical costs during 12 months after initiation of therapy were assessed using Cox proportional hazard and GLM models, respectively. RESULTS: Age, sex, provider specialty, and prior 12-month healthcare utilization significantly influenced initial antidepressant choice. Fewer venlafaxine-treated patients discontinued their initial therapy relative to SSRIs' (persistence to initial treatment: 38.4% vs. 29.4% and 24.4% vs. 15.8% at 6 and 12 months, respectively; p < 0.0001), and they were less likely to require treatment switching. Overall 12-month direct medical costs for SSRI- and venlafaxine-treated patients were Can$2759 and Can$2604, respectively. Patients treated with SSRIs had significantly higher expenditures in a univariate analysis (cost ratio: 1.06 [95% CI: 1.02, 1.10]). However, after controlling for potential confounding factors such as patients' characteristics, prior healthcare utilization, and comorbid conditions in multivariate analyses, the overall expenditures were similar in both groups (cost ratio: 1.03 [95% CI: 0.99, 1.07]). CONCLUSIONS: Direct medical costs were generally similar among patients with depression treated with venlafaxine and SSRIs. In a 'real world' setting, the higher acquisition cost of venlafaxine is offset by savings due to fewer hospitalizations and fewer outpatient medical visits. Differences in treatment persistence may also, in part, explain the observed differences in average direct medical costs between venlafaxine and SSRIs.

Adolescent↗

PubMed2004

Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure.

BACKGROUND: Because of the prevalence and expense of congestive heart failure (CHF), significant efforts have been made to develop disease management (DM) programs that will improve clinical and financial outcomes. The effectiveness of such programs in a large, heterogeneous population of CHF patients remains unknown. METHODS AND RESULTS: We randomized 1069 patients (aged 70.9+/-10.3 years) with systolic (ejection fraction 35+/-9%) or echocardiographically confirmed diastolic heart failure (HF) to assess telephonic DM over an 18-month period. Data were collected at baseline and at 6-month intervals. Survival analysis was performed by Kaplan-Meier and Cox regression methods. Healthcare utilization was defined after extensive record review, with an attempt to account for all inpatient and outpatient visits, medications, and diagnostic tests. We obtained data on 92% of the patients, from nearly 53,000 health-related encounters. Total cost per patient was defined by adding estimated costs for the observed encounters, excluding the cost of the DM. Kaplan-Meier analysis showed that DM patients had a reduced mortality rate (P=0.037), with DM patients surviving an average of 76 days longer than controls. Subgroup analysis showed that DM had beneficial outcomes in patients with systolic HF (hazard ratio 0.62; P=0.040), which was more pronounced in NYHA classes III and IV. Although improvements in NYHA class were more likely with DM (P<0.001), 6-minute walk data from 217 patients in whom data were available at each visit showed no significant benefit from DM (P=0.08). Total and CHF-related healthcare utilization, including medications, office or emergency department visits, procedures, or hospitalizations, was not decreased by DM. Repeated-measures ANOVA for cost by group showed no significant differences, even in the higher NYHA class groups. CONCLUSIONS: Participation in DM resulted in a significant survival benefit, most notably in symptomatic systolic HF patients. Although DM was associated with improved NYHA class, 6-minute walk test results did not improve. Healthcare utilization was not reduced by DM, and it conferred no cost savings. DM in HF results in improved life expectancy but does not improve objective measures of functional capacity and does not reduce cost.

Aged↗

PubMed2005

Preventive healthcare of infants in a region of Lebanon: parental beliefs, attitudes and behaviors.

OBJECTIVES: This study aimed to investigate healthcare seeking behaviors of mothers for themselves and their infants in the Bekaa Valley, Lebanon, to identify attitudes and beliefs towards the preventive healthcare of infants and to assess whether a healthcare-based intervention program would be accepted by the population. METHODS: Ninety-two interviews were conducted with women who had delivered a live birth in two hospitals in the Bekaa. The hospitals selected attracted women from different socioeconomic classes. RESULTS: Differences were found in adequacy of healthcare utilization based on household size, number of children and prenatal care utilization. There was a higher perception of barriers to healthcare by parents who did not seek adequate preventive care for their infants. Mothers of infants who had inadequate care had a lower perception of severity of illness and of physicians' ability to prevent illness. The population believes strongly that medical professionals are reliable sources of health information and guidance. Infants' mothers and grandmothers are important sources of healthcare-related information. CONCLUSIONS: Rates of preventive infant healthcare in the Bekaa need improvement. Any intervention must target mothers and grandmothers, as they appear to influence the medical care of infants. Other targets include parents of larger families. Dissemination of information regarding the seriousness of illness and the ability to prevent illness is required. The medical profession may influence health choices made by this population. However, further investigation of healthcare barriers, especially economic and geographic barriers, is needed. In preparing to improve healthcare utilization for infants in the Bekaa, local, regional and international organizations should refer to the population's beliefs, attitudes and behaviors described in this study, as these findings may aid in planning interventions that are likely to positively impact mothers and infants.

Adolescent↗

PubMed2000

Utilization of healthcare services by people living with HIV/AIDS in Europe. Eurosupport Group.

Our objective was to compare the utilization of healthcare/support services for people with HIV infection in Europe. Between August 1996 and September 1997 self-administered anonymous questionnaires were distributed by reference HIV treatment centres and HIV support organizations. The questionnaire was completed by 1366 people living with HIV/AIDS. A small number of people had received influenza or pneumococcal vaccinations (34% and 19% respectively). Many patients did not receive dental care (48% of participants from the southern countries) and only 72% of the women had a gynaecological examination. More participants from the south reported insufficient access to healthcare/support services, particularly for nursing care (19%), psychological support (33%), nutritional advice (45%), access to support organizations (36%), and legal advice (46%). In conclusion, many people living with HIV/AIDS in Europe do not benefit from certain annual medical procedures proposed by international guidelines and consider themselves to have insufficient access to health/support services.

Acquired Immunodeficiency Syndrome↗

PubMed2025

Clinical Characteristics associated with functional seizures in individuals with psychosis.

BACKGROUND AND HYPOTHESIS: Functional seizures (FS) are episodes characterized by seizure-like events that are not caused by hypersynchronous neuronal activity. Prior studies have suggested an increased prevalence of psychotic disorders among patients with FS, but results have been inconsistent. We hypothesize that FS are associated with psychosis and that among patients with psychosis, the presence of FS may influence patient clinical characteristics, mortality, and medical resource utilization. STUDY DESIGN: The association between FS and psychosis was assessed using electronic health records data from a total of 761,848 individuals receiving care at Vanderbilt University Medical Center between 1989 and 2023. Analyses of the association between FS and psychiatric outcomes, sexual trauma, healthcare utilization, and other clinical comorbidities were conducted in a subset of 5219 patients with psychosis. STUDY RESULTS: Odds of FS were elevated among patients with psychosis compared to controls (OR = 10.09, 95 % CI = 8.40-12.13). Among patients with psychosis, those with FS exhibited higher rates of suicidality (OR = 2.18 95 % CI = 1.50-3.17), catatonia (OR = 2.15, 95 % CI = 1.33-3.45), sexual trauma history (OR = 2.93, 95 % CI = 2.00-4.29) and had a greater number of antipsychotic trials (4.63 versus 3.37, beta = 1.23, SE = 0.18, adjusted p < 0.001) than those without FS. Furthermore, patients with comorbid FS had more hospital presentations at one, three, five, and ten years after receiving a psychosis diagnosis (adjusted p < 0.001). CONCLUSIONS: FS are more common among patients with psychosis and are associated with increased healthcare utilization as well as an increased prevalence of suicidality, catatonia, and certain psychiatric and medical comorbidities.

Humans↗

PubMed2001

Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS).

OBJECTIVES: The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework. DESIGN: A random stratified sample of subjects age 75 to 94 was selected from the National Population Register (a complete listing of the Israeli population maintained by the Ministry of the Interior). The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, and 90-94), sex, and place of birth (Europe/America, Asia/Africa, and Israel). SETTING: Community-dwelling old-old Jewish Israelis. PARTICIPANTS: 1,487 people living in the community at the time of the baseline interview. MEASUREMENTS: The dependent variables were PM in the month before the interview and ERU and OH in the previous year. The independent variables were: predisposing variables (age, sex, place of birth, and education); enabling variables (income and the social network variables of marital status, living arrangements, and number of in-person contacts per week with any child); and need variables (number of self-reported chronic medical conditions, subjective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of physical robustness, and engaging in regular physical sportive activities). RESULTS: The predisposing and enabling factors were only minimally associated with utilization rates in the old old in Israel, with the exception of lower rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old-old population studied. Healthcare utilization was found to be associated primarily with health and functional status. CONCLUSION: In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic disease and disability is driven primarily by health needs, rather than by extraneous factors such as income and education. The study indicates that equity in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate estimates of future needs.

Activities of Daily Living↗